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Little is known about how students experience and interpret this assessment format and how psychological and contextual factors shape self-efficacy, motivation, and engagement. 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BMC Medical Education (2025) 25:1736 BMC Medical Education  \n[https://doi.org/10.1186/s12909-025-08301-5](https://doi.org/10.1186/s12909-025-08301-5)  \nRESEARCH Open Access  \nUnderstanding students’ self-efficacy and motivation in sequential OSCE:  \na qualitative study  \nJun Jie Lim 1*, Chris Roberts 1*, Shareen Nisha Jauhar Ali 1, Paul Collini 1, Amir Burney 1 and Dyfrig Hughes 1  \nAbstract  \nBackground With the introduction of the UK Medical Licensing Assessment (UKMLA), many medical schools have adopted a sequential Objective Structured Clinical Examination (OSCE) format to evaluate clinical competence more efficiently. Sequential testing was designed to improve diagnostic accuracy and maximise the effectiveness of testing resources by administering a relatively shorter screening test for all students, followed by a confirmation test only for students who did not meet the passing threshold of the first test. While its psychometric robustness is well established, little is known about how students experience and interpret this assessment format. This study exploreshow psychological and contextual factors shape students’ self-efficacy, motivation and engagement within sequential OSCEs.  \nMethods Semi-structured interviews with 22 medical students were conducted following two full sequences of sequential OSCEs in the third and final year of study. Data were analysed using framework analysis informed by selfefficacy and attribution theory.  \nResults Students described multiple positive sources of self-efficacy, including sequential practice opportunities, peer and senior modelling, verbal reassurance, effective faculty-student communication and well-timed testing intervals. Negative influences included uncertainty about the format, emotional distress, unclear pass threshold, lack of assessment clarity, delayed feedback and insufficient support. Students who viewed sequential testing as a developmental opportunity reported higher confidence and adaptive attributions, whereas those who perceived it as punitive described heightened anxiety and reduced motivation. These patterns reveal an anxiety–achievement paradox—high objective success rates coexisting with persistent psychological stress.  \nConclusions Sequential OSCEs can support learning when implemented with transparent communication, equitable access to preparation resources, and timely, supportive feedback. Attending to the emotional and motivational dimensions of assessment may improve the educational value of sequential testing and promote student well-being within high-stakes clinical assessment systems.  \n*Correspondence:  \nJun Jie Lim [jj.lim@sheffield.ac.uk](jj.lim@sheffield.ac.uk)  \nChris Roberts [chris. roberts@sheffield.ac.uk](chris. roberts@sheffield.ac.uk)  \nFull list of author information is available at the end of the article  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/l](http://creativecommons.org/l)icenses/by/4.0/.  \nLim et al. BMC Medical Education (2025) 25:1736 Page 2 of 12  \nKeywords Objective structured clinical examinations (OSCE), Sequential testing, Learner motivation, Self-efficacy, Medical Education, Clinical assessment, Medical licensing e","cbCaimRZw9SrAx3Y","https://ap.wps.com/l/cbCaimRZw9SrAx3Y","pdf",1371587,12,"English","# Abstract\n# Background\n# Methods\n# Results\n# Conclusions\n# Introduction","[{\"question\":\"Why did medical schools adopt sequential OSCE formats after UKMLA implementation?\",\"answer\":\"Sequential testing was introduced to improve diagnostic accuracy and maximize assessment resources by using a shorter screening test for all students, followed by a confirmation test only for those who do not meet the passing threshold of the first test.\"},{\"question\":\"How did students’ perceptions affect their self-efficacy and motivation in the study?\",\"answer\":\"Students viewing sequential testing as developmental reported higher confidence and more adaptive attributions, while those perceiving it as punitive reported heightened anxiety and reduced motivation.\"},{\"question\":\"What educational actions does the study recommend to support learning in sequential OSCEs?\",\"answer\":\"The study concludes that sequential OSCEs can support learning when communication is transparent, preparation resources are equitably accessible, and timely supportive feedback is provided, addressing emotional and motivational factors to promote well-being.\"}]","Understanding students’ self-efficacy and motivation in sequential OSCE - a qualitative study | PDF"]