Assessment is now seen as a learning experience. there is little literature on objective structured clinical examination role for formative assessment especially in developing world Many studies showed that formative-OSCE contributes positively to final summative examination performance though most studies address this point through the students' perception toward the formative-OSCE.

Having research that evaluates the effect of formative-OSCE introduction on a subsequent summative-OSCE in randomised controlled design may be of benefit for institutions considering the establishment of their own formative-OSCEs particularly in low resource countries.

Formative assessments are systematically designed instructional interventions to assess and provide feedback on students' strengths and weaknesses in the course of teaching and learning and educational experts recommend its use in addition to summative assessment. Moreover, it is a requirement in undergraduate medical education and must be at the heart of student training not just included to satisfy accreditation requirement, yet unlike other professional training culture such as music in which feedback is expected, respected and given regularly to all learners, the investigators haven't cultivated a true feedback culture in medical education.

In a performance-based assessment, the Objective Structured Clinical Examination (OSCE) has gained importance because of its reliability and could be in a summative or formative manner to measure clinical competence. Clinical skills development requires time and practice at a rate that can accelerated by feedback to optimize experiential learning and improve future performance for which a learner should enter a reflection period during which available feedback is examined.

There are some medical schools where formative assessments are institutionalized and carried out systematically, unfortunately, this kind of assessment is not very frequent in Mediterranean countries.

Undergraduate medical education in Iraq is currently going through a transitional period. The Medical college of Hawler medical university (HMU) which provides a 6-year MBChB program, has started the process of changing its curriculum to competency-based medical education (CBME) and formative assessment is a requirement in this process. In the traditional curriculum training in pediatric is introduced in 5th year with summative assessment composed of 50% written test, 30% OSCE, 10% logbook, 10% history taking skills. Students should be competent to record case history, examine children, make a provisional diagnosis, interpret investigations and communicate with children and their families given that at the allotted time end, students present the case findings and evaluated by the faculty. However, a faculty member doesn't actively observe the students' actual performance of these skills or competencies so the purpose of formative assessment is not fully met. Use of OSCE as formative assessment can overcome this problem.

Attempts have been made in OSCE implementation for summative assessment, however, formative-OSCEs introduction and evaluation in Iraqi medical colleges is lacking. Iraqi medical schools are facing challenges in staff recruitment and adequate resource provision. The latter is one of the numerous concerns and challenges to the CBME implementation.

Many studies showed that formative-OSCE contributes positively to final summative examination performance though most studies address this point through the students' perception toward the formative-OSCE.

Inclusion Criteria:

• 5th-year students of both gender

Exclusion Criteria:

• students who did not fulfill the 4th year requirements.
• absent on the day of performing formative OSCE
• did not agree to participate in formative OSCE

The staff who participated in the summative-OSCE(outcome assessor) were unaware of the group assignment and the two-teaching staff who participated in the intervention (Formative-OSCE) did not participate in the summative exam.