Implementation and student evaluation of clinical final examination in nursing education

Raters and examinees training for objective structured clinical examination: comparing the effectiveness of three instructional methodologies

BACKGROUND

Utilizing the objective structured clinical examination (OSCE) ensures objectivity when it comes to the assessment of nursing students' skills and competency. However, one challenge in OSCE integration is rater and examinee training and orientation.

AIM

This study employed a quasi-experimental design to evaluate the effectiveness of different instructional methodologies in training and preparing raters and examinees for the OSCE.

METHODS

Participants were divided into three group of training methodologies: online, simulation, and traditional lecture (six raters and 18 examinees were assigned to each group). A total of 18 raters and 54 examinees partook.

RESULTS

The study found that raters trained through simulation exhibited a slight agreement with their rates, compared to those who were trained online and in traditional lectures. Moreover, examinees who were trained through the simulation methodology performed better compared to those trained via the other methodologies.

CONCLUSIONS

The study findings indicate that using simulation by training raters and examinees in the OSCE is the most effective approach.

The effect of objective structured clinical examinations for nursing students

Twenty core nursing skills have been identified by the Korean Accreditation Board of Nursing Education. Proficiency in these skills is essential for all nursing professions, and many educational strategies exist to develop these skills in nursing students, including the Objective Structured Clinical Examination (OSCE). To date, no study on the effects of the OSCE on nursing education has been published. Therefore, we evaluated the effects of the OSCE on the core nursing skills of 207 pre-licensure nursing students in Korea. We measured the nursing students' confidence, skills, and knowledge acquisition and retention. A one-way analysis of variance and Fisher's least significant difference were used for data analysis. Among the four nursing areas (fall, transfusion, pre-operative, and post-operative), students demonstrated the highest confidence level scores in pre-operative nursing. On the OSCE, students scored the highest in transfusion nursing. Significant differences were found between prior knowledge, knowledge acquisition, and retention. Our findings confirm that the OSCE, after lectures and core nursing skill practice, improved the retention of nursing students' knowledge. Therefore, this program can positively influence nursing students' knowledge level, and implementing the OSCE can strengthen students' clinical competency.

Perspectives and experiences of newly registered nurses surrounding the objective structured clinical examination in an obstetrics and gynecology hospital: A qualitative study in Shanghai, China

OBJECTIVES

Newly registered nurses in China are required to attend two years of standardized training programs after graduation, and an evaluation of the training program's effectiveness is critical. The objective structured clinical examination is a relatively new and objective approach to exploring the effectiveness of training programs and is increasingly being encouraged and used in clinics. However, the perspectives and experiences of newly registered nurses in obstetrics and gynecology regarding the objective structured clinical examination are unclear. Therefore, the objective of this study was to investigate newly registered nurses' perspectives and experiences of the objective structured clinical examination in an obstetrics and gynecology hospital.

DESIGN

This qualitative study was conducted using a phenomenological approach.

DATA SOURCES

Twenty-four newly registered nurses taking the objective structured clinical examination in a third-level obstetrics and gynecology hospital in Shanghai, China.

REVIEW METHODS

Semi-structured face-to-face interviews were conducted between July and August 2021. The Colaizzi seven-step framework was applied for data analysis.

RESULTS

Three main themes and six sub-themes emerged: 1) high satisfaction with the objective structured clinical examination; 2) gaining experience and growing as nurses; and 3) high pressure.

CONCLUSION

The objective clinical structured examination can be used to assess the competence of newly registered nurses after training in an obstetrics and gynecology hospital. The examination not only enables an objective and comprehensive evaluation of others and self-evaluation but also leads to positive psychological experiences in newly registered nurses. However, interventions are needed to relieve examination pressure and to provide effective support for participants. The objective clinical structured examination can be incorporated into the training assessment system; this study provides a basis for improving training programs and the training of newly registered nurses.

The effect of flipped classroom in multiple clinical skills training for clinical interns on Objective Structured Clinical Examinations (OSCE)

AIMS

The flipped classroom (FC) is a hybrid approach, combining online learning and face-to-face classroom activities. To comprehensively evaluate the role of the Flipped Classroom (FC) model in clinical skills teaching of medical interns and investigate the acceptance and recognition of FC and Objective Structured Clinical Examinations (OSCE).

METHODS

In the teaching of clinical skills, the students were further grouped into two groups- A and B (A = 37, B = 42), using a computer-based random digital method. group A adopted the traditional classroom (TC) model, and group B adopted the FC model. OSCE was used to assess the clinical skills of the two groups of interns. Two independent sample t-test was used to analyze the difference of participant's demographic data and OSCE scores between the two different teaching model. We sent FC questionnaires to group A and OSCE questionnaires to groups A and B.

RESULTS

The score of OSCE in group B was higher than that in group A (P = 0.024), especially in the heart physical examination (P < 0.050), lung physical examination (P < 0.050), and abdominal physical examination (P < 0.050). The result of the FC questionnaires showed that regarding online courses, most students in group B thought watching videos was a good way to prepare for class (97.6%), For offline courses, most medical interns said that it enhanced their learning ability (88.1%), and they could accept this form of teaching (85.7%). As for the form of OSCE questionnaires, most people in group A and B said that they knew more about this form of assessment (81.0%), that it truly reflected the clinical ability (82.3%).

CONCLUSIONS

FC model has shown good results in clinical skills training, while FC and OSCE can be further promoted in future teaching and assessment.

Instruments used in graduating nursing students' exit exams: an integrative review

IMPACT STATEMENT

This review provides a comprehensive analysis of undergraduate nursing students' exit examinations and indicates that more clinical evaluation methods should be developed to ensure adequate competence.

Assessment Practices of Student’s Clinical Competences in Nurse Education

Background:

Clinical competence in nursing practices includes all the theoretical and clinical knowledge used by the student in a clinical setting. It also involves psychomotor as well as problem-solving skills. The assessment focuses on evaluating the student's ability to provide both safe and competent care for the patients. However, it requires the use of several assessment methods that must be varied according to the components of the clinical competence.

Several studies have revealed that the evaluation of this competency is mostly limited to knowledge testing or the acquisition of technical skills verification.

Aims:

This study has two objectives. Firstly, it aims to analyze the assessment practices related to clinical competence and adopted by teachers in higher institutes of nursing and health technology in Morocco. Secondly, it seeks to identify the difficulties faced by them in using a variety of appropriate assessment tools to target all the components of clinical competence.

Methods:

Based on the theoretical model adapted from the Miller’s pyramid by Mehay and Burns in 2009, relating to the assessment of clinical competence, a self-administered questionnaire was shared with 129 nursing teachers.

Results:

The results indicate that 98.06% of participants use a given tool to assess clinical competence; however, using the appropriate tools to evaluate all its components is limited, and the assessment tools are not characterized by variety.

Conclusion:

Reflecting on the evaluation of clinical competences, a clinical assessment model could be proposed to be in accordance with the theoretical model and to measure its impact on nursing students' learning.

The usefulness and acceptance of the OSCE in nursing schools

This qualitative study explores the usefulness and acceptance attributed by students and faculty members to an Objective Structured Clinical Evaluation (OSCE) administered to nursing undergraduates in Catalonia (Spain) for 10 years. Seventy undergraduate nursing students and twelve faculty members participated in the study. The data collection techniques included an open-ended questionnaire, a student focus group, and individualized faculty interviews. The students experienced the OSCE positively as a learning event that offered an opportunity for feedback that could help them master the required competencies. The OSCE increased students' responsibility by presenting them with a set of challenges that they had to tackle individually. Moreover, it reaffirmed their confidence in situations that closely resembled professional practice. Faculty members valued the ability of the OSCE to integrate and assess competencies, its objectivity, and the indirect information it provided on the effectiveness of the curriculum. The educational impact attributed to the OSCE and its acceptance among faculty and students suggest that it would be useful to re-implement it in the Bachelor's of Nursing in Catalan universities. Our findings may be of use to other nursing programs considering how to assess competency-based education, especially in the context of the European Higher Education Area.

Experiences of using an OSCE protocol in clinical examinations of nursing students - A comparison of student and faculty assessments

Peer-assessment in nursing education using an OSCE protocol is an increasing educational activity that complements that of teachers. However, little is known about how students' and teachers' assessments correspond. The study aimed to compare OSCE assessments made by student examiners and faculty examiners during examinations of clinical skills in undergraduate nursing education. Four cohorts of third-year nursing students participated between 2014 and 2016. The students underwent a clinical examination of the management of central venous catheters and totally implantable venous access devices. Students who performed the examinations were observed both by a faculty examiner and student examiner. Both observers used the same OSCE protocol for the assessment but independently. The OSCE protocols from both faculty and student examiners were reviewed and compared. Total agreement between the student and faculty examiner was reached in 127 of 135 (94%) paired protocols. The level of agreement was substantial with a kappa value of 0.79 (95% CI 0.65-0.93). The conclusion was that the level of agreement between student and faculty examiners was high when using an OSCE protocol in clinical examinations of two different clinical skill tasks. The structured checklist (OSCE protocol) was easy to use for the student examiners despite the lack of experience or training in advance.

Mitigating the Challenges of Objective Structured Clinical Examination (OSCE) in Nursing Education: A Phenomenological Research Study

BACKGROUND

Objective evaluation of clinical competencies is a key component of undergraduate nursing education programs. Objective Structured Clinical Examination (OSCE), widely used in nursing education internationally has limited utilization in undergraduate nursing programs in the United States. The efficacy of OSCE as a valuable method of objective evaluation of students' clinical competencies is not so much the problem for the nursing faculty; overcoming the impediments of its implementation is a much greater challenge.

OBJECTIVE

To explore the strategies for mitigating the challenges of OSCE in baccalaureate nursing education program.

DESIGN/PARTICIPANTS/SETTING

In this descriptive phenomenological research study, 10 undergraduate nursing faculty participated in semi-structured interviews at a public university in the North-Eastern region of United States.

METHOD

Observations and semi-structured interviews were conducted. All interviews were recorded and transcribed. Colaizzi seven steps analysis framework was used to identify major themes in the collected data. The clear, detailed, and sequential procedural processes in both data collection and analysis ensured rigorous and trustworthy results.

RESULTS

Five mitigating OSCE strategies utilized by the faculty included: administrative and technical supports, use of clinical instructors during evaluation, faculty OSCE education, limitation of validation to the required skills essential for professional practice, and collaboration among all course faculty members.

CONCLUSION

Utilization of OSCE as an objective evaluation method is feasible in United States undergraduate nursing education programs if creative strategies are determined to mitigate its challenges.

An Innovative Evaluation in Fundamental Nursing Curriculum for Novice Nursing Students: An Observational Research

BACKGROUND

<Fundamental Nursing> is the first specialized curriculum for nursing students, laying a foundation for nursing education. <Fundamental Nursing> includes many important basic nursing skills, which suggests the traditional examination could not evaluate how well students learn. Since the OSCE (objective structured clinical examination) developed, it has been used among newly graduated nurses, postgraduate nursing students and achieved some success. OSCE might be a better way to evaluate and reflect students' fundamental nursing skills and comprehensive abilities, although few studies have put it into practice.

OBJECTIVES

To build an examination model relating to <Fundamental Nursing> based on OSCE, and put this examination model into practice, and then evaluate the reliability and validity of this examination model.

DESIGN

This study is to design an examination model based on literature and teaching purposes of <Fundamental Nursing>. A quantitative descriptive survey methodology was used to obtain the students' outcome and the views of the students on the process and outcome.

SETTINGS

This study was conducted in the nursing school of one comprehensive university in Beijing, China.

PARTICIPANTS

99 undergraduate nursing students in second year participated in this study.

METHODS

The OSCE consisted of 4 interactive simulated patient stations, 2 operating stations without standard patients, 2 theoretical stations. We designed 4 standardized process-based case scenarios and corresponding scripts pertinent to each station. 4 standard patients and 8 teachers of <Fundamental Nursing> were recruited, trained and evaluated before the implementation of objective structured clinical examination.

RESULTS

The average score of overall fundamental nursing skills was 90.51 ± 4.00. The Cronbach alpha was 0.665, demonstrating the OSCE is reliable. The content validity of each station varies from 0.90-1, and the criterion validity was promising (R = 0.661, p = 0.000). Also, most students were in favor of OSCE to evaluate in <Fundamental Nursing>.

CONCLUSIONS

The OSCE is a reliable and valid assessment tool in <Fundamental Nursing>. Meanwhile, it could inspire students' critical thinking and promote students' communication skills. Through successive application of OSCE in nursing education from the very beginning, it might also have some potential effect on the clinical performance.

Enhancing OSCE preparedness with video exemplars in undergraduate nursing students. A mixed method study

BACKGROUND

Objective structured clinical examinations (OSCEs) are designed to assess clinical skill performance and competency of students in preparation for 'real world' clinical responsibilities. OSCEs are commonly used in health professional education and are typically associated with high levels of student anxiety, which may present a significant barrier to performance. Students, including nursing students, have identified that flexible access to exemplar OSCEs might reduce their anxiety and enable them to better prepare for such examinations.

AIM

To implement and evaluate an innovative approach to preparing students for OSCEs in an undergraduate (registration) acute care nursing course.

METHOD

A set of digitized OSCE exemplars were prepared and embedded in the University-based course website as part of usual course learning activities. Use of the exemplars was monitored, pre and post OSCE surveys were conducted, and qualitative data were collected to evaluate the approach. OSCE grades were also examined.

FINDINGS

The online OSCE exemplars increased self-rated student confidence, knowledge, and capacity to prepare and provided clarity around assessment expectations. OSCE exemplars were accessed frequently and positively received; but did not impact on performance.

CONCLUSION

Video exemplars aid student preparation for OSCEs, providing a flexible, innovative and clear example of the assessment process. Video exemplars improved self-rated student confidence and understanding of performance expectations, leading to increased engagement and reduced anxiety when preparing for the OSCE, but not overall OSCE performance. Such OSCE exemplars could be used to increase staff capacity and improve the quality of the student learning experience.

Towards the implementation of OSCE in undergraduate nursing curriculum: A qualitative study

BACKGROUND

Despite the fact that Objective Structured Clinical Examination is considered to be an efficient assessment method, their implementation in the undergraduate nursing curriculum encounters difficulties. However, the initiative of the European Higher Education Area to promote competency-based assessment may represent an opportunity to introduce this instrument in undergraduate nursing curriculum.

OBJECTIVE

To explore the perception of nursing faculty members regarding the implementation of the OSCE as an assessment tool in Catalan Nursing Schools.

DESIGN/PARTICIPANTS/SETTING

In this qualitative study, fifteen teachers participated in semi-structured interviews in eight Catalan Nursing Schools.

METHODS

Semi-structured interviews were conducted. A thematic content analysis was used to identify major themes in the interview data and collaborative analysis was undertaken to ensure rigorous results.

RESULTS

The relevant aspects that are emphasized by teachers included the consideration of the dual purpose of the OSCE via its formative and evaluative facets by enhancing the feedback received by students about their performance on the OSCE. The OSCE should be administered towards the end of the degree program and should complement other methods of assessment. Despite its high cost, the OSCE was deemed to be efficient as it enables student competencies to be assessed with objective criteria, which is a difficult task with other instruments. OSCE implementation is feasible with the institutional support of and collaborative work between schools.

CONCLUSIONS

The implementation of the OSCE in the Catalan undergraduate nursing degree programs is feasible if the project receives the support of all involved parties and if creative strategies are determined to reduce economic costs and optimize resources. With adequate feedback, the OSCE is an assessment tool that can provide high-impact training to students.

Undergraduate nursing students' subjective attitudes to curriculum for Simulation-based objective structured clinical examination

BACKGROUND

The objective structured clinical examination (OSCE) is an effective educational method to evaluate the clinical competencies of students.

OBJECTIVE

To identify undergraduate nursing students' subjective attitudes to a curriculum for simulation-based OSCE (C-SOSCE).

DESIGN

Q methodology was used since it integrates the use of quantitative and qualitative methods.

PARTICIPANTS

A convenience P-sample consisting of 44 third-year nursing students.

METHODS

Forty selected Q-statements were obtained from each participant and were classified into a normal distribution by using a 9-point bipolar scale. The collected data were analyzed using the pc-QUANL program.

RESULTS

Three discrete factors emerged: Factor I (C-SOSCE stimulates self-study; self-directed learning perspectives), Factor II (C-SOSCE promotes self-confidence; practical learning perspectives), and Factor III (C-SOSCE needs proficient personnel; constructive learning perspectives).

CONCLUSIONS

Subjective positions of the three factors that were identified can be applied during the planning stages of an effective C-SOSCE. These findings establish a baseline that will lead to further research.

Have OSCEs come of age in nursing education?

This article is intended to contribute to the current debate as to whether the objective structured clinical examination (OSCE) should become a standard assessment tool for undergraduate nursing education as they currently are for medicine. The authors describe how one UK university developed an OSCE for a nursing undergraduate programme with the aim of emphasising the need for nursing students to be competent in clinical skills and offering a means of standardising the assessment of these skills. There has been an increasing number of research studies carried out in this area at international level and this article's main contribution to the literature is the description of the Angoff standard-setting procedure that was used to calibrate the OSCE at this University and which makes it the first nursing OSCE in the UK to incorporate a scientific standard-setting procedure.