Using the OSCE to measure clinical skills performance in nursing

[Ecos among nursing students]

Objective, structured clinical examinations provide an adaptive, harmonized and egalitarian device for standardized assessment of health care students. This method is structured around several thematic stations, with a rhythmic and timed passage. All future professionals in the field, including nursing students, could benefit from this method.

3D Virtual Reality Smartphone Training for Chemotherapy Drug Administration by Non-oncology Nurses: A Randomized Controlled Trial

Chemotherapy agents are cytotoxic materials. Thus, there is a need for the operators to be familiar with the knowledge and procedures before operation. We conducted a randomized controlled trial investigating the effectiveness of an immersive 3D VR teaching of chemotherapy administration operated in a smartphone coupled with a visual and audio device. We adopted a two-arm single-blind design and recruited 83 nurses, and they were randomized using a cluster approach. The VR group learned chemotherapy administration through VR, while the controlled group learned through document reading. The Knowledge and Attitude of Chemotherapy Administration (KACA) was administrated before the intervention, while the Objective Structured Clinical Examination (OSCE) and the Checklist of Action Accomplishment (CAA) were administrated one month after the intervention. The VR group scored higher than the controlled group in the CAA (95.69 ± 5.37 vs. 91.98 ± 9.31, p = 0.02) and the OSCE (73.07 ± 10.99 vs. 67.44 ±10.65, p = 0.02). Stepwise regression demonstrated that service years, an education level of undergraduate or above, and VR exposure contributed positively to the OSCE score (adjusted R² = 0.194, p = 0.028). The use of VR improves the learning efficacy of chemotherapy administration in non-oncology nurses. We recommend using VR as a teaching tool for chemotherapy administration and other chemotherapy-related skills in a VR learning group with senior nurses with higher education levels as advisors. The study provides an approach to online training, especially during the COVID-19 pandemic. (CONSORT 2010 guidelines, registry number: NCT 04840732).

Emotional intelligence and its impacts on the clinical performance of nurses in general public hospitals

Objectives

The nursing profession is considered to be at a high risk of workplace stress, workload, and burnout due to the high job demands. The nurses require the appropriate and prompt coping mechanisms to relieve the effects of stress. The nurses have to be emotionally intelligent to overcome the work-related stress to meet the clinical-based duties. But there is a paucity of the effect of emotional intelligence (EI) on the clinical performance of nurses in the literature. Therefore, the role of dimensions of EI in the improvement of clinical performance of nurses was explored in this study.

Methods

A total of 194 nurses with different education levels and experiences were included from various clinical departments and shifts of public hospitals in Iraqi Kurdistan.

Results

The mean age of the nurses was 29.44 years, with ages ranging from 23 years to 36 years. The nurses were men (56.70%), married (53.10%), non-smokers (86.10%), physically active (55.70%), and irregular physically active (63.90%). Nurses were able to appraise their own emotions but not the emotions of other nurses. They regulated their own emotions but were weak in regulating the emotions of other nurses. They did not utilize emotions in coming up with new ideas and facing obstacles in clinical settings. Generally, the nurses reported that a little clinical performance is required in medical settings. The levels of interpersonal communication and problem solving were improved with an increasing appraisal and regulating own emotions. The level of problem solving was improved with appraising own emotions and utilizing emotions in facing obstacles.

Conclusions

Nurses need to know how to regulate others’ emotions and utilize these emotions in coming up with new ideas and facing the obstacles positively in medical settings.

Effect of music therapy on nursing students' first objective structured clinical exams, anxiety levels and vital signs: A randomized controlled study

BACKGROUND

Music is a tool that can be used to reduce stress and anxiety, maintain vital signs at normal levels, and increase exam success.

OBJECTIVES

This study aimed to determine the effect of music therapy on nursing students' first objective structured clinical exam success, anxiety levels, and vital signs, and to reveal their views about music therapy in the context of an exam.

DESIGN

Mixed-pattern single-blind randomized controlled qualitative study.

SETTING

Department of Nursing, Faculty of Health Sciences, Ankara, Turkey.

PARTICIPANTS

First-year students enrolled in the Fundamentals of Nursing II course were randomly assigned to an experimental (n = 61) or control group (n = 64). Twenty-two (22) experimental group students provided the sample for the qualitative stage.

METHODS

Data were collected between February and June 2018 using the Informative Features Form, State-trait Anxiety Inventory, Vital Signs Assessment Form, Skill Checklists, and Focus-group Interview Form. All students completed the theoretical classes, laboratory classes, and small-group studies. The experimental group participated in five music therapy sessions two weeks before the exam. All students' vital signs were measured before and after the exam. Three focus group interviews were conducted with the 22 experimental group students in the week after the exam.

RESULTS

The blood pressure values of the experimental group before and after the exam were significantly lower than those of the control group (p < 0.05). No significant difference was observed between exam success and anxiety levels between the two groups. In the focus group interviews, students said they found music therapy suitable for reducing anxiety in their daily lives, but not before the exam.

CONCLUSIONS

Music therapy had positive effects on the students' blood pressure but had no effect on exam success or anxiety levels. This study suggests that more music therapy sessions be conducted with different groups of students in greater numbers before different exams.

Observations on the relationship between the dietetic objective structured clinical examination and placement outcome

AIM

Objective structured clinical examinations (OSCEs) are used extensively in medical education to prepare students for the clinical setting. Their use in dietetic education is still relatively new, and relationships to placement outcomes are unknown. The aim of this study was to explore 11 years of OSCE and placement data to answer the following questions: Does the OSCE predict dietetic placement outcome? and, What are the student perceptions of the benefits of OSCE in preparation for practice?

METHODS

Data were collected retrospectively from 328 students between 2006 and 2017 who had completed their final year OSCE and placement. Aggregate OSCE marks and mean marks obtained in active and passive OSCE stations were compared with placement outcome. Evaluation questionnaires completed by students at the end of the OSCE were collated.

RESULTS

Aggregate marks achieved in OSCE stations were significantly different for students who passed (mean = 63.24, SD = 7.94), struggled (mean = 58.25, SD = 8.82) or failed (mean = 57.31, SD = 8.28) placement, P < 0.001. Majority of students perceived the OSCE as a meaningful and fair assessment (92%) that helped to prepare them for practice (82%).

CONCLUSIONS

The OSCE provides a meaningful assessment of dietetic student skills in preparation for practice. Aggregate OSCE marks provide a consistent indicator of students who are likely to struggle in practice.

Dental students' concerns regarding OSPE and OSCE: a qualitative feedback for process improvement

OBJECTIVES

Objective structured practical examination (OSPE) and objective structured clinical examination (OSCE) have become established as reliable, valid and objective methods of assessing practical and clinical skills in dental schools. This study explored the perceptions of dental undergraduates' regarding OSPE and OSCE.

DESIGN AND SETTING

Two focus groups were made; the first consisted of students who had recently undergone an OSPE, while the other group was of fresh graduates (FG) who had given an OSCE in the final examination. A trained facilitator conducted the discussion-based interview for each focus group. Both discussions were recorded via audio recorders and transcribed verbatim. The data were thereafter analysed thematically.

RESULTS

Findings from the study suggested that the students and FGs were generally satisfied with the OSPE and OSCE. However, they perceived that the time allocated to the stations was not well balanced, nor were the examiners trained to conduct the examination. More importantly, the FGs opined that practical skills were not adequately tested on the OSCE, and thus the curricular content was not adequately covered.

CONCLUSION

The study highlights issues that may arise while conducting the OSPE and OSCE, thus informing future guidelines for conducting OSPE and OSCE.

Assessing Nursing Students' Clinical Competencies Using a Problem-Focused Objective Structured Clinical Examination

The objectives of this study were to develop, implement, and evaluate an innovative modified Objective Structured Clinical Examination (OSCE) model, and to compare students' performance of different clinical skills as assessed by standardized patients and OSCE examiners. Data were obtained from final year undergraduate students undergoing the modified OSCE as a graduation examination. Seventy-seven students rotated through four stations (nine substations). Standardized patients scored students higher than examiners in history taking (9.14 ± 0.92 vs. 8.42 ± 0.85), response to emergency event (8.88 ± 1.12 vs. 7.62 ± 1.54), executive medical orders (8.77 ± 0.96 vs. 8.25 ± 1.43), technical operation (18.21 ± 1.26 vs. 16.91 ± 1.35), nursing evaluation (4.53 ± 0.28 vs. 4.29 ± 0.52), and health education stations (13.79 ± 1.31 vs. 11.93 ± 2.25; p < .01). In addition, the results indicated that the difference between standardized patient and examiner scores for physical examination skills was nonsignificant (8.70 ± 1.18 vs. 8.80 ± 1.27; p > .05). The modified, problem-focused, and nursing process-driven OSCE model effectively assessed nursing students' clinical competencies, and clinical and critical thinking.

Reaccreditation of non-medical prescribers: maintaining competence

There is no systematic and robust method to assess the competence of non-medical prescribers (NMPs) locally or nationally. NMPs have a responsibility to remain up to date with the knowledge and skills to enable them to prescribe competently and safely within their field of expertise. In 2012, the National Prescribing Centre developed a single competency framework for prescribers defining a set of nine dimensions within three domains that can be used to underpin personal responsibility for prescribing. The authors identified validated assessment tools using a literature search, and selected those suitable for mapping against the nine dimensions. It was hoped that trust NMPs could provide evidence of competence covering all three of the framework domains using the chosen tools. Five NMPs used the tools to create a portfolio and audited them for suitability in establishing a robust and credible evidence-led system to evaluate and accredit ongoing competence. Feedback on their ease of use and applicability was sought. Trust NMPs were then invited to a workshop where the evidence was presented and they were asked to comment on, and contribute to, finalising the tools before they were embedded within trust policy.

Standard Setting Methods for Pass/Fail Decisions on High-Stakes Objective Structured Clinical Examinations: A Validity Study

CONSTRUCT: Authentic standard setting methods will demonstrate high convergent validity evidence of their outcomes, that is, cutoff scores and pass/fail decisions, with most other methods when compared with each other.

BACKGROUND

The objective structured clinical examination (OSCE) was established for valid, reliable, and objective assessment of clinical skills in health professions education. Various standard setting methods have been proposed to identify objective, reliable, and valid cutoff scores on OSCEs. These methods may identify different cutoff scores for the same examinations. Identification of valid and reliable cutoff scores for OSCEs remains an important issue and a challenge.

APPROACH

Thirty OSCE stations administered at least twice in the years 2010-2012 to 393 medical students in Years 2 and 3 at Aga Khan University are included. Psychometric properties of the scores are determined. Cutoff scores and pass/fail decisions of Wijnen, Cohen, Mean-1.5SD, Mean-1SD, Angoff, borderline group and borderline regression (BL-R) methods are compared with each other and with three variants of cluster analysis using repeated measures analysis of variance and Cohen's kappa.

RESULTS

The mean psychometric indices on the 30 OSCE stations are reliability coefficient = 0.76 (SD = 0.12); standard error of measurement = 5.66 (SD = 1.38); coefficient of determination = 0.47 (SD = 0.19), and intergrade discrimination = 7.19 (SD = 1.89). BL-R and Wijnen methods show the highest convergent validity evidence among other methods on the defined criteria. Angoff and Mean-1.5SD demonstrated least convergent validity evidence. The three cluster variants showed substantial convergent validity with borderline methods.

CONCLUSIONS

Although there was a high level of convergent validity of Wijnen method, it lacks the theoretical strength to be used for competency-based assessments. The BL-R method is found to show the highest convergent validity evidences for OSCEs with other standard setting methods used in the present study. We also found that cluster analysis using mean method can be used for quality assurance of borderline methods. These findings should be further confirmed by studies in other settings.

Development and validation of a musculoskeletal physical examination decision-making test for medical students

OBJECTIVE

Despite a renewed emphasis among educators, musculoskeletal education is still lacking in medical school and residency training programs. We created a musculoskeletal multiple-choice physical examination decision-making test to assess competency and physical examination knowledge of our trainees.

DESIGN

We developed a 20-question test in musculoskeletal physical examination decision-making test with content that most medical students and orthopedic residents should know. All questions were reviewed by ratings of US orthopedic chairmen. It was administered to postgraduate year 2 to 5 orthopedic residents and 2 groups of medical students: 1 group immediately after their 3-week musculoskeletal course and the other 1 year after the musculoskeletal course completion. We hypothesized that residents would score highest, medical students 1 year post-musculoskeletal training lowest, and students immediately post-musculoskeletal training midrange. We administered an established cognitive knowledge test to compare student knowledge base as we expected the scores to correlate.

SETTING

Academic medical center in the Midwestern United States.

PARTICIPANTS

Orthopedic residents, chairmen, and medical students.

RESULTS

Fifty-four orthopedic chairmen (54 of 110 or 49%) responded to our survey, rating a mean overall question importance of 7.12 (0 = Not Important; 5 = Important; 10 = Very Important). Mean physical examination decision-making scores were 89% for residents, 77% for immediate post-musculoskeletal trained medical students, and 59% 1 year post-musculoskeletal trained medical students (F = 42.07, p<0.001). The physical examination decision-making test was found to be internally consistent (Kuder-Richardson Formula 20 = 0.69). The musculoskeletal cognitive knowledge test was 78% for immediate post-musculoskeletal trained students and 71% for the 1 year post-musculoskeletal trained students. The student physical examination and cognitive knowledge scores were correlated (r = 0.54, p<0.001), but were not significantly different for either class.

CONCLUSIONS

The physical examination decision-making test was found to be internally consistent in exposing the deficiencies of musculoskeletal education skills of our medical students and differentiated between ability levels in musculoskeletal physical examination decision-making (residents vs recently instructed musculoskeletal students vs 1 year post-musculoskeletal instruction).

Finding reality: the use of objective structured clinical examination (OSCE) in the assessment of mental health nursing students interpersonal skills

This paper presents the implementation of an objective structured clinical examination (OSCE) in the assessment of mental health nursing students' interpersonal skills. It begins by providing a rationale for the use of this instrument to assess such ski lls and offers a brief discussion of the development of OSCEs. The preparation and implementation of the OSCE is explored and both students' and tutors' reflections of the process are highlighted. The strengths and problems, particularly the use of an ac tor and video tape recordings are examined, in the light of other studies. The paper concludes by advocating the use of such an assessment tool as a formative exercise.

Student nurses' ability to perform pain assessment

The objective of this study was to investigate student nurses' ability to handle a pain assessment situation. A systematic way of working based on knowledge within the area is emphasised in nursing education today. The performance of 32 student nurses at a university college in Sweden took place in an arranged assessment situation that closely simulated clinical practice. The conversation between the student and the patient (a voluntary patient) was videotaped and analysed with content analysis according to predetermined components of pain assessment. The results showed that one-third of the students had performed adequately based on the requirements for pain assessment in the curriculum for nursing education. Two-thirds of the group did not handle the situation systematically and also showed a lack of knowledge of pain assessment, and among these was a group of students whose performance was inadequate. The results indicate that during their education it is very important for student nurses to obtain experience and guidance in how to work systematically and to have their knowledge and skills in pain assessment evaluated.

Training of Undergraduate Clinicians in Vascular Access: An Integrative Review

Introduction: Peripheral venous cannulas are predominantly inserted by nurses and medical practitioners. Placement and related care of such devices are one of the most frequently performed tasks by these staff members. Clinicians in training should be given ample opportunity to practice these skills before patient encounters begin.

Aims: To identify the best available evidence on the training of undergraduate clinicians in peripheral venous access.

Methods: We used an integrative literature review method that considered both experimental- and nonexperimental-design studies that addressed the issue of clinician peripheral venous access training of undergraduates. The electronic databases Medline, Embase, Ovid Nursing Database, British Nursing Index, Pre Medline, Mosby's Index, and CINAHL were searched using a predetermined search strategy. The Cochrane and Joanna Briggs databases were also searched along with the reference lists of published materials.

Results: A total of 56 articles were retrieved using the defined search strategy. There were 11 experimental-design studies and 1 nonexperimental-design study selected for final review after independent assessment for methodologic quality. Retrieved articles found disparity between actual skill and student self-evaluation. Teaching methods varied with the use of traditional task trainers and high-fidelity simulation. No method was found to be superior.

Conclusion: Skill acquisition in vascular access is an international issue and one that has been addressed in varying degrees. We identified heterogeneity in training methods that were tailored to institutional requirements and resources. Training in this skill is imperative to ensure competency before patient encounters.

The cost of the objective structured clinical examination on an Italian nursing bachelor's degree course

The OSCE (Objective Structured Clinical Examination) is considered the most valid and reliable method for assessing the clinical skills of students training for health professions, but its use is limited by the related high costs. We analyzed the cost retrospectively of using an OSCE designed for second-year students (2009) in our degree course, adopting the Reznick et al. guidelines (1993), which recommend assessing both high-end costs and low-end costs. The high-end costs adopting the OSCE amounted to € 145.23 per student, while the low-end costs were € 31.51 per student. Considering the economic crisis and the cost-containment measures applied also in nursing education, strategies for further reducing costs are discussed.

Using Objective Structured Clinical Examination (OSCE) in undergraduate psychiatric nursing education: is it reliable and valid?

While there is widespread use of OSCE in general nursing specialties, psychiatric nursing has been slow to adopt this evaluation method and it has only recently been introduced to psychiatric nursing education.

AIM

The main aim of the present study is to test the first application, validity and reliability of the OSCE in undergraduate psychiatric nursing education.

METHOD

OSCE was developed to assess undergraduate psychiatric nursing students' clinical skills. The students' evaluation of the OSCE process was obtained after the completion of each OSCE circuit.

RESULTS

The psychiatric nursing OSCE proved to be a reliable and valid method in assessing psychiatric nursing clinical competencies. In general, the students perceived OSCE as a positive experience and stressful on the other hand.

CONCLUSION

OSCE is a reliable and valid method of assessing the students' psychiatric nursing competency skills. It has been shown to have many advantages over traditional methods of assessment and has the ability to objectively assess psychiatric nursing skills.

Assessment of musculoskeletal physical examination skills and attitudes of orthopaedic residents

BACKGROUND

Although the musculoskeletal physical examination is an essential part of patient encounters, we believe that it is underemphasized in residency education and that residents' physical examination skills may be lacking. We sought to assess attitudes regarding teaching of the physical examination in orthopaedic residencies, to assess physical examination knowledge and skills among residents, and to develop a method to track the skill level of residents in order to improve our physical examination curriculum.

METHODS

We created a thirty-question multiple-choice musculoskeletal physical examination test and administered it to our residents. We created a five-question survey assessing attitudes toward physical examination teaching in orthopaedic residencies and distributed it to U.S. orthopaedic department chairs We developed an Objective Structured Clinical Examination (OSCE), in which standardized patients enact four clinical scenarios, to observe and assess physical examination skills.

RESULTS

The mean score on the multiple-choice physical examination test was 76% despite the fact that our residents consistently scored above 90% on the Orthopaedic In-Training Examination. Department chairs and residents agreed that, although learning to perform the physical examination is important, there is not enough time in the clinical setting to observe and critique a resident's patient examination. The overall score of our residents on the OSCE was 66%.

CONCLUSIONS

We have exposed a deficiency in the physical examination knowledge and skills of our residents. Although the musculoskeletal physical examination is a vital practice component, our data indicate that it is likely underemphasized in training. Clinic time alone is likely insufficient for the teaching and learning of the musculoskeletal physical examination.

Implementation of an objective structured clinical exam (OSCE) into orthopedic surgery residency training

OBJECTIVE

While the musculoskeletal (MSK) physical examination (PE) is an essential part of a patient encounter, we believe it is an underemphasized component of orthopedic residency education and that resident PE skills may be lacking. The purpose of this investigation was to (1) assess the attitudes regarding PE teaching in orthopedic residencies today; (2) develop an MSK objective structured clinical examination (OSCE) to assess the MSK PE knowledge and skills of our orthopedic residents.

DESIGN

Prospective, uncontrolled, observational.

SETTING

A major Midwestern tertiary referral center and academic medical center.

PARTICIPANTS

The orthopedic surgery residents in our program. Twenty-two of 24 completed the OSCE.

RESULTS

Surveys showed that residents agreed that although learning the PE is important, there is not enough time in clinic to actually observe and critique a resident examining a patient. For the 22 residents (postgraduate year [PGY] 2-5) who participated in the OSCE, the overall score was 66%. Scores were significantly better for the trauma scenario (78%; p < 0.05) than for the shoulder (67%), spine (64%), and knee (59%) encounters. The overall scores for each component of the OSCE were: (1) history 53%; (2) PE 60%; (3) 5-question posttest 64%; and (4) communication skills 90%.

CONCLUSIONS

We have exposed a deficiency in the PE knowledge and skills of our residents. Clinic time alone may be insufficient to both teach and learn the MSK PE. The use of a MSK OSCE, while novel in orthopedics, will allow more direct observation of our residents MSK PE skills and also allow us to follow resident skills longitudinally through their training. We hope that our efforts will encourage other programs to assess their PE curriculum and perhaps prompt change.

Simulation: an effective pedagogical approach for nursing?

Simulation features strongly within the undergraduate nursing curriculum for many Universities. It provides a variety of opportunities for students as they develop their clinical nursing skills. The nursing literature highlights the potential of this approach and the positive opportunities afforded to students in terms of developing competence and confidence. However, much of this literature focuses upon the more operational concerns of simulation. This paper reflects upon the evolution of simulation in nurse education. It considers the theoretical positioning and understanding of simulation as a teaching and learning approach for undergraduate nursing skills development. The work of Vygotsky (1978) and Lave and Wenger (1991) are highlighted in order to begin to explore the theoretical basis of simulation as an effective pedagogical approach for nurse education today, enabling students to learn to be nurses.

Competency-based training: objective structured clinical exercises (OSCE) in marriage and family therapy

The field of marriage and family therapy (MFT) has recently engaged in the process of defining core competencies for the profession. Many MFT training programs are adapting their curriculum to develop more competency-based training strategies. The Objective Structured Clinical Examination (OSCE) is widely used in the medical profession to assess clinical competence. These examinations involve using simulated clinical situations as a tool in conducting summative evaluations of trainee competence. This article describes an adaptation of the OSCE procedures for competency-based training of MFT students. Instead of using the procedures as a summative examination as is typical in medical education, this article proposes how to use them as formative exercises in the development of student competence. The development of the OSCE is discussed, including "blueprinting," focused competencies, procedures, and feedback protocols. The article concludes with suggestions of how to continue the development of the OSCE for evaluation in MFT education.

Developing and examining an Objective Structured Clinical Examination

Objective Structured Clinical Examinations are commonly used within pre-registration and post-qualification nurse education to test clinical competence. Station development and refinement of the pass mark is essential to the examination process. In this paper the process of blue-printing and standardisation are described as one method of agreeing examination content and subsequent pass mark. Issues of validity and reliability are discussed in relation to these and to the process of examining. The development of good practice guidelines to ensure consistency between different markers of the same station and of a single marker examining different students on one station is described. Recommendations in relation to transparency are made to optimise student understanding of what they are being tested on and hence their performance in the examination.

Undergraduate students as standardized patients to assess advanced practice nursing student competencies

Evaluating clinical skills of students in an online distance education program can be challenging because of the diverse location of students. The authors describe a unique and cost-efficient method of using standardized patients to evaluate these skills. The project involved undergraduate students representing standardized patients for graduate advanced practice nurse students.

Nursing competence 10 years on: fit for practice and purpose yet?

AIMS AND OBJECTIVES

This paper examines how nurses are prepared to be clinically competent and safe at registration, so that they are fit for practice and purpose. It follows up two papers on competence published in 1997 and 1998 and investigates subsequent developments.

BACKGROUND

In 1979, major changes in nursing affected nurse education and preparation for competence. In the following two decades, it became clear that nurses lacked clinical skills. This paper examines subsequent changes and asks the question whether this crucial shortcoming has now been remedied. This paper considers the background and context of change in nursing and nurse education in the 1980s. It looks at the new ideology, to prepare the 'knowledgeable doer' and examines the consequences of the change on nursing competency from the 1990s to the present day.

METHODS

This is a position paper. Professional policy documents from the English National Board for Nursing, Midwifery and Health Visiting, United Kingdom Central Council for Nursing, Midwifery and Health Visiting and Nursing and Midwifery Council, government reports and legislation on nursing and relevant nursing literature are examined and critically analysed and conclusions drawn.

CONCLUSIONS

From 1923-1977, mandatory nursing syllabuses set by the General Nursing Council of England and Wales required the registered nurse to have acquired certain specific clinical skills. These were rigorously tested to an explicit standard set by the General Nursing Council before a nurse was awarded state registration. Twenty-five years later, the loss of this system for ensuring this competence and the implications of this loss, have been widely recognised. As a result, many nurse training institutions have introduced clinical skills laboratories, simulation of practice and the Objective Structured Clinical Examination. However, to the authors' surprise and contrary to their initial expectations, the Nursing and Midwifery Council has not made these systems uniform or mandatory and so still has no way of ensuring all nurse training is producing safe nurses in the United Kingdom. The authors conclude that the untested educational ideology that brought root and branch change to nurse training in 1983 and which failed to produce nurses 'fit for practice and purpose' may still prevail.

RELEVANCE TO CLINICAL PRACTICE

The present paper demonstrates that United Kingdom nurse training still has no uniform and mandatory system in place to ensure, as far as is possible, that all registered nurses are clinically competent and safe to practice.

The debate in favour of using simulation education in pre-registration adult nursing

The purpose of this paper is to have a fresh look at the literature on the advantages and disadvantages of simulation education as a teaching, learning and assessment methodology within pre-registration nurse education. It will highlight the reasons why simulation education has been re-introduced into nurse education within many Higher Education Institutions (HEI) in the United Kingdom (UK). This is in an attempt to enable the student nurse to develop competence in the clinical skills required for fitness for award, practice and purpose. This comes at a time when the Nursing and Midwifery Council (NMC) are conducting further research on simulation education and whether it can replace practice hours.

Assessment of clinical nurse specialists in rheumatology using an OSCE

OBJECTIVE

To introduce a new method of assessment; an observed structured clinical examination (OSCE) into a postgraduate course for rheumatology clinical nurse specialists.

METHOD

The OSCE was introduced into a physical assessment module, which focused on the nurses' ability to perform an examination of patients' shoulders, knees and hands. A modified blueprinting exercise was used to ensure adequate sampling of the different components of the syllabus. This resulted in five active stations and one rest station. The active stations included history-taking, physical examination of the shoulder, knee and hand complexes and multidisciplinary management plans. To enhance authenticity real, rather than simulated, patients were used where practical.

RESULTS

All 11 students passed all stations, the lowest score related to history-taking and the highest score related to devising a management plan. All 11 students rated the OSCE a worthwhile experience reflecting the learning outcomes of the module and recommended that the OSCE should be used to assess the next cohort of students. Eight students found the OSCE too 'anxiety-provoking' and did not want this method of assessment to be used in other modules. All examiners felt this mode of assessment was more valid than the previous assessment format of a viva on a single patient.

CONCLUSION

This was the first time an OSCE was used in a postgraduate course to assess the physical examination skills of rheumatology nurse specialists. The course faculty, examiners and students found it was a reliable and valid means of assessment.

Development of a clinical evaluation tool for baccalaureate nursing students

The purpose of clinical evaluation is to facilitate the development of students into safe, ethical and accountable practitioners. Evaluation measures should ensure fairness, consistency across settings and teachers, utilize indicators which reflect the realities of practice and education and facilitate deeper level student/teacher clinical discourse and learning. A new clinical evaluation tool was developed in a baccalaureate program in Ontario to address the variety of tools utilized and the need to demonstrate progression in depth and scope of practice. A consistent evaluation process was needed, leveled over the four years of the program and framed by the School's five program outcomes: knowledge worker, critical thinker, self-directed learner, evolving professional and effective communicator. A new tool was borne through an examination of relevant literature, the five program outcomes, College of Nurses of Ontario entry to practice competencies, practicum course outlines and various tools used in the undergraduate program. The process of tool development involved multiple drafts, ongoing dialogue and meetings with clinical teachers and course coordinators as well as feedback from students. Commitment, collaboration and collegiality were key elements in the construction of this tool.

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

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.

OSCEs--seven years on the bandwagon: the progress of an objective structured clinical evaluation programme

The original purpose of Objective Structured Clinical Examination (OSCE), as first described in the medical literature [Harden, R.M., Stevenson, M., Downie, W.W., Wilson, G.M., 1975. Assessment of clinical competence using objective structured examination. British Medical Journal, 1, 447-451], provided a means of examining the skills acquisition of medical students. A review of the literature, since that time, provides the background to the development of OSCEs into pre-registration nursing curricula, with the OSCE programme at the University of Salford presented here as a case study. The original student sample was a mixture of 150-250 adult, child and mental health students in each of seven cohorts over a period of four years. Each student undertook a 30-min formative, simulated patient, holistic care OSCE in their second year of the programme. Later developments included one remote workstation connected to and as part of the holistic patient care encounter. In subsequent curricula, the larger cohorts of around 250-300 students were accommodated in a formative rotational three-workstation OSCE, based on clinical skills to be acquired prior to their first clinical placement. A summative patient-centred OSCE was undertaken in practice at a later date. The educational and practice value of OSCEs regarding their clinical content and context in nursing curricula now and in the future are explored, along with the practicalities of implementation.

Oncology nursing students' views of a modified OSCE

This paper discusses oncology nursing students' views of an objective structured clinical examination (OSCE). The OSCE has been used as a form of assessment in medical education since the 1970s. It has subsequently been used by nursing faculties as one of a number of approaches to assessment of clinical skills. As a form of assessment it has been lauded as being more objective than traditional clinical examinations. The information in this study was collected through annual evaluations since 1998, when the OSCE was first employed to assess the students on a post-graduate oncology nursing programme. The sample comprised 185 students, and the principle areas addressed were students' perceptions regarding their degree of preparation for the examination, the overall efficacy and relevance of the OSCE in testing clinical skills and their views on stress and anxiety associated with this form of assessment. The results indicate that while students acknowledge the OSCE was stressful, they felt they were well prepared and appreciated the efficacy and relevance of this assessment method.

Identification and Validation of Competencies for Use in Objective Structured Clinical Examinations for Lay Caregivers

Cancer care has shifted from the traditional hospital to alternative settings, thus requiring lay individuals to assume increased direct care responsibility. Cooperative Care is an example of an alternative acute care delivery model where a family member or a friend is responsible for care previously provided by healthcare professionals. The success of alternative models is dependent on effective educational programs with clearly defined expectations and methods for evaluating caregiver competence. Objective structured clinical examinations (OSCEs) provide a standardized approach to evaluating caregiver performance in a simulated situation. The purpose of the first phase of this instrument development project was to identify and validate competencies for inclusion in OSCEs to be used with lay caregivers in preparation for Cooperative Care. The study included multiple methods of data collection: analysis of documents, viewing videos, observation with note taking, and a focus group session. All classes and materials provided for lay caregivers were reviewed. Core content domains and competencies were identified and used to develop OSCEs. A focus group of healthcare providers responsible for the education and care of patients and their caregivers validated the competencies embedded within the OSCEs. This study demonstrated the efficacy of the approach used for the identification and validation of competencies for lay caregivers.

Standardizing the assessment of clinical competence: an overview of intensive care course design

Rationale for the development of the Certificate in Health Studies: Intensive Care and High Dependency for Adults course developed at Queens University Belfast, Northern Ireland. Structure and content of clinical module reviewed. Clinical assessment strategy discussed. Focus on the utilization of a standardized portfolio, individualized learning contract and objective structured clinical examination (OSCE) to evaluate clinical competence. Evaluation of OSCE as an assessment tool and of the course provision.

Clinical competence assessment in nursing: a systematic review of the literature

BACKGROUND

The assessment of clinical competence has returned to centre stage of nurse education. However, there is little evidence to support the use of clinical competence and a wide variety of methods for its use.

RESEARCH QUESTION

The present study was designed to investigate the evidence for the use of clinical competence assessment in nursing.

DESIGN

A review using systematic methods of literature pertaining to clinical competence in nursing was conducted using defined dates, databases and search terms.

RESULTS

There is still considerable confusion about the definition of clinical competence and most of the methods in use to define or measure competence have not been developed systematically and issues of reliability and validity have barely been addressed.

CONCLUSION

The assessment of clinical competence remains almost universally accepted in the nurse education literature as a laudable pursuit yet there are aspects of it that remain at odds with the higher education of nurses.

Caring and competency

The long-term crisis in nursing, particularly in acute care hospitals, is demonstrated in studies on negligence by the Institute of Medicine in To Err is Human: Building a Safer Health System1 and Crossing the Quality Chasm: A New Health System for the 21st Century.2 A review of the nursing literature reflects unclear definitions of competency and its component caring, and no single theory of competency has been adopted from the literature and used in the education of nurses. The American Nurses 2001 Code of Ethics does not resolve this confusion, because it does not correct the individual acts of nursing incompetencies in acute care hospitals. The author defines caring and competency by providing examples of what they are not in examining 200 actual cases of hospital nursing acts of incompetence by nursing discipline. None of these examples of imputed negligence was reported to the National Practitioner Data Bank because the "corporate shield" protected the nurses by not being named in the complaint nor named as part of the settlement against the hospital.A new model of the hospitalist, the nurse hospitalist, is presented to act as a daily teacher and facilitator for hospital nurses based on a curriculum of day-to-day examples of substandard patient care. This nurse specialist is an inpatient generalist advanced practice nurse who is employed by the hospital and reports to the chief nurse executive. The author proposes that this new model of the nurse hospitalist be devoted entirely to collaborating with nurse leaders, educators, charge nurses, and floor nurses throughout disciplines in advancing the competency of nursing. This daily proactive and prospective model of improving nursing performance in a facultative manner offers strategies to mitigate the limitations of the retrospective model of quality control. Total quality improvement practiced retroactively is ineffective. The author recommends no structural change in the institution but an educational agenda by the nurse hospitalist, with hospital administration to assist nurses in a new learning environment.

Clinical Evaluation in Advanced Practice Nursing Education: Using Standardized Patients in Health Assessment

Clinical education is critically important because competency in practice ultimately will determine the future of advanced practice nursing. Skills taught in Health Assessment, the first in a series of clinical courses, exposed students to tools that form the basis on which other competencies are built. The availability of standardized patients, people who participate in enacting a simulated but seemingly "real life" clinical encounter in a realistic clinical setting for the benefit of student learning and/or evaluation, made this instructional development project possible. The underlying assumption of this project was that clinical advanced practice nursing student education is enhanced by using an authentic clinical environment, known as a simulation center, with standardized patients and by using one or more evaluation techniques with multiple evaluators (i.e., peer, self, faculty, standardized patient). The student clinical experience was expected to improve and overall learning to increase by this method. This improvement was reflected at the end-of-course evaluations and in the quality of the final videotaped physical examination, which was superior to previous years. Student and faculty satisfaction with this teaching-learning process exceeded all expectations.

Misplaced confidence in a profession's ability to safeguard the public?

A major requirement of a profession is to safeguard the public in providing a valid and reliable means of admitting to practice only those who will meet minimum requirements. Nursing uses two different forms of assessment (clinical and academic assessments) in attempting to discriminate between those who are likely to be safe and competent to practice and those who are not. The paper reviews the literature on systems of assessment with a specific focus on Behaviourally Anchored Rating Scales (BARS) and Objective Structured Clinical Examination (OSCE). The conclusion drawn is that the methods described are inadequate in predicting/assessing the clinical performance of nurses. An implication for the nursing profession is the possible loss of confidence in its ability to safeguard the public.