Using mock OSCEs (Objective Structured Clinical Examinations) as a learning activity

Background:  Adult NP students in their final clinical seminar are traditionally evaluated using OSCE (Objective Structured Clinical Examination) testing.  Several students were marked down for impersonal interaction with the standardized patients – for example, not looking at the patient while taking the history.   Overall, students scored poorly in “clinical courtesy.”  In course evaluations, students wrote they felt underprepared, and that they would rather have this kind of learning experience integrated throughout the semester instead of waiting until the end of class. Students requested more “hands on” learning experiences, including mock patient encounters, and activities which would allow them to practice clinical decision making, including choice of medications, labs, and other diagnostic tests. 

Objective:  to create a higher level learning activity that required students to think at all levels of Bloom’s taxonomy, including, knowledge retrieval, comprehension, application, analysis, synthesis, and application. Students requested more “hands on” learning experiences, including mock patient encounters, and activities which would allow them to practice clinical decision making, including choice of medications, labs, and other diagnostic tests. 

Methods: 

Twelve students were assigned in teams of three to design four scenarios:  phone call, adult patient, lab review, and gynecological case.  Afterward, students completed online evaluations of peer designed scenarios  and online self evaluations of their mock OSCE design – what went well, what was unexpected, what they would do differently next time. Because of time constraints, debriefing took place the following week.  At the end of the semester students were evaluated using final OSCEs as before.

Results:  Clinical courtesy scores improved considerably.  Teamwork was observed by this instructor.  The students constructed high quality scenarios.   Student facilitation of timekeeping and scenarios led to increased understanding of testing process. Students gave very positive feedback for OSCE practice and peer review.

Conclusions:  Graduating NP students are eager for active learning experiences which will allow them to practice their skills.  Constructing mock OSCEs as a learning experience facilitates higher level learning by incorporating cognitive, psychomotor and affective domains, and is worth studying more comprehensively as a learning tool.