Objective structured clinical examination (OSCE): Review of literature and implications for nursing education
Introduction
This paper explores the use of the objective structured clinical examination (OSCE) as a means of assessing students within both preregistration and postqualification/postgraduate nursing education. It identifies strengths and limitations of this approach to assessment, and offers a narrative literature review to explore a range of issues pertaining to the OSCE process, including consideration of its reliability and validity. These insights are then used to makes evidence based suggestions regarding ways in which OSCE can be most effectively utilised within nursing education.
My personal interest in the OSCE examination stems from using a modified version over the last 5 years to assess a postqualification (PQ) nursing module in ‘history taking and physical examination’. Our initial decision to use OSCE when the course commenced in 2000 was one we initially viewed as pragmatic; a transitional arrangement until there were enough trained nurses with these advanced health assessment skills available to assess students in the practice setting. It is only as we have worked with OSCE over the past 5 years, and explored the literature more closely, that we have come to realise that it may not be a ‘second best’ option after all. It is this debate that lies at the core of this review paper.
Section snippets
Definitions
The OSCE has been defined by various authors, perhaps most concisely by Watson et al. (2002) who describes it as an examination where
‘students demonstrate their competence under a variety of simulated conditions’ (p. 424)
OSCE was first described by Harden et al. (1975), designed to assess the clinical skills and competence of final year medical students. Prior to this the main mode of assessment for medical students’ practice competency was observing their clinical examination of a small number
Comparing OSCE to other modes of assessment
As the use of OSCE has grown, so health professionals have begun to debate many aspects of the process. In critically evaluating OSCE, much attention is given to its trustworthiness as a means of assessment; in other words whether or not the scores students achieve in an OSCE examination can be regarded as a valid and reliable measure of their competence. Most readers will be comfortable with the notion that validity is concerned with whether a test measures what it is supposed to measure
Interrater reliability
A key aspects of reliability explored in studies is the accuracy of judgements made by examiners. This is important since the number of OSCE stations in a typical OSCE means individual stations are frequently reliant on the judgements of single examiners. Accuracy is therefore tested experimentally using inter rater reliability (IRR), with selected stations being independently marked by two assessors whose marks are later compared. Most such studies use measures of correlation; whereby 0 shows
Challenges in nursing education
The evidence considered originates from a range of health care disciplines, but despite some exemplars of nursing focused research, the dominant evidence base is derived from medical practice. There are a number of potential reasons for this, not least the length of time OSCE has been in use in the different professions. But a key reason may also be that the nursing OSCE often looks very different to the traditional medical OSCE. In this respect, it is interesting to reflect on the findings of
Conclusion
In conclusion, it seems that OSCE examination offers an attractive option for assessment of practitioner competency. It seems to offer particular strengths in terms of assessor objectivity and parity of the assessment process for all students, especially when compared with other assessment of practice processes. However, it is not without limitations, not only in terms of student stress and its considerable demands on academia, but also in terms of the considerable challenges of ensuring the
Acknowledgements
The author gratefully acknowledges the 2005 Florence Nightingale Foundation Travel Scholarship which underpinned many of the insights contributing to the development of this paper. NB: This paper is based on a core paper presented at the ‘Nurse Education Tomorrow’ Conference, Durham, September 5, 2005.
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