Scaffolding for Problem Solving Using Goldilocks Help in Objective Structured Clinical Examinations

Objective: Objective Structured Clinical Examinations (OSCEs) can be overwhelming for students due to time constraints and anxiety. Algorithms and scaffolds can assist with problem solving by breaking the process into prompts and steps. Methods: In total, 60 assessment data points based on performance tier (high, middle, and low) from students across Malaysian and Australian institutions were selected. Content and thematic analyses, structured around the Goldilocks Help model steps, were employed to assess students' metacognitive processes that occur during OSCE problem solving. Results: Students from all performance levels initially focused on understanding patient history and medications. Top and middle performers effectively used medical resources for safety checks and decision-making, while lower performers struggled with identifying medication-related problems, reflecting gaps in knowledge application. Emphasis on each step of the Goldilocks model varied across stations. All students prioritized initial patient information gathering, but their ability to analyze and plan interventions differed according to their knowledge level. Conclusion: This study provides evidence that student pharmacists' natural problem-solving process, as described in post-OSCE reflections, follows through the 5 Goldilocks Help steps during OSCEs. Low performing students struggled with step 2 (Analyze) and spent excessive time on step 3 (Plan). Educators can use Goldilocks Help to support low performing students by guiding their thought processes through a more systematic way until they are able to build their expertise to approach problems in a more flexible manner.