Objective Structured Clinical Examination (OSCE) in Undergraduate Nurse Education
Purpose/Aims
1. To develop the OSCE as an evaluative tool of clinical performance in a scaffolded simulated environment.
2. To examine psychometric properties of tools used in the OSCEs.
Rationale/Background
The 2011 IOM report on the Future of Nursing calls for a need to focus on both competency and performance based assessments in which students demonstrate their grasp and application of theory in real-world or realistically simulated situations. In addition, a recently published study through the NCSBN provides strong evidence for simulation as a powerful learning tool (Hayden, et al, 2014). Results indicate that students participating in high-quality, structured simulation-based learning experiences versus those in traditional clinical learning placements had similar outcomes. Objective Structured Clinical Examinations (OSCEs) provides a simulated assessment, reflecting real-life situations, where the level of difficulty is standardized relative to the stage of learning. OSCEs have been used in international nursing education for some time and are beginning to be used in programs within the US. Potentially they can enhance the assessment of clinical competencies using pre-determined objectives with the advantage being strict control over the clinical context in which students demonstrate specific behavioral outcomes.
Brief Description of Project
OSCEs include several stations which simulate different healthcare scenarios. Participants are given instructions at the beginning of the term informing them of the constructs and competencies the OSCE will measure. A few weeks before the OSCE, students are given additional instructions, which include the overall focus of the OSCE, the types of stations (i.e. safety or health interviewing), SBARs, and tools needed during the activity. The course content, learning activities and instruction combine to support students in preparing for the OSCE, as well as engage students to become active agents in their learning. Currently, in our project, all OSCEs are going through content validity of scenarios as well as testing psychometric properties of the grading rubrics. In addition, a remediation plan is in place to allow faculty and students to focus on active student learning. The goal is to ensure valid, reliable, fair, and objective assessment of students while providing them with formative feedback to improve and enhance their nursing practice.
Outcomes Achieved
The outcomes to date include: (a), a detailed plan for scaffolding and spiraling learning throughout each course and throughout the nursing program; (b), being able to accurately align clinical assessment opportunities to the outcomes and competencies students need to achieve in each course; and (c), enhancing educational practice by allowing faculty and students to discover where the gaps in learning occur.
Conclusions/Recommendations
With the current complexity of nursing practice, the need for assessment of student clinical performance was recognized by the IOM. Further, scaffolded instruction should be based on periodic and accurate assessment of performance as students’ progress in their programs. OSCEs add a rigorous, controllable method of assessing this clinical competency and progression in a safe environment. Future research will focus on validity and reliability of OSCE rubrics and on developing more advanced objective standardized clinical assessments (OSCAs) to align with scaffolded and spiraled learning.