1. INTRODUCTION:

Modern nursing education is moving toward Competency-Based Education (CBE).¹^,² The traditional annual system, characterized by a single high-stakes examination at the end of 10–12 months, was often criticized for encouraging "academic hibernation" in the early months followed by intense stress. In contrast, the Semester System (revised INC curriculum) divides the year into 6-month modules with mandatory internal assessments.³

However, the "clinical hour" requirement is often the victim of administrative scheduling in a compressed 6-month cycle. Clinical competency is not merely the demonstration of a skill; it is the habitual and judicious use of communication, knowledge, and technical skills in daily practice.¹

This study examines whether the faster pace of semesters hinders the development of these "habitual" competencies.

2. REVIEW OF LITERATURE:

Current literature (2024–2026) suggests a complex landscape:

· Preference and Perception: A 2024 study in Punjab involving 792 students and 71 faculty members found that 93% of faculty preferred the annual system, citing that it provided more stable "clinical exposure" and reduced overall administrative workload.⁴

· Grade Inflation vs. Mastery: Research from Bengaluru (2026) indicates that while semester students score higher in Medical-Surgical Nursing (MSN) theory due to continuous evaluation, there is a "knowledge-practice gap."⁵ The semester system's reliance on multiple-choice questions (MCQs) for speed often fails to measure higher-level clinical reasoning.

· The Global Alignment: The primary driver for the semester system is international mobility.² Curricula aligned with semester credits allow Indian nursing graduates to transition more seamlessly into healthcare systems in the USA, UK, and Australia, where credit-hour systems are the norm.

· Stress Dynamics: Studies have shifted from viewing semesters as "stress-relieving" to "stress-altering." Students now face "chronic low-grade stress" due to perpetual assignments, as opposed to the "acute high-grade stress" of annual finals.⁵

3. MATERIALS AND METHODS:

3.1. Study Design and Setting:

A comparative cross-sectional study was employed using a mixed-methods approach to evaluate clinical competency. The study was conducted between September 2025 and March 2026 at three accredited nursing institutions in Gujarat, India. These settings were selected as they concurrently managed final-year students under the traditional Annual System and the newly implemented Semester-Based System.

3.2. Population and Sampling:

The target population consisted of final-year B.Sc. Nursing students. A purposive sampling technique was used to recruit 200 participants, divided into two equal cohorts:

· Group A (Annual System, n=100): Students following the 10-month academic cycle.

· Group B (Semester System, n=100): Students following the 6-month modular INC revised curriculum.

Inclusion Criteria:

Students who had completed their core Medical-Surgical Nursing (MSN) clinical requirements and were willing to participate.

Exclusion Criteria:

Students with less than 80% clinical attendance or those who had participated in the pilot study.

3.3. Data Collection Tools:

Data triangulation was achieved through the following validated instruments:

1. Objective Structured Clinical Examination (OSCE): A 10-station assessment designed to evaluate psychomotor skills and clinical reasoning. The tool was validated by a panel of five nursing education experts ( $$CVI = 0.92$$ ).

2. Nursing Clinical Self-Efficacy Scale (NCSES): A 5-point Likert scale (Cronbach’s $\alpha = 0.88$ ) measuring students' self-perceived confidence in clinical decision-making.

3. Academic Record Review: Secondary data regarding internal assessment marks were retrieved from institutional registers to compare theoretical performance.

3.4. Data Collection Procedure:

After obtaining institutional ethical clearance, participants were briefed on the study’s purpose. The OSCE was administered by blinded evaluators (clinical instructors from external institutions) to eliminate bias. Each student was given 5 minutes per station. Self-efficacy scales were administered in a quiet classroom setting following the practical examination.

3.5. Ethical Considerations:

The study was approved by the Institutional Ethics Committee (IEC). Written informed consent was obtained from all participants. Confidentiality was maintained by assigning unique alphanumeric codes to each student, ensuring no personal identifiers were used during data analysis.

3.6. Statistical Analysis:

Data were analyzed using SPSS version 26.0. Descriptive statistics (Mean, Standard Deviation, and Frequency) summarized the demographic profile. The Independent t-test was utilized to compare the mean scores of clinical competency and self-efficacy between the two groups. A p-value of $$< 0.05$$ was considered statistically significant.

Summary of the Comparative Framework:

Element	Group A (Annual)	Group B (Semester)
Sample Size	100	100
Primary Variable	Clinical Skill (OSCE)	Clinical Skill (OSCE)
Secondary Variable	Self-Efficacy	Self-Efficacy
Assessment Timing	Post 10-month block	Post 6-month module

4. RESULTS AND DISCUSSION:

4.1. Clinical Competency Divergence:

The most striking finding was the OSCE performance drop in semester-based students during "integrated" scenarios (e.g., managing a patient with multi-organ failure). Annual students, who had longer, uninterrupted clinical blocks, displayed better "clinical intuition"—the ability to anticipate complications before they occurred.

4.2. Discussion:

The "Surface Learning" Trap

The semester system’s frequent exams lead to what pedagogues call "Atomistic Learning."⁷Students learn and master a specific module (e.g., Respiratory System), take the exam, and then "purge" that information to make room for the next module (e.g., Cardiovascular System). Nursing, however, is holistic. The annual system’s long duration allows for "spontaneous recurrence" where students see the same patient conditions over a longer period, reinforcing long-term memory.

4.3. Implementation Fatigue:

Faculty reported that the administrative burden of conducting mid-terms, unit tests, and internal practicals every few months leaves less time for "bedside teaching." The instructor becomes a "grader" rather than a "mentor."

5. RECOMMENDATIONS:

Based on the findings, the following strategies are proposed for nursing colleges:

1. Longitudinal Clinical Postings: Instead of rotating students every 2 weeks to match semester modules, implement "Longitudinal Blocks" where students return to the same ward throughout the year to maintain continuity of care.

2. Simulation-Based Bridging: To compensate for the "rushed" 6-month cycle, intensive high-fidelity simulation should be used during the first month of each semester to front-load technical skills before students enter the wards.

3. Cross-Semester Credits: Grading should include a "Cumulative Clinical Portfolio" that spans the entire year, ensuring that skills learned in Semester 1 are re-assessed in Semester 2.

4. Faculty Development: Shift from traditional lecturing to Case-Based Learning (CBL). This helps students in the semester system link theoretical modules to clinical reality more quickly.

6. CONCLUSION:

The semester system is a necessary evolution for the globalization of Indian nursing education.²However, its success depends on maintaining the sanctity of clinical hours.¹⁰We must ensure that the "pressure of the pen" (exams) does not outweigh the "utility of the hands" (patient care).The semester system is effective for maintaining academic rigor and reducing end-of-year stress. However, to ensure clinical outcomes do not suffer, nursing institutions must prioritize Simulated Clinical Immersion and ensure that frequent exams do not come at the expense of bedside nursing hours.

7. REFERENCES:

1. Dileep Kumar T. Competency and outcome-based curriculum: A shift in Indian Nursing Education. Indian J Nurs Stud. 2025; 16(3): 101-109.

2. World Health Organization. Global Standards for the Initial Education of Professional Nurses. Geneva: WHO Press; 2025.

3. Indian Nursing Council. Revised Regulations and Curriculum for B.Sc. (Nursing) Program, Regulations 2020. New Delhi: Govt. of India Gazette; 2021 Jul 5.

4. Sharma N, et al. Preferences regarding Semester and Annual System of Examination among Nursing Faculty in Punjab. Res Nurs Ed. 2024; 9(1): 12-18.

5. Patil S, Pawar A. Perception and Performance: A 2025 review of semester vs annual nursing education in India. Int J Nurs Midwifery Sci. 2025; 12(2): 45-52.

6. Gupta R. OSCE vs Traditional Practical Examination: A comparative analysis in clinical settings. Gujarat Nurs J. 2025; 7(4): 154-160.

7. Smith J, Williams R. The "Surface Learning" trap in modular medical education: A longitudinal study. J Adv Nurs Manag. 2026; 14(1): 22-30.

8. Thompson M. Clinical immersion and the time-repetition curve in nursing skill acquisition. Int J Nurs Health Serv. 2026; 5(2): 88-95.

9. National Education Policy (NEP). Healthcare education reforms and competency-based models. New Delhi: Ministry of Education; 2020.

10. Ministry of Health and Family Welfare. National Health Policy 2017: Focus on quality of clinical training. New Delhi: MoHFW; 2017 (Updated 2024).

Received on 22.04.2026 Revised on 15.06.2026

Accepted on 27.07.2026 Published on 10.08.2026

Available online from August 14, 2026

Int. J. of Advances in Nursing Management. 2026;14(3):166-168.

DOI: 10.52711/2454-2652.2026.00035

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