Ensuring robust OSCE assessments: A reflective account from a Scottish school of nursing

Abstract

Aim

This paper reflects on the experience of one Scottish University in conducting a face-to-face Objective Structured Examination (OSCE) for large cohorts of student nurses. It outlines the challenges experienced and learning gained.

Borton’s model of reflection frames this work due to its simplicity, ease of application and cyclical nature.

Background

The theoretical framework for the OSCE is critical thinking, enabling students to apply those skills authentically. OSCE’s are designed to transfer classroom knowledge to clinical practice and offer an authentic work-based assessment.

Design

Validity and robustness are key considerations in any assessment and in OSCE, the number of stations that students encounter is important and debated. We used a case-study based OSCE approach initially over four stations and following reflection, changed to one long station with four phases.

Results

In OSCE examinations, interrater reliability is a necessity, and students expect equity of approach. We identified that despite clear marking criteria, marks were polarised, with students achieving high or low marks with little middle ground. Review of examination papers highlighted that although students’ overall performance was good, some had failed in at least one station, suggesting a four-station approach may skew results. On reflection we hypothesised that using a one station case study-based, phased approach enabled the examiner to build up a more holistic picture of student knowledge and skills. It also provided the student opportunity to develop a rapport with the examiner and standardised patient, thereby putting them more at ease. We argue that this approach is holistic, authentic and student centred.

Conclusions

Our experience highlights that a single station, four phase OSCE is preferrable, enabling students to integrate all aspects of the assessment and provides a holistic view of clinical skills and knowledge.