The Objective Structured Clinical Examination in evolving nurse practitioner education: A study of students' and examiners’ experiences

Recommendations After an Objective Structured Clinical Examination Program Evaluation

BACKGROUND

The use of objective structured clinical examinations (OSCEs) is a well-established method of clinical assessment in the medical profession, and these are currently being integrated into advanced practice nursing curricula.

METHOD

A program assessment was conducted at a current family nurse practitioner track within a southwestern U.S. university using the OSCE evaluative strategy. The logic model from the Centers for Disease Control and Prevention framework was incorporated. Both focus group and the de-identified faculty-scored student rubrics during the fall, spring, and summer semesters of one cohort of students (N = 73) were examined.

RESULTS

Strengths and challenges were found in the areas of student preparation, scoring/grading with variations of inter-rater reliability, and debriefing.

CONCLUSION

Establishing a specific OSCE center with a dedicated director could support adequate attainment of formative and summative competencies for nurse practitioners and provide faculty education and standardized student preparation, while adhering to the multiple guidelines and standards related to nurse practitioner competency evaluation with simulation. [J Contin Educ Nurs. 2023;54(4):169-175.].

An example of evaluation of tuning nursing competences in the licensure exam: An observational study

Introduction The licensure exam in nursing has always focused on the curricula used in universities. 'Tuning' was the first project that sought to harmonize training purposes regarding competences and learning outcomes in Europe. The Tuning educational structures have been offered in various disciplines, including nursing with the development of the Tuning Nursing Project. The study describes which of 47 Tuning Nursing Competences were evaluated during the licensure exam in nursing degree courses, and what types of trials were used for their assessment. Methods A multicentric observational study was conducted in 4 universities in Italy. Data were collected in academic years 2017-2019, using two grids: one for cognitive and one for psychomotor tests. Results The Tuning competences were requested 7522 times. The most frequently demanded were those associated with domain number two, "Nursing practice and clinical decision making". The level of performance most required in cognitive tests was the autonomy of judgement, and both tests concerned the fields of non-communicable diseases and the hospitalized adult patient. Conclusions The competences most often assessed coincided with those deemed core for the first cycle of studies at the European level. Unfortunately, it has been detected a high degree of discrepancy in the types of tests used in different schools.

The Episodic Tool: An innovative approach to teach clinical decision making in advanced health assessment

Advanced health assessment (AHA) serves as the foundational course in advanced practice nurse education in which students apply clinical decision-making skills to gather appropriate subjective and objective data and to begin to formulate diagnostic hypotheses. Summative objective structured clinical exams (OSCEs) have been used in AHA courses to evaluate students' clinical competence. After implementing summative OSCEs in AHA, we found that students struggled with evaluations requiring critical thinking skills and subsequently designed a teaching tool to address this gap. An Episodic Tool was created for the six main body systems with a chief complaint and three age and gender combinations. In small groups, students used the tool to identify pertinent history and physical exam components for a specific age and gender. A faculty-facilitated group discussion followed. A pre/post design was used in this quality improvement project to compare OSCE and oral clinical exam (OCE) scores. OCEs were used in 2020 due to COVID-19 limitations. There was a statistically significant increase of 7 % in the mean OCE/OSCE scores after implementation of the tool (p < .001). Qualitative feedback from students and faculty suggested the tool effectively enhanced students' critical thinking and clinical decision-making skills and promoted consistency across course sections.

Reported outcomes and characteristics of objective structured clinical examinations in advanced practice nursing education: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to identify the outcomes reported from objective structured clinical examinations in advanced practice registered nurse education and to describe their characteristics.

INTRODUCTION

Graduate medical education has used objective structured clinical examinations to assess student health professionals since 1975. Nursing programs have adopted objective structured clinical examinations to assess evidence-based practice and clinical competency of advance practice nursing students, but little is known about the outcomes that are being reported.

INCLUSION CRITERIA

This review will consider evidence on the outcomes and other characteristics of objective structured clinical examinations for students enrolled in graduate-level advanced practice nurse education programs (ie, nurse practitioners, clinical nurse specialists, nurse midwives, and nurse anesthetists). All types of evidence will be considered, including quantitative and qualitative studies, systematic reviews, as well as text and opinion papers.

METHODS

This review will be conducted in accordance with the JBI methodology for scoping reviews. A literature search will be conducted in PubMed, CINAHL, MEDLINE, Nursing and Allied Health, Scopus, and Google Scholar. Sources that are published in English or that could be translated into English will be considered for inclusion. No date limit will be applied. Study selection and data extraction will be conducted by three independent reviewers. Any disagreements will be resolved through discussion. The scoping review findings will be presented in a narrative style and reported using diagrams and extraction tables.

Challenges of objective structured clinical examination in undergraduate nursing curriculum: Experiences of faculties and students

BACKGROUND

Assessment of clinical competence of nursing students is necessary to ensure safe practice and the realization of professional clinical standards. An Objective Structured Clinical Examination (OSCE) is commonly used internationally in nursing education programs to assess clinical competence, but is a new process in Iranian nursing curricula.

OBJECTIVE

The aim of this study was to explore and describe challenges associated with OSCE implementation based on the experiences of faculty members and nursing students, with the objective of further improving the assessment of clinical competence in nursing education.

DESIGN

This study used a qualitative approach that included thematic analysis of the transcribed interviews.

SETTING

Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences (TBZMED), Tabriz, Iran.

PARTICIPANTS

Purposive sampling was used to select eighteen faculty members and fifteen students from those interested. These participants represent a reasonable cross-section of those who had participated in the OSCE.

METHODS

A pre-developed interview guide was used to inform semi-structured in-depth interviews. These were recorded and analyzed using the 6-phase thematic analysis method as described by Braun and Clarke (2013). Themes were independently verified.

RESULTS

Challenges identified by participants around OSCEs as part of undergraduate nursing education were extracted from the interview data. Two main themes were evident from the data: 1) shortcomings in executive and technical infrastructure, 2) shortcomings in educational infrastructure. These themes reflected both student and faculty experiences. These also aligned with themes that commonly emerge in related literature.

CONCLUSION

The study findings illustrate several key challenges associated with organizing and implementing OSCEs and so provides unique insights into the development of strategies to implementing and promoting OSCEs in nursing education. We recommend that managers and authorities in nursing education focus on these challenges and explore processes to successfully introduce this exam for assessment of nursing student capacity.

Development of clinical competence - a longitudinal survey of nurse practitioner students

BACKGROUND

In order to achieve a sustainable standard of advanced clinical competence for nurse practitioners leading to a credible role, it is important to investigate the development of clinical competence among nurse practitioner students.

AIM

The aim of the present study is to analyse the development of nurse practitioner students' self-assessed clinical competence from the beginning of their education to after completion of their clinical studies.

DESIGN

The study involved the application of a longitudinal survey design adhering to STROBE guidelines.

METHODS

The participants consisted of 36 registered nurses from a nurse practitioner programme at a Norwegian university. The Professional Nurse Self-Assessment Scale II was used for data collection during the period August 2015 to May 2020.

RESULTS

The students developed their clinical competence the most for direct clinical practice. Our findings are inconclusive in terms of whether the students developed clinical competence regarding consultation, coaching and guidance, and collaboration. However, they do indicate a lack of development in some aspects of clinical leadership. The students with the lowest level of clinical competence developed their clinical competence regarding direct clinical practice significantly more than the students with the highest level of clinical competence. The differences between students with high and low levels of clinical competence were levelled out during their education. Thus, the students as a whole became a more homogenous group after completion of their clinical studies. Previous work experience in primary healthcare was a statistically significant, yet minor, predictor of the development of clinical competence.

CONCLUSION

Our findings indicate that the students developed their clinical competence for direct clinical practice in accordance with the intended learning outcomes of the university's Master's programme and international standards for nurse practitioners. It is imperative that the clinical field supports nurse practitioners by facilitating extended work-task fits that are appropriate to their newly developed clinical competence. We refrain from concluding with a recommendation that prior clinical work experience should be an entry requirement for nurse practitioner programmes. However, we recommend an evaluation of the nurse practitioner education programme with the aim of investigating whether the curriculum meets the academic standards of clinical leadership expected in advanced level of nursing.

Using Objective Structured Clinical Examination as a Teaching Tool in a Hybrid Advanced Health Assessment Course

BACKGROUND

Advanced health assessment is a required course in advanced practice RN (APRN) education, essential to providing the foundation for differential diagnosis (DD) skills and the ability to formulate a plan of care.

PROBLEM

Feedback from clinical preceptors revealed that our doctor of nursing practice (DNP) students struggled to make a DD.

APPROACH

This educational quality improvement project collected data from 7 cohorts of DNP students in either the Family Nurse Practitioner or Adult Gerontology Nurse Practitioner program to evaluate their readiness for clinical practicums and to inform necessary curriculum revisions.

OUTCOMES

Data revealed that students' ability to identify 3 DDs correctly during the summative health assessment objective structured clinical examination was inconsistent. Qualitative data revealed students lacked understanding on how to use results from the physical assessment to formulate a DD.

CONCLUSION

The findings of this project corroborate those from the literature that suggest we should teach APRN students DD skills explicitly.

The use and effect of OSCES in post-registration nurses: An integrative review

BACKGROUND

Objective structured clinical examinations (OSCEs) have been used in the undergraduate medical setting since the 1970s, however little is known about its use and effectiveness in post-registration nurse education.

OBJECTIVES

The purpose of this review was to critically analyse studies using OSCEs in post-registration nurse education and to explore the use and effectiveness of OSCEs in this cohort.

DESIGN

This review was conducted using the Whittemore and Knafl's framework for integrated reviews.

DATA SOURCES

Using the search terms OSCE OR OSCA OR objective structured clinical examination AND nursing NOT undergraduate, a comprehensive review was conducted using CINHAL and MEDLINE.

METHODS

The initial search located 173 studies. After screening and checking eligibility 19 studies were critically appraised. The final number of studies included in this review was 16.

RESULTS

Three themes were generated: (i) Application of OSCEs in post-registration level nursing (ii) OSCEs more than an exam: Learning enhancements and (iii) Participant perceived impact of OSCEs.

CONCLUSION

OSCEs for post-registration nurses have evolved from the original OSCE design and have been adapted to a wide range of clinical settings and specialities. OSCEs were recognized as a valuable learning and assessment tool across the world for post-registration nurses. OSCEs offered strengths in terms of learner satisfaction and increased self-efficacy for this cohort. There was limited evidence supporting the effects of OSCEs within post-registration nursing education in comparison with other educational tools. Further research is needed to explore whether the knowledge gained in OSCEs is translated into clinical practice and whether simulation-based education is more effective in achieving enhanced knowledge compared to traditional-based education. Future research is required using RCT methods to compare the impact of OSCE to traditional-based education.