FNP Student Clinical Evaluation Across Distance Settings

The University Family Nurse Practitioner (FNP) students reside in 20 different states and complete didactic courses in online format.  During the three clinical courses in the FNP program, students complete clinical practicum hours in their home communities. Clinical competence is measured in two ways in each of the three clinical courses; with one evaluative visit by a clinical faculty in their clinical setting, and with two Objective Structured Clinical Examinations (OSCEs) during on-campus class sessions. 

 The OSCEs are graded scripted patient scenarios constructed to evaluate the competencies of interviewing skills, history taking,  physical examination, knowledge, diagnostic thinking, diagnosis, management, communication, knowledge, patient education, ordering of diagnostic, treatment, follow-up of care, and referral of care if needed.

 The OSCE was introduced as a formative evaluation in the FNP clinical courses in 2005. Experience has been gained in the design of the OSCEs, the grading and the content of the |OSCE examination. Although modifications have been made, the overall content and approach to the rigor of the examination has remained consistent across the past eight years. Students enrolled in the program complete two OSCEs each semester of their three clinical courses, with a total of six OSCEs.

 Performance scores on OSCEs were compared to clinical course grades for FNP students in 2011 (n=52) by Beckham (2013). This study demonstrated moderate correlation between clinical evaluation and OSCEs in the first clinical course only.  While reviewing the data, it became apparent that different evaluation instruments were used in the OSCEs and in the clinical site evaluation, making comparisons difficult. Faculty have revised and adopted the same evaluation instrument for OSCEs and clinical site evaluations and hope this will reflect a more consistent evaluative process. Current  research is being conducted  to determine if there is an optimal number of OSCEs needed to demonstrate clinical competence developmentally (across courses). Preliminary results will be presented.