Objective structured clinical examination (OSCE): Review of literature and implications for nursing education

Summary

Objective structured clinical examination (OSCE) has been used to assess medical students since the mid 1970s, and in more recent years has been increasingly utilised to assess students from nursing and the allied health professions. This growing utilisation has led to considerable debate within the literature pertaining to the optimal use of OSCE as an assessment process.

The purpose of this paper is to present a narrative review regarding some of the key issues affecting the utilisation of OSCE within the assessment of nursing students. The paper briefly reviews the historical development of OSCE within health professional assessment, and summarises some of its key strengths and limitations. It then offers a more ‘in depth’ consideration of the research literature pertaining to the reliability and validity of the OSCE process, which is then used as a basis for exploring some of the particular issues that need to be considered when OSCE is used to assess nursing students. Key issues identified include the need to carefully prepare and pilot new OSCE examinations and marking tools in order to ensure reliability and validity is optimised, and also the need to carefully consider the length, number and interdependence of OSCE stations to ensure that the potentially competing requirements of validity and reliability are balanced. The paper also recognises that whilst the evidence base regarding OSCE is extensive, the evidence base specific to nursing is more limited. There is therefore scope for further research in this area, as well as the need for careful debate regarding how national guidance may be a way of enhancing and standardising future OSCE examinations. The paper concludes that whilst caution must be applied in relying on OSCE as a sole means of practitioner assessment, used carefully it can make a helpful and meaningful contribution to health professional 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.