IDENTIFYING Strengths and Weaknesses in the UTILIZATION of Objective Structured Clinical Examination (OSCE) in a Nursing Program
McWilliam, Paula L., Botwinski, Carol A., Nursing Education Perspectives
ABSTRACT Objective Structured Clinical Examination (OSCE) is used in nursing to assess students' transfer of classroom and laboratory learning experiences into simulated clinical practice. OSCE is a performance-based exam in which students are observed demonstrating a multitude of clinical behaviors. The purpose of this study was to identify strengths and weaknesses in the utilization of OSCE in this nursing program with 60 full-time students ages 21 to 23. An evaluation methodology was used for this study. Interviews were conducted with two groups: faculty facilitators of OSCE and standardized patients (SPs). Areas of focus were: data collection of students' performance, SP selection and training, and modification of the Nursing Interview Interaction Scale (NIIS). It was found that with appropriate SP selection and training, utilization of appropriate tools, and good data collection, OSCE can offer a valid and reliable means of testing nursing students' clinical competencies.
Key Words Clinical Simulation - Nursing Competencies - Objective Structured Clinical Examination (OSCE) - Nursing Education - Performance-Based Exam
IT IS ACKNOWLEDGED THAT CLINICAL COMPETENCY IN NURSING ENCOMPASSES CLINICAL JUDGMENT. Nursing students must be able to draw on significant information and respond appropriately in a concerned and involved manner in patient care situations (Cox, 2000; Watson, Stimpson, Topping & Porock, 2002). A major challenge for educators is how to evaluate the student's ability to select the necessary elements from his or her own knowledge and skill acquisition and transfer these skills into a wide range of clinical situations (National Council of State Boards of Nursing, 2009). Each student will have different exposure to different patients, making it difficult to measure individual and program outcomes (Rentschler, Eaton, Cappiello, McNally, & McWilliam, 2007).
The Objective Structured Clinical Examination (OSCE), developed in Scotland by Harden and colleagues (1975) with the intent to evaluate medical students' clinical competencies, was first described in a report in the British Medical Journal (Redfern, Norman, Calman, Watson, & Murrells, 2002). It has been adapted and applied to other disciplines in health care and is now nationally recognized as a model for evaluating clinical competencies in medicine and nursing (Alinier, 2003).
OSCE is a performance-based exam in which students are observed demonstrating a multitude of clinical behaviors with standardized patients (SPs). The main objective is to assess students' transfer of classroom and laboratory learning experiences into simulated clinical practice. OSCE is effective when there is a need for performance-based assessments, as in nursing, and clinical competencies are tested in a triple domain environment - cognitive, affective and psychomotor (Linn, Baker, & Stephen, 1991; Newble, 2004; Rushforth, 2006). Checklists, which focus on practical and technical skills, and standardized global rating scales, which focus on patient interviewing skills, are OSCE evaluation tools that best reflect measurements of students' clinical competencies (Newble; Rushforth).
This article reports on the use and evaluation of OSCE in a baccalaureate nursing program at a public university in the New England area. The school of nursing offers basic undergraduate degrees, registered nurse completion, and graduate nursing programs. The nursing courses emphasize critical thinking, problem solving, decision-making, and clinical skills. The focus is on the health needs of patients at all age levels in a variety of health care settings, and clinical experiences are provided in area hospitals and community health care agencies.
Senior students conclude the program with a clinical immersion experience. Before participating in the immersion, students are required to participate in an OSCE that provides a formative evaluation of their clinical competencies to better evaluate preparation for the clinical immersion. …