INTRODUCTION:

There are various methods for evaluating clinical skills among which objective structured clinical examination (OSCE) has been recognized as the most reliable method for evaluation of the clinical skills (Hosseini et al, 2011). The Objective Structured Clinical Examination (OSCE) is a form of assessment in, which the student demonstrates clinical skills, and underpinning knowledge, usually in simulated conditions (Fidment, 2012).

Objective Structured Clinical Examination (OSCE), widely used in nursing education internationally has limited utilization in undergraduate nursing programs in the United States.

The efficacy of OSCE as a valuable method of objective evaluation of students' clinical competencies is not so much the problem for the nursing faculty; overcoming the impediments of its implementation is a much greater challenge (Obizoba C, 2018).

OSCE is a modern type of examination often used in health sciences (e.g., medicine, physical therapy, nursing, pharmacy, etc.) to test clinical skill performance such as communication, clinical examination, medical procedures or prescription and exercise prescription. Nurses are trained with specific clinical skills, and objective structured clinical examination (OSCE) could be a better approach to assess clinical skills of nursing students (Jelly P, 2017).

Hitherto very few literatures had explored the challenges faced by the nursing students towards OSCE method of clinical assessment. The dearth of qualitative nursing literatures on OSCE triggered us to conduct a phenomenological study to explore the challenges in Objective Structured Clinical Examination (OSCE) among B.Sc Nursing III year students.

METHODS:

This study was approved with waiver consent by expedited review under Institutional Review Board. After obtaining process consent from III year B.Sc Nursing students, participants who fulfilled the inclusion criteria were enrolled in the study through gain entree. Risk Benefit ratio commensurate maximize benefits for the participants.

The research design used for this study was qualitative phenomenological design. We used age and gender as the categorical variables in this research. The sample size comprises of 5 B.Sc Nursing III year students. Based on data saturation, the participants were curtailed and extracted with total 5 III year B.Sc Nursing students. We recruited participants by adopting purposive typical case sampling technique. Typical participants, who were already exposed to mental health nursing OSCE pattern of examination, were enrolled in our study.

The clear, detailed and sequential procedural processes in both data collection and analysis ensured rigorous and trustworthy results. Observations and semi-structured interviews were conducted. Vignettes were used in course of semi structured interview. All interviews were recorded and transcribed for the III year B.Sc Nursing students who had faced challenges in mental health nursing OSCE pattern of examination. Investigator triangulation strategy was used for collecting the data, coding and making analytic decisions.

Colaizzi seven steps analysis framework was used to identify major themes in the collected data.

After developing category scheme, data was coded with Nvivo qualitative software and reflexivity analysis of the data was done by adhering Colaizzi seven step analytic methods.

RESULTS:

Demographic profile depicted that paramount of the participants were 20 years of age, predominantly female. The results were organized into themes that emerged from the data to illustrate the commonalities among the B.Sc Nursing III year student’s experiences in relation to their challenges in OSCE. The two themes which we identified were the anxiety related to OSCE and the time confinement in particular stations (manned stations). Following are the themes illuminated through the rich quotations of the participant’s lived experience on challenges faced in mental health nursing OSCE pattern of examination.

Theme 1: Anxiety related to OSCE:

The following direct quote by the B.Sc Nursing III year students illustrates the lived experience on challenges in OSCE. Some of the discourse quotes by the participants reflecting anxiety related to OSCE.

“Before the commencement of OSCE, I developed anxiety by reason of new clinical exam pattern. I was little bit nervous about the questions [pause]”.

One of the participants addressing the following statement related to OSCE anxiety.

“Honesty speaking, I am anxious about the manned stations. OSCE in mental health nursing was something very new to me [voice softening]”.

From theme 1 the interviewees shared their anxious experience related to mental health nursing OSCE pattern. Participants revealed exam and state anxiety. Most of the participants expressed anxious facial expression, sighing and silence.

Theme 2: Time confinement in manned stations:

Rich quotes by the B.Sc Nursing III year students who explores, addressing the time confinement. Participants quoted the following texts:

“I faced limited time boundary in manned stations [appearing distressed]. Talking to simulated patients and collecting relevant data was quite difficult within the stipulated time [with emphasis]. Compared to manned stations, unmanned stations were ok [smiling softly] in time confinement, in mental health nursing OSCE”.

As illustrated, the theme 2 depicts that participant encountered limited time in manned stations. Further, the time confinement can be altered and lengthened partly in manned stations, in course of conducting mental health nursing OSCE.

DISCUSSION:

The results of our study portrayed 2 themes Viz the anxiety related to OSCE and the time confinement in manned stations. Similar research results indicated that participants regarded the OSCE as a valuable assessment tool that enhances in depth learning and preparation of students for clinical practice. Participants also perceived the exam to be a stressful experience, citing the need for more time on examination stations. This paper supports evidence of the value of the OSCE as an appraisal of physical assessment skills in undergraduate nursing education (Bani-Issa W, A Tamimi M, 2019).

The major findings reveal that OSCE is an effective tool for evaluation from faculty and student perspectives in all the studies. The key issues recognized include the complexity of the exam, time consumption, accelerated stress perception of the students and high cost in the conduction of the exam (Jansiraninatarajan, 2014).

Byrne E and Smyth S, (2008) conducted a qualitative study by adopting hermeneutic phenomenology for interpreting student’s lived experiences of the OSCE process. Conclusion revealed that students already exposed to an OSCE described feeling less anxious and better prepared for their subsequent clinical placements. Analysis revealed three main themes Viz (1) anxiety about the OSCE, (2) preparation was a seen as a coping strategy and (3) simulation was a further cause of anxiety. The OSCE had caused feelings of anxiety, yet students felt that the assessment was ultimately beneficial to them.

Fidment S, (2012) explored the healthcare student's experience of an OSCE. Hermeneutic phenomenology was used as this study's underpinning methodology. Analysis revealed three main themes namely anxiety about the OSCE, preparation was a seen as a coping strategy and simulation was a further cause of anxiety. This study concludes that students valued the OSCE as a worthwhile assessment. However there are major concerns for students, which need careful consideration by academic faculty developing this type of assessment.

CONCLUSION:

The Objective Structured Clinical Examination (OSCE) is considered as a useful method of teaching because it is a safe practice to help students gain more confidence when confronted by technical instruments present in the hospital environment (Mater et al, 2014). We identified 2 challenges and themes in mental health nursing OSCE pattern of examination Viz the anxiety related to OSCE and the time confinement in manned stations.

REFERENCES:

1. Hosseini SA, Fatehi N, Eslamian J and Zamani M, 2011. Reviewing the nursing students’ views toward OSCE test. Iran J Nurs Midwifery Res; 16(4): 318-320.

2. Fidment S, 2012. The Objective Structured Clinical Exam (OSCE): A Qualitative Study exploring the Healthcare Student’s Experience. Student Engagement and Experience Journal, 1(1): 1-11.

3. Obizoba C, 2018. Mitigating the Challenges of Objective Structured Clinical Examination (OSCE) in Nursing Education: A Phenomenological Research Study. Nurse Educ Today; 68: 71-74.

4. Jelly P, Sharma R, 2017. OSCE vs. TEM: Different approaches to assess clinical skills of nursing students. Iranian J Nursing Midwifery Res; 22: 78-80.

5. Bani-Issa W, A Tamimi M, 2019. Experiences of nursing students and examiners with the Objective Structured Clinical Examination method in physical assessment education: A mixed methods study. Nurse Educ Pract; 35: 83-89. Epub 2019 Feb 2.

6. Jansiraninatarajan, 2014. Integrative Review Literature on Objective Structured Clinical Examination and its implications in Nursing Education. 3(4) Ver, PP 23-30

7. Byrne, E and Smyth S, 2008. Lecturer’s experiences and perspectives of using an objective structured clinical examination. Nurse Education in Practice. 8, 283-289.

8. Mater E, Ahmed E, ElSayed A, ElShaikh M and Farag M. 2014. The Impact of the Objective Structured Clinical Examination Approach for Clinical Evaluation Skills on the Student's Performance in Nursing College. World Journal of Medical Sciences. 11(4): 609-613.

Received on 30.04.2021 Modified on 12.05.2021

Int. J. of Advances in Nur. Management. 2021; 9(3):325-327.

DOI: 10.52711/2454-2652.2021.00074