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Board's eye view: is there a fairer way to evaluate capability?

Weighing up the pros and cons of using objective structured clinical examinations, to evaluate students' capabilities in clinical practice

Weighing up the pros and cons of using objective structured clinical examinations to evaluate students' capabilities in clinical practice.


Advanced life-support examinations typically involve the use of manikins. Picture: iStock

The objective structured clinical examination (OSCE) is a popular form of assessment in clinical practice and higher education. Advanced life-support OSCEs – adult, paediatric and trauma – typically involve the use of manikins and almost every emergency nurse will have taken part in one.

OSCEs involve many complex issues, not least due to their contrived nature. As an experienced OSCE assessor and observer, I believe they may not give an accurate evaluation of a person’s capability.

Due to stress, individuals known to be competent in practice can be unable to demonstrate their knowledge and skills in OSCEs, where there is little time to calm the nerves to allow better performance.

Pros and cons

Other students, however, may be able to learn like automata and thus perform well in OSCEs, yet demonstrate little critical thinking underneath. It is also common for someone to put in a sterling performance overall, but miss one essential criterion, creating a ‘critical fail’. Is this really fair? Or a good way to learn? For conscientious people, failing an OSCE simply crushes the spirit and kills confidence.

Then there is examiner recall and fatigue. Concentrating for long periods on high-stake decisions is mentally exhausting. Do assessors always observe accurately? I have moderated video footage of OSCEs because assessors disagreed on what they saw. When viewed on video, issues can be clarified. However, more controversy can be introduced when poor practice is observed later and was not noticed at the time.

How can we be sure this is not more widespread?

No form of assessment is foolproof, but perhaps a written reflection on an OSCE performance would more constructive and meaningful than the ‘do or die’ of 15 minutes under extreme pressure. This might not be possible in a two-day advanced life-support course, but could be achieved in the university setting. It would surely be a step forward and a more productive experience all round.


About the author

Lorna McInulty is senior lecturer in emergency and unscheduled care at the University of Central Lancashire, Preston, and a member of the Emergency Nurse editorial board

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