Experiences of nursing students and examiners with the Objective Structured Clinical Examination method in physical assessment education: A mixed methods study

Highlights

• The Objective Structure Clinical Exam process was perceived to be a worthwhile and meaningful assessment tool covering a wide range of skills.

• The exam was perceived as a stressful experience with more time and preparation needed.

• Early preparation, training of simulated patients, and better organization is needed to promote the evaluative efficacy of the exam.

• Adopting a blended learning approach to assess students' clinical competencies is recommended to hone their skills in physical assessment.

Abstract

This study explores the experiences of undergraduate nursing students and examiners with the Objective Structured Clinical Examination (OSCE) as an evaluation of physical assessment skills. A mixed methods approach captures participants’ perceptions and experiences with the OSCE. The sample consisted of 55 students enrolled in the physical assessment course and eight external examiners. Data were collected using a standardized questionnaire and focus group interviews, using semi-structured questions, recorded and transcribed for thematic analysis. Quantitative data were analyzed using SPSS software. Results indicated that participants regarded the OSCE as a valuable assessment tool that enhances in-depth learning and preparation of students for clinical practice. Participants also perceived the exam to be a stressful experience, citing the need for more time on examination stations. Recommendations for improving the OSCE process included extending preparation prior to the exam, training of simulated patients, adopting a blended learning model, and upgrading the setting of the exam. This paper supports evidence of the value of the OSCE as an appraisal of physical assessment skills in undergraduate nursing education.

Introduction

The American Association of Colleges of Nursing (AACN) states that the baccalaureate generalist nurse requires strong critical reasoning, clinical judgment, communication and assessment skills (American Association of Colleges of Nursing, 2008). One of the different methods used to evaluate students' skills acquisition is the Objective Structured Clinical Examination (OSCE). The OSCE is a station-based exam introduced in the mid-1970s to assess clinical competencies among medical students (Rushforth, 2007). The exam was developed as an alternative assessment method for evaluating clinical competencies which is less subjective than clinical observation and more realistic than theory exams (Goh et al., 2016). The OSCE is a form of performance-based testing used to measure candidates’ specific clinical competencies (Marcyjanik and Johnson, 2016). During an OSCE, candidates are observed and evaluated by external examiners as they progress through a series of structured stations with standardized patients prepared to test specific skills like interviewing, communication, clinical judgment, and physical examination (Traynor and Galanouli, 2015).

In recent decades, educational institutions within a range of countries, including the United States (Obizoba, 2018), China (Shen et al., 2018), Australia (Massey et al., 2017), Spain (Solà et al., 2017), Indonesia (Uliyah, and Hidayat, 2017), and Singapore (Goh et al., 2016), have adopted the OSCE to assess cognitive, psychomotor, and affective abilities of students. Literature indicates that the OSCE is regarded as a feasible, reliable and valid strategy for assessing clinical skills in nursing (Selim et al., 2012; Shen et al., 2018; Traynor and Galanouli, 2015). Within undergraduate nursing education, this method has been successfully utilized to assess students’ competencies in mental health (Selim et al., 2012), midwifery nursing education (Muldoon et al., 2014), pediatric nursing (Pierre et al., 2004), and the fundamentals of nursing practice in novice nursing students (Shen et al., 2018).

The department of Nursing at XXX in the United Arab Emirates (UAE) has also adopted the OSCE to assess undergraduate students' competencies in courses such as physical assessment, fundamentals of nursing, adult health nursing, mental health nursing, and critical care nursing. The aim was to prepare students for clinical practice through objective measures of their clinical skills. Although the OSCE exams have been conducted with several graduate student cohorts at the University of XXX since 2006, no attempt has yet been made to evaluate either students' or examiners’ experiences with the OSCE.

The overall aim of this study was to provide a perspective on the value of OSCE in measuring physical assessment competencies among undergraduate nursing students. Using a mixed method research design approach, the OSCE experiences of both students and external examiners in physical assessment courses are reported.