Challenges of Objective Structured Clinical Examination in Nursing Education: An Integrative Review

The Objective Structured Clinical Examination (OSCE) is a performance-based exam designed for the assessment of clinical competence. OSCEs are commonly and effectively used in a range of health professional education programs, but rarely are the challenges around the introduction and integration of such assessment techniques explored. This is critical for their use to be diversified into international clinical programs, particularly those based in non-English speaking areas. Therefore, the present review aimed to specifically investigate the challenges and barriers to OSCE implementation in undergraduate nursing education. The study was designed based on the integrative review method by Whittemore and Knafl. The data collection sources were CINAHL, EMBASE, Medline, PubMed, and Cochrane databases, which were searched using the keywords "OSCE", "Nursing", "Nursing Education", "Assessment", "Clinical Competence", "Challenge", "Problems", "Barriers", "Experiences", and their combinations. Database searches yielded 207 studies whose abstracts were independently evaluated for relevance prior to full texts review.

Following the screening, 22 studies were considered eligible and entered the analysis. Three main themes for OSCE-related challenges included: i) challenges related to exam validity and reliability, ii) implementation and technical challenges, and iii) inherent challenges of the OSCE. Overall the quality of evidence included was moderate. Synthesis of data from these studies can assist ease of implementation in future programs, as well as help to inform strategies to improve the OSCE implementation in the design and implantation of nursing curricula.