the objective structured clinical examination ( osce ) was developed in 1975 by harden et al . in osce many articles reported osce and discussed about its validity and reliability.[36 ] the team structured objective clinical examination ( tosce ) was planned as a variation of osce . it was also used to evaluate shared education between midwifery and medical students in one study . in another study , the modified type of tosce named team objective structured bedside assessment ( tosba ) was described . this paper describes the process and structure of a 12 station tosce exam in a competitive examination for medical students known as the national medical science olympiad in iran . the evaluation of tosce from participants viewpoint , its advantages and disadvantages will be discussed . the objective structured clinical examination ( osce ) was developed in 1975 by harden et al . in osce many articles reported osce and discussed about its validity and reliability.[36 ] the team structured objective clinical examination ( tosce ) was planned as a variation of osce . it was also used to evaluate shared education between midwifery and medical students in one study . in another study , the modified type of tosce named team objective structured bedside assessment ( tosba ) was described . this paper describes the process and structure of a 12 station tosce exam in a competitive examination for medical students known as the national medical science olympiad in iran . the evaluation of tosce from participants viewpoint , its advantages and disadvantages will be discussed . as we mentioned in our previous articles , the aim of medical science olympiad in iran is to indentify scientifically talented individuals , to motivate students , orient extracurricular activities , and to foster their creativity . the first olympiad was held in isfahan in 2009 and the second in shiraz 2010 in three areas : health system management , basic science , and clinical science . in each area , , we discuss about tosce as a part of group stage of clinical area of the second olympiad . one hundred and thirty five top ranked students as examinees came from 45 medical universities ( 3 examinees from each university ) , who were tested in individual stage of clinical science area . after individual stage the mean grade of each university team was calculated and the nine best university teams with higher scores were invited for the team exam . only undergraduate students were allowed to participate in the olympiad . an expert panel from all the medical universities in iran participated in designing tosce questions . to ensure content validity of the exam , these experts designed an osce blueprint for each station based on the defined objectives in emergency medicine in medical and surgical fields . each station comprised of three different elements and all the three members of a team should answer each element first and then decided on the whole station based on the group consensus . for example , at one station the first student should take history , the second should do the physical examination and the third should see laboratory data and then they should discuss about diagnosis based on the group consensus . the main aim for stations was to develop a team work toward management of an emergency medicine problem . expert panel discussed about the time for each station and finally decided to consider 15 min for each station and 12 stations were designed to ensure exam reliability . the content validity of the stations was determined by content experts and using a blueprint based on important domains ( such as cardiology , nephrology and etc ) . reliability of each station s checklist was measured after the exam by cronbach s alpha as a measure of internal consistency . the performance of each group was evaluated by pre mentioned criteria agreed by expert committee . this questionnaire consisted of 11 items on the students opinion about this exam in a 5 point likert scale and some open questions . validity of the questionnaire was determined by medical education experts in the scientific olympiad committee and the reliability was determined after a pilot study ( r=8 ) . we used descriptive statistics ( mean and standard deviation ) for analysis of questionnaire data . the participants answers to open - ended questions were categorized by grouping similar comments for each question . one hundred and thirty five top ranked students as examinees came from 45 medical universities ( 3 examinees from each university ) , who were tested in individual stage of clinical science area . after individual stage the mean grade of each university team was calculated and the nine best university teams with higher scores were invited for the team exam . only undergraduate students were allowed to participate in the olympiad . an expert panel from all the medical universities in iran participated in designing tosce questions . to ensure content validity of the exam , these experts designed an osce blueprint for each station based on the defined objectives in emergency medicine in medical and surgical fields . each station comprised of three different elements and all the three members of a team should answer each element first and then decided on the whole station based on the group consensus . for example , at one station the first student should take history , the second should do the physical examination and the third should see laboratory data and then they should discuss about diagnosis based on the group consensus . the main aim for stations was to develop a team work toward management of an emergency medicine problem . expert panel discussed about the time for each station and finally decided to consider 15 min for each station and 12 stations were designed to ensure exam reliability . the content validity of the stations was determined by content experts and using a blueprint based on important domains ( such as cardiology , nephrology and etc ) . reliability of each station s checklist was measured after the exam by cronbach s alpha as a measure of internal consistency . the performance of each group was evaluated by pre mentioned criteria agreed by expert committee . this questionnaire consisted of 11 items on the students opinion about this exam in a 5 point likert scale and some open questions . validity of the questionnaire was determined by medical education experts in the scientific olympiad committee and the reliability was determined after a pilot study ( r=8 ) . we used descriptive statistics ( mean and standard deviation ) for analysis of questionnaire data . the participants answers to open - ended questions nine teams from nine universities acquired the highest grades and participated in the tosce . therefore , the reliability of each station in tosce most students either agreed or strongly agreed that tosce was a useful examination for measuring competency . more than 50% of them reported this exam reinforces team work and problem solving ability . 48.1% of them believed that 15 min was not enough for each station and they needed more time for reaching team consensus and answering the questions . participants views of the tosce exam in open questions , the students mentioned that this kind of exam was new and exciting for them . some of the students ideas are mentioned below : 
 the most significant aspect of this tosce format was promoting a team activity toward emergency medicine problem management;everyone was trying to do best in the team which was an important activity;the best thing about this sharing activity was the fact that we learned to decide who does what and how to have a consensus in our team . the most significant aspect of this tosce format was promoting a team activity toward emergency medicine problem management ; everyone was trying to do best in the team which was an important activity ; the best thing about this sharing activity was the fact that we learned to decide who does what and how to have a consensus in our team . the results of validity , reliability and participants satisfaction of the tosce described in this paper as a part of second national medical science olympiad represented that this kind of exam was useful for measuring clinical competency and also team activity from students viewpoints . brian reported a group osce ( gosce ) in 1991 that was performed for postgraduate assessment of general practitioners in united kingdom and concluded that gosce is a good method for formative and self assessment . george hospital medical school in london and concluded that this kind of exam is feasible , although , some students are unfamiliar with it . also , elliot and colleagues stated a gosce for assessment of clinical and interpersonal skills in united states of america and reported that gosce influence curriculum , students and faculties well . in the present study , the students were generally agreed that tosce gave them an opportunity to work with their peers well . most students had not a classroom experience for working in teams . in some classes , the high rank students think that working in groups may lead to do more than their usual duties , otherwise , they should accept the risk of getting bad grades in group works due to difficult and lazy group members that do not want to do anything as a group member . it seems necessary to empower our students in team activities and tosce exam seems to be useful for achieving this goal . in our study near half of the participants believed that they needed more time in stations , especially for getting group consensus . the 5 min station is most frequently used in osces , but some articles reported that students may need more time . in our tosce , the expert panel decided to consider 15 min for each three part station , although it seems that more time was needed as reported by half of the students . the most important strength of this study was that participants were from nine different universities in iran , besides an expert panel of teachers from different medical universities were selected based on their expertize . to our knowledge , this is the first report of a tosce in a norm reference competitive exam such as olympiad . this tosce was used for the first time in the second national medical science olympiad in shiraz , while in the first olympiad in isfahan other kinds of exams were used to assess group dynamic and clinical competence . the main limitation of this study was that examinees were the top ranked students and were not a good representative of all medical students , especially in team work . although , further evidence is required on tosce effectiveness as a method for group clinical problem solving , we believe that the tosce is a useful tool .
introduction : second national medical sciences olympiad was done in shiraz in august 2010 with aim of indentifying scientifically talented individuals , motivating students and orienting extracurricular activities . 
 this olympiad was done in 3 areas , basic sciences , clinical sciences and management . in clinical sciences , we used tosce ( team objective structured clinical examination ) . in this article 
 we report the details of this exam and participants satisfaction.materials and methods : this olympiad in clinical medical sciences was held in 2 levels : individual and team . in the team stage 
 , 9 teams from 9 universities participated . 
 we used tosce for measuring clinical competency of teams . 
 each team consisted of 3 students . 
 we designed 12 stations based on emergency medicine in medical and surgical fields . 
 the time considered for each station was 15 min , after doing this exam the view of students was measured using a valid and reliable questionnaire.results:most of the students believed that tosce was a useful examination for measuring competency . more than 50% of students reported that success in this exam needs clinical competency , team work and problem solving ability . 
 nearly , half ( 48.1% ) of students believed that 15 min is not enough for each station and they need more time.conclusion:the results of this study showed that this kind of exam is useful for measuring clinical competency from students viewpoint .