An exam flow is like a road map with different routes and stops you can take to get to your destination. You may want to include various components in your exam sessions, such as an honor code, door notes, or evaluations. The exam flow also dictates the length of time an exam session is recorded, along with the amount of time given for any post-encounter evaluation activities. The exam flow combines all these components and settings into a set of instructions for the system so each exam session utilizing that exam flow runs smoothly and consistently for all participants. 

Please note that in student or admin-driven flows, participants can advance before the timer expires. However, in system-driven flows, participants must remain in the phase until the timer ends.

Things to know before you begin

• When editing a previously configured exam flow in an exam room, it is important to refresh the Control Interface after making your edits and before running your session. The system will prompt you with a reminder if/when making edits.  
• You cannot edit an exam flow associated with a Scenario if that Scenario is being used actively to capture an exam session. Once the active session has been completed, edits can be made to the exam flow.  

Create an exam flow

To set up an exam flow, you'll first click into the course you'd like to work in. From there, take these steps.

1. Within the Curriculum area, click Add New Scenario.

2. Enter a title (this is required), Overview and Learning Objectives (optional).

3. Select Standardized Patient.

4. Select your exam flow settings.

• Exam Phases Advancement
  • Proctor or student driven - Allows phase advancement to be prompted by proctor action in the control interface and/or student action in the learner exam interface.  
  • System Automated – Click here to learn more about System Automated exam flows
• Audio and User settings
  • Audio announcements – Audio announcements let faculty members configure text to voice announcements which are played from the learner and/or patient workstation to provide information (“you have 1 minute remaining)” or to prompt for action ("please submit your evaluations”) during an exam session. 
  • Allow multiple users - Allows multiple learners to log into a single room/exam interface, so that any captured exam session using this exam flow/Scenario can be associated with one or more learners (when appropriate).
• Exam Phases
  • Honor Code - Allows for required institutional honor code to be accepted or agreed to after login and prior to progressing further into exam session.  
  • Door Notes – Typically contains information about the encounter or instructions before entering the room. Learners will have 1 hour to complete this phase. 
  • Exam EMR – Electronic medical records. To learn more about EMRs, click here. Learners will have 1 hour to complete this phase.
  • Encounter - An exam period when the learner and standardized patient are engaged directly. This is typically a recorded exam phase, during which an EMR can be presented to the learner on the patient exam interface. Learners will have 4 hours to complete this phase.
  • Post Encounter - The reflection phase following the encounter which allows for learner or patient (or both) participants to complete an evaluation. Scores will be attributed to the learner participant in the exam session. Learners will have 1 hour to complete this phase.

5. Click Save to save the exam flow.

Note: When editing an already created exam flow, all exam components will expand.

Create an exam flow with follow-up

When creating an exam flow with follow-up, clicking + Add Follow-up will create a new set of follow-up components to configure. Taking this action will also auto collapse all previously chosen exam components from the initial block, ensuring you will not lose your previously configured exam component selections.  

Once you have created and saved your exam and added a follow-up (optional), you will see the exam flow settings which were used to create the exam flow on the scenario home page. 

Disable Exam Encounter Recording

In certain situations, participants should have encounters without recording, such as during exams on sensitive topics (e.g., pelvic exams, breast exams). In these instances, participants may still need to receive pre-encounter materials (HC, DN, EMR) and complete an evaluation after the encounter while following a structured examination workflow. Recording the video may be inappropriate or undesired in these cases. The steps below outline how to disable recording while keeping all other necessary exam flow configuration options intact.

1. Create SP Scenario 

• Create a new Scenario using the Standardized Patient scenario requirement. 
• Enter your scenario details. 

2. Configure Exam Flow 

• In the exam flow editor portion of the Scenario creation page, locate the toggle switch labeled Recording is ON In the Encounter phase accordion menu. 
• Switch the toggle to the Recording is OFF position to disable recording and click Save.

3. Configure Room 

• Assign the newly created SP (Standardized Patient) Scenario to the appropriate exam room. 
• Verify that the room setup reflects the new scenario configuration. 

4. Conduct the Encounter 

• Proceed through any pre-encounter work. 
• Begin the encounter and observe the following: 
  • Monitor Interface: 
    • Live streams are enabled by default (configurable option potentially in a later ticket). 
    • The recording indicator light is not active/grayed out. 
    • Monitor evaluations remain accessible during the encounter. 
  • Control Interface: 
    • The recording indicator light is not active/grayed out. 
    • The red background is retained, indicating the encounter phase is in progress. 
  • Participant Interface: 
    • No changes. 
  • Patient Interface: 
    • No changes. 

5. Complete the Encounter 

• Complete the encounter as usual, ensuring no recording indicator lights are shown in either the control or monitor interfaces. 
• Confirm that no session recording/video is created.

6. Conduct Follow-Up Phase (if applicable)

• The follow-up phase will mimic the encounter phase behavior outlined above.

7. Verify Remote OSCE Behavior 

• Confirm that the behavior during Remote OSCE remains consistent with the in-room behavior described above, with the following exception: 
  • Remote OSCE Monitor Interface does not allow remote viewing of Scenarios where recording is disabled during the encounter.