Objective structured clinical examination in pre-licensure nursing education: Successes and lessons learned

Abstract : Objective structured clinical examination (OSCE) is a widely used method for the evaluation of skills in medical education yet has limited use in pre-licensure nursing education in the United States. When implemented correctly, this method allows for an objective, reliable assessment of psychomotor skills, an essential component of undergraduate education. The aim of this project was to create and implement an OSCE to evaluate foundational nursing skills of pre-licensure nursing students. With an understanding of Healthcare Simulation Standards of Best Practice (HSSOBP) Evaluation of Learning and Performance, an evaluation tool was created, acknowledging timing of the evaluation, the objective, and OSCE principles. Pre-licensure nursing students were tested on three medication administration skills (oral, injection, and intravenous) and one sterile skill (foley insertion or central line dressing change). Students randomly drew skills and were evaluated by a different faculty member for each one. Lead faculty reviewed rubrics for consistency and met with students to provide feedback after all stations had been completed. Through the testing of multiple cohorts, evaluators were educated and trained, building consistency and reliability in student assessments. Evaluation of the OSCE after each cohort allowed for identification of changes needed to the rubric, content facilitation methods, and skill scenarios. It was found that this method provided students with clear expectations needed to successfully complete a skill and limited subjectivity. In this environment, students were able to demonstrate critical thinking and their ability to perform skills safely before proceeding to clinical rotations.