PERCEPTION OF OSCE AND ITS CHALLENGES AMONG

UNDERGRADUATE NURSING STUDENTS OF LADOKE

AKINTOLA UNIVERSITY OF TECHNOLOGY OGBOMOSO OYO
STATE NIGERIA

BY

AMUSAN BISOLA MARY

DEPARTMENT OF MEDICAL SURGICAL NURSING

FACULTY OF NURSING SCIENCES,
COLLEGE OF HEALTH SCIENCES,
LADOKE AKINTOLA UNIVERSITY OF TECHNOLOGY,
OGBOMOSO, OYO STATE.
 CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Objective structured clinical examination (OSCE) is widely used for clinical skills and
competency evaluation. It is a recognized type of examination often used in health sciences. It is
a practical, real-world approach to learning and assessment which is conducted in a well-
structured and objective way to assess clinical skill performance and competence in a range of
skills. The content and scoring procedure of OSCE are standardized. Each OSCE station focuses
on particular clinical competencies. A standardized scoring tool or checklist usually describes
what an examinee does or does not do well (Rao, 2021).

Healthcare professionals’ clinical skills are commonly assessed through OSCE because it has
been a versatile and reproducible evaluation tool since its introduction as a method of student
assessment in the 1970s (Alaskar et al., 2022). OSCE is a quick and efficient evaluation method,
allowing instructors to offer rapid feedback to students about identified clinical deficits and skills
that are being mastered (Alaskar et al., 2022). The distinctive benefits of OSCE made it one of
the highly proposed methods for clinical skills evaluation (Ghasi et al., 2020). It was often
reported as an exciting teaching method that encourages students toward active learning. It
develops logical and critical thinking skills rather than promoting passive learning. It ensures a
safe, controlled environment without compromising patients’ safety. Students who undergo
OSCE learn empirically and, therefore, develop self-confidence in addition to the value-added
knowledge they accumulate (Alaskar et al., 2022).
In nursing programmes, clinical education forms the core of a nurse’s professional practice.
Therefore, assessing nursing students’ clinical competence is crucial to their education (Smrekar
et al., 2018). The OSCE has gained acceptance since its development in the 1970s as a method to
evaluate the clinical performance of nursing students (Alamri et al., 2022). It uses standardized
scenarios that mimic real-life clinical situations and is administered in a highly controlled
environment (Aronowitz et al., 2018). Unlike traditional clinical exams, which have been
criticized for lacking objectivity and uniformity, the OSCE is one of the most reliable assessment
tools; it enhances students’ learning, allowing students to demonstrate the full extent of their
knowledge and skills, all the while providing a more objective method of assessment (Alamri et
al., 2022).

OSCE helps in enhancing the safety and quality of nursing care and ultimately prepares students
for their future professional role. Besides the summative assessment, OSCE can also be used as a
formative assessment through which the nursing educator provides feedback to students as part
of the teaching process (Elbilgahy et al., 2020). The field of nursing is continuously advancing as
a scientific and clinical discipline. The primary objective of the Bachelor of Nursing training
program is to educate individuals who can acquire essential skills and knowledge through both
theoretical and practical training. The aim is to equip graduates with the necessary competencies
to effectively fulfill professional responsibilities and carry out various tasks (Soltaninejad et al.,
2020).

The benefits of OSCEs include a valid, reliable, stable, objective, fair, and powerful assessment
learning strategy, making it more rigorous (Ataro et al., 2020; Ferreira et al., 2020). The OSCEs
also help students identify their areas of weakness, improve their professional skills as nurses,
and increase their motivation to study and practice (Khan et al., 2021; Müller et al., 2019).
Hence, it is crucial to examine the perceived influence of OSCE, primarily from the viewpoint of
the students, as they are the primary stakeholders. Consequently, the study aimed to evaluate the
perception of OSCE and its challenges among undergraduate nursing students in Ladoke
Akintola University of technology, Ogbomoso, Oyo state, Nigeria.
1.2 Statement of the Problem
Students globally find OSCE to be valuable but extremely stressful, as they come with
significant pressure and high expectations (Hilliard, 2018; McClenny, 2018; Robinson et al.,
2018; Saunders et al., 2019). These stress factors can hinder their capacity to learn effectively,
and the assessment and evaluation of OSCEs may exhibit inconsistencies. McClenny (2018)
suggests that educators should investigate methods to establish clear frameworks for teaching
and learning the course material, with an emphasis on aiding and readying students for the
testing process. According to Alaskar et al., (2022) , students believed OSCE was stressful, and
58.4% thought it was threatening because of inadequate preparation. In Africa,resource
constraints which can make it difficult to organize and execute OSCEs effectively and this
includes shortage of standardized patients who can accurately portray various medical conditions
and scenarios which can be challenging particularly in remote or underserved areas, examination
rooms, medical equipment and also inadequate student preparation time which in turn affect the
perception of nursing student about OSCE negatively(Ataro et al., 2020).
A study in Nigeria also reported the same insufficiencies which affect student's perception
(Onasoga, 2021).It is on this considerations that the researcher aims to assess the perception of
OSCE and its challenges among undergraduate nursing students of Ladoke Akintola University
of Technology, Ogbomoso, Oyo State Nigeria.

1.3 Objectives
1.3.1 Broad Objectives
The study will assess the perception of OSCE and its challenges among undergraduate nursing
students in Ladoke Akintola University of technology, Ogbomoso, Oyo state, Nigeria.
1.3.2 Specific Objectives
1. To assess the perception of OSCE among undergraduate nursing students of Ladoke
Akintola University of Technology, Ogbomoso, Oyo State, Nigeria.
2. To assess the performance of undergraduate nursing students in OSCE of Ladoke
Akintola University of Technology Ogbomoso Oyo State Nigeria.
3. To assess the challenges of OSCE among undergraduate nursing students of Ladoke
Akintola University of Technology, Ogbomoso, Oyo State, Nigeria.
1.4 Research Questions and Hypotheses
1.4.1 Research Questions
1. What is the perception of OSCE among undergraduate nursing students of Ladoke
Akintola University in Technology Ogbomoso Oyo State Nigeria?
2. What is the performance of undergraduate nursing students in OSCE in Ladoke Akintola
University of Technology Ogbomoso Oyo State Nigeria?
3. What are the challenges of OSCE among undergraduate nursing students of Ladoke
Akintola University of Technology, Ogbomoso, Oyo State, Nigeria?
1.4.2 Research Hypotheses
1. There is no significant relationship between the Sociodemographic factors and the
performance of undergraduate nursing students in OSCE in Ladoke Akintola University
of Technology, Ogbomoso, Oyo State Nigeria.
2. There is no significant relationship between perception of OSCE among undergraduate
nursing students and their performance in Ladoke Akintola University of Technology,
Ogbomoso Oyo State Nigeria.

1.5 Significance of the study

This study might provide valuable insights into the effectiveness of OSCE as an assessment
method and help nursing educators identify areas for improvement in their OSCE
implementation leading to enhanced educational experiences and better prepared nursing
graduates. Exploring students' perceptions and challenges with OSCE might reveal the strengths
and weaknesses of the approach. This will guide educators in fine-tuning the OSCE format,
content, and evaluation criteria, ultimately enhancing the validity and reliability of the
assessment. Furthermore, this study might serve as a foundation for future studies in nursing
education and assessment methodologies. It might help stimulate further research into alternative
assessment methods or the integration of technology in nursing education to enhance the learning
experience.

1.6 Scope of the Study

The scope of the study is on perception and challenges of OSCE among undergraduate nursing
students in Ladoke Akintola University of Technology Ogbomoso Oyo State Nigeria. Students
are the primary stakeholders, hence, it is crucial to examine the perception and challenges of
OSCE primarily from their viewpoint.

1.7 Operational Definition of Terms

Perception: It is the subjective understanding, interpretation, and awareness regarding OSCE,
which encompasses their thoughts, beliefs, attitudes, and feelings towards OSCE, both positive
and negative among undergraduate nursing students of Ladoke Akintola University of
Technology, Ogbomoso, Oyo State Nigeria.
Challenges: This refers to the difficulties or obstacles that undergraduate nursing students may
encounter when participating in Objective Structured Clinical Examinations (OSCE) and how
these challenges affect their perception of OSCE in Ladoke Akintola University of Technology
Ogbomoso, Oyo State Nigeria.
OSCE (Objective Structured Clinical Examination): This is a method of assessment used in
nursing education to evaluate the clinical competence and performance of undergraduate nursing
students. It is a structured examination where students encounter a series of simulated clinical
scenarios in a controlled environment in Ladoke Akintola University of Technology, Ogbomoso,
Oyo State Nigeria.
Undergraduate Nursing Student: These are students who are currently at the clinical stage of
their nursing education but have not yet completed their degree requirements. These students are
actively engaged in clinical and also theoretical nursing education, preparing them for entry-level
nursing practice in Ladoke Akintola University of Technology, Ogbomoso, Oyo State Nigeria.
 CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction
This section aims to provide a comprehensive examination of past research conducted on the
subject of OSCE (Objective Structured Clinical Examination) perception and its challenges. The
intention is to enhance comprehension and fill existing gaps in the existing knowledge. The
chapter encompasses a conceptual review, an empirical review, and a theoretical framework.

2.1 Conceptual Review

2.1.1 OSCE in Nursing Education
The OSCE is a structured, simulation-based assessment approach that replicates real-life clinical
scenarios in a controlled setting. During an OSCE, nursing students rotate through a series of
stations, each representing different clinical scenarios that require them to perform various tasks,
such as patient assessment, communication, and clinical interventions (Miller et al., 2018).
Nurses play a vital role in healthcare, providing comprehensive patient care and building strong
patient relationships. Ensuring high-quality clinical care relies on effective training and
assessment methods. Nursing education is crucial, and one such evaluation method is the
Objective Structured Clinical Examination (OSCE). Originally introduced by Harden et al. for
medical students in 1975, OSCEs have been adapted for nursing students as well. During
OSCEs, students rotate through various test stations, spending a few minutes at each station to
interact with real patients or actors in simulated clinical scenarios. These examinations
thoroughly assess clinical skills, promote learning, and are known for their fairness, reliability,
validity, and objectivity compared to other evaluation methods.
Recent research has demonstrated that combining simulation-based education with OSCEs
enhances the objectivity of clinical competency assessments. Consequently, OSCEs have been
recognized as an effective tool for evaluating nursing students' clinical performance both during
their education and after graduation, making them an integral part of nursing education across
different disciplines. OSCEs, which are used to assess and enhance the transfer of classroom and
lab learning to simulated clinical scenarios, have been criticized for assuming that simulation
performance directly translates into real-world competence. The uncertainty and unpredictability
of actual patient care may limit the validity of such assumptions. To strengthen the quality of
care, it is suggested to integrate skills like perception, comprehension, and projection into
OSCEs. Situational awareness (SA) is crucial in this context, representing how individuals pay
attention to their surroundings, process information, and make decisions accordingly. SA has
three stages: perception (SA1), comprehension (SA2), and projection (SA3). In SA1, people use
sensory input to understand the environment. In SA2, they process information to fully grasp the
situation. In SA3, they form predictions and strategies based on their understanding. The highest
level of SA involves the formulation of actions and strategies for the future. SA is influenced by
various factors such as knowledge, perception, task goals, and memory, and it varies with the
dynamic nature of nursing care. Student evaluations are vital in systemic teaching approaches.
Summative and formative evaluations address the challenges and operational difficulties in the
teaching process, supporting future learning. In the age of the internet, information skills have
become essential for students' competitiveness (Tseng et al., 2021).
OSCE assess a wide range of nursing skills, including:
1. Communication: Assessing the nurse's ability to effectively communicate with patients,
colleagues, and other healthcare professionals.
2. Clinical Reasoning: Evaluating the nurse's ability to make sound clinical judgments based
on patient information and assessment data.
3. Physical Examination: Assessing the nurse's proficiency in conducting a systematic and
accurate physical assessment of a patient.
4. Technical Skills: Evaluating the nurse's ability to perform various nursing procedures
safely and accurately (e.g., wound dressing, medication administration, etc.).
 5. Professionalism: Assessing qualities like empathy, respect, and ethical decision-making.
OSCE has become a valuable tool in nursing education, providing a comprehensive and
standardized approach to assess students' clinical competencies and decision-making abilities
(Yuan, 2021).
2.1.1.1 Stages involved in OSCE
OSCE involves various stages, and here is a typical explanation of these stages.
Introduction and Preparation
Candidates receive instructions and a brief orientation to the examination process. They are
informed about the stations they will encounter and the allotted time for each one. During this
phase, candidates may receive reading materials or specific tasks to prepare for certain stations
(Majumder et al., 2019)
Stations
The OSCE includes multiple stations, each representing different clinical scenarios or situations.
Each station focuses on specific aspects like history-taking, physical examination,
communication with patients or colleagues, procedural skills, or clinical problem-solving.
Candidates rotate through the stations sequentially or following a predetermined order
(Majumder et al., 2019).
Scenario Presentation
At the start of each station, candidates are introduced to the scenario and the task they must
perform. They may encounter a standardized patient (an actor trained to play the role of a
patient), a mannequin, or simulation software based on the station's requirements. The scenario
provides relevant patient information, clinical history, and presenting symptoms (Majumder et
al., 2019).
Time-Limited Assessment
Candidates have a designated time limit (usually a few minutes) to complete the task or
interaction at each station. This time constraint evaluates their ability to manage time efficiently
while making accurate clinical decisions and communicating effectively (Majumder et al., 2019).
Performance Evaluation
At each station, examiners objectively assess the candidate's performance using predefined
criteria and checklists. The evaluation includes aspects such as diagnostic accuracy, appropriate
history-taking, physical examination skills, communication proficiency, empathy, and
professionalism (Majumder et al., 2019).
Transition between Stations
There is a brief transition time between stations, allowing candidates to mentally prepare for the
next scenario. Additional instructions or information relevant to the upcoming station may be
provided during this time. After completing all stations, candidates may have an opportunity to
debrief or provide feedback on their performance. In some cases, there might be a formal
feedback session with the examiners, where candidates receive constructive criticism and
suggestions for improvement (Majumder et al., 2019).

2.1.2 Acceptance of OSCE in Nursing

The Objective Structured Clinical Examination (OSCE) is widely accepted and commonly used
in nursing education and licensure assessments worldwide. OSCE is a practical, hands-on
examination format designed to assess the clinical competence of nursing students or practicing
nurses. It allows candidates to demonstrate their clinical skills, critical thinking, and decision-
making abilities in a controlled and standardized environment (Al-Hashimi et al., 2023).
2.1.2.1 Reasons for acceptance in Nursing
Here are some reasons why OSCE is widely accepted in nursing education and practice.
Standardized evaluation
OSCE provides a standardized and objective evaluation process, ensuring that all candidates are
assessed using the same criteria and scenarios. This helps to minimize bias and ensures fairness
in the assessment process (Al-Hashimi et al., 2023).
Real-life simulation
OSCE stations are designed to simulate real-life clinical scenarios, allowing candidates to
showcase their ability to apply theoretical knowledge to practical situations. This provides a
more authentic assessment of a nurse's readiness to handle patient care (Al-Hashimi et al., 2023).
Comprehensive assessment
OSCE can assess a wide range of nursing skills, including communication, physical assessment,
clinical decision-making, medication administration, patient education, and more. It offers a
comprehensive evaluation of a nurse's clinical competence (Al-Hashimi et al., 2023).
Immediate feedback
OSCE allows for immediate feedback, which can be valuable for candidates to identify areas of
improvement and build on their strengths (Al-Hashimi et al., 2023).
Learning environment
OSCE is conducted in a controlled and safe environment, making it an ideal assessment method
for evaluating clinical skills without putting real patients at risk (Al-Hashimi et al., 2023).
High reliability
OSCE is considered to be a reliable assessment tool, with good inter-rater reliability, meaning
different examiners would arrive at similar scores for the same candidate (Al-Hashimi et al.,
2023).
Alignment with nursing practice
OSCE is designed to assess the practical skills and competencies that are directly relevant to
nursing practice, making it a relevant and meaningful assessment method (Al-Hashimi et al.,
2023).
Widely recognized and used
OSCE is well-established and widely accepted in nursing education and licensure assessments
globally, with many nursing programs and licensing bodies incorporating it into their evaluation
processes. While OSCE has many advantages (Practicability, decreased bias and Broader content
coverage), it also requires careful planning, preparation, and standardization to ensure its
effectiveness as an assessment tool. This includes developing clear assessment criteria, training
examiners, and creating well-structured scenarios that align with the learning outcomes of the
nursing program. When properly implemented, OSCE can be a valuable tool for evaluating and
ensuring the competence of nursing professionals (Al-Hashimi et al., 2023).
2.1.2.2 Variations of OSCE
Objective Structured Practical Examinations (OSPE)
These variants are used to evaluate practical abilities, information, and/or data interpretation in
settings other than clinical ones.
Objective Structured Assessment of Technical Skills (OSATS)
This is a tool designed for objective skills assessment. It consists of a global rating scale and a
procedure-specific checklist. It is primarily used for feedback or tracking the advancement of
training in surgical specialties.
Objective Structured Video Examinations (OSVE)
In this variation, videotaped recordings of patient-doctor encounters are shown to students at the
same time as questions pertaining to the video clip are posed, and written responses are marked
uniformly.
Team Objective Structured Clinical Examination (TOSCE)
This is a formative assessment that covers common consultations in general practice. Teams of
students visit each station in a group, carrying out one task per candidate in a sequential order,
and are then marked for their performance and given feedback. This improves efficiency and
promotes learning from peers.

2.1.3 Perception of OSCE

The perception of OSCE by students is multi-faceted, encompassing anxiety, authenticity,
fairness, feedback, and skill improvement. While OSCEs can be stress-inducing, they are
generally seen as effective tools for assessing clinical competence and providing valuable
learning experiences. Understanding students' perceptions of OSCEs is crucial for educators and
institutions to refine assessment methods and support students in their journey toward becoming
competent healthcare professionals (Fisseha & Desalegn, 2021).
Anxiety and Stress: OSCEs are often associated with anxiety and stress among students. The
high-stakes nature of the examination, timed stations, and the presence of evaluators can
contribute to this perception. However, some level of stress can be seen as a positive motivator
for preparation(Al-Ghareeb et al., 2019).
Authentic Learning Experience: Many students appreciate the authenticity of OSCEs. They
believe that OSCEs closely resemble the clinical situations they will encounter in their future
careers. This perception can enhance their engagement and motivation to prepare adequately (Al-
Hashimi et al., 2023).
Fairness and Objectivity: OSCEs are seen as fair and objective by students because they are
assessed against predefined criteria. This perception of fairness is crucial in maintaining the
credibility and trustworthiness of the assessment process (Onasoga, 2021).
Feedback and Learning: Students generally value the feedback provided during OSCE
assessments. Constructive feedback helps them identify their strengths and areas for
improvement, facilitating their learning process (Thabet et al., 2021).
Preparation Strategies: Students develop various strategies to prepare for OSCEs, such as
practicing with peers, reviewing clinical guidelines, and using simulation resources. These
strategies reflect their dedication to performing well in this assessment (Opiah et al., 2022).
Improvement in Clinical Skills: Many students perceive OSCEs as opportunities for skill
enhancement. The detailed feedback received allows them to focus on specific areas for
improvement, ultimately benefiting their clinical competence (Phetcharak, 2021).
Time Management and Pressure: OSCEs test students' ability to manage time and work under
pressure. Some students find this aspect challenging, but they acknowledge its relevance in the
real clinical setting (Awad et al., 2019).

2.1.4 Challenges of OSCE

The following are the challenges of OSCE among undergraduate nursing students:
Standardization: Ensuring consistency in exam content and administration across multiple
stations and examiners can be challenging (Ataro et al., 2020).
Examiner Bias: It's important to minimize examiner bias to ensure fair evaluation of students
(Rao, 2021).
Time Management: OSCEs can be time-consuming to set up and administer, both for
organizers and students (Alaskar et al.,2022).
Stress and Anxiety: students often experience high levels of stress and anxiety during OSCE
which can affect their performance ( Saunders et al., 2019).
Resource Intensive: Organizing OSCEs requires significant resources, including personnel,
facilities, and materials (Awad et al., 2019).
Variation in Stations: Creating a balanced mix of stations that adequately assess a wide range
of clinical skills and competencies can be challenging (Onasoga, 2020).
Candidate Feedback: Providing timely and constructive feedback to students can be difficult,
especially in large-scale OSCE ( Awad et al.,2019).
Technological Issues: Technical problems with equipment or software used in OSCE can
disrupt the examination process. Addressing these challenges requires careful planning, training
of examiners, and ongoing evaluation and refinement of the OSCE format and content ( Ataro et
al.,2022).
2.2 Theoretical Framework
The theoretical review for this study is the social cognitive theory. The theory states that
individuals learn by observing a model's actions and the outcomes of those actions. They then
retain this sequence of events in their memory and utilize this knowledge to influence their own
future behaviors.
2.2.1 The social cognitive Theory
Albert Bandura developed the social cognitive theory (SCT) in 1986, the theory which started as
social learning theory (SLT) in the 1960s emphasizes the reciprocal interaction between an
individual's behavior, cognitive processes, and the environment. It highlights the importance of
observational learning and the role of modeling in shaping human behavior. Social cognitive
theory examines how people develop and sustain behaviors while considering the impact of their
social surroundings. It recognizes that a person's previous experiences play a significant role in
determining whether they will exhibit a certain behavior. These past experiences shape their
understanding of rewards, expectations, and beliefs, influencing whether they will engage in a
particular behavior and their motivations for doing so. The outcomes of behaviors, whether they
result in rewards or punishments, play a crucial role in shaping the observer's decision to
replicate the modeled behavior. If a behavior is rewarded, individuals are more likely to adopt
and repeat it. On the other hand, if a behavior leads to negative consequences or punishments,
people may avoid replicating that behavior. In other words, people do not learn new behaviors
solely by trying them and either succeeding or failing, but rather, the survival of humanity is
dependent upon the replication of the actions of others. The survival and progression of
humanity depend on the transmission and replication of successful behaviors that contribute to
the well-being of individuals and society as a whole. Depending on whether people are rewarded
or punished for their behavior and the outcome of the behavior, the observer may choose to
replicate behavior modeled. By observing others and learning from their experiences, individuals
can efficiently gain knowledge and adapt to their environment, enhancing their chances of
survival and success. The theory also aim to elucidate the process by which individuals govern
their actions using mechanisms of control and reinforcement, with the ultimate objective of
attaining goal-oriented behavior that can be sustained over an extended period.
Figure 2.1: The social cognitive theory (Bandura, 2000)

2.2.2 Application of the theory to the study

This theoretical framework provides valuable insights into the factors that shape students'
attitudes toward OSCE and their learning experiences in clinical simulations. Albert Bandura,
posits that human behavior is influenced by three main factors: cognitive processes (such as
perceptions, beliefs, and expectations), environmental factors (including social interactions and
physical surroundings), and personal factors (such as individual characteristics and experiences).
The theory emphasizes that learning can occur through observation, modeling, and the
interaction between cognitive, behavioral, and environmental factors. Application of the theory
in perception and challenges of OSCE is through the following ways:
Learning through Observation: Social Cognitive Theory emphasizes the role of observational
learning. In the context of OSCE (Objective Structured Clinical Examination), nursing students
often observe and learn from the experiences of their peers. This theory could help analyze how
students perceive and learn from these observations.
Self-Efficacy: Social Cognitive Theory highlights self-efficacy, which is a person's belief in
their ability to perform a specific task. In the context of OSCE challenges, it can be used to
explore how students' self-efficacy beliefs influence their perception of OSCE and their ability to
overcome challenges.
Social Influence: The theory also emphasizes the impact of social influences on individuals.
Using this theory in this research could investigate how interactions with peers, instructors, or
clinical mentors affect nursing students' perception of OSCE and how these interactions
contribute to their challenges or successes.
Reciprocal Determinism: Social Cognitive Theory proposes that behavior, personal factors, and
environmental influences interact in a reciprocal manner. In this research, it can be applied to
examine how OSCE perceptions among nursing students are shaped by their personal attributes,
the educational environment, and their actual experiences during OSCE assessments.
Overall, integrating Social Cognitive Theory into the research could provide a comprehensive
framework for understanding the perception of OSCE and its challenges among undergraduate
nursing students by considering the social and cognitive factors that influence their experiences.

2.3 Empirical Review

2.3.1 Review of literature related to perception of OSCE
In a study carried out by García-Mayor et al., (2021) on Nursing students' perceptions on the use
of clinical simulation in psychiatric and mental health nursing by means of objective structured
clinical examination (OSCE), which was carried out in the University of Málaga (Spain). The
study population consisted of 141 nursing students enrolled in a mental health course and
currently in the third year of their Nursing Degree, the study results show that these nursing
students considered the methodology in question to be useful preparation for clinical practice
(mean score = 4.78, SD = 0.45), that they appreciated the participation of an expert (mean score
= 4.72, SD = 0.60) and that receiving the opinions of their peers about their performance was an
enriching part of the experience (mean score = 4.54, SD = 0.64). The OSCE technique received
very positive feedback from the participants, who also believed that it should be used more
regularly. From this study, debriefing is seen as a crucial component of both the participants'
happiness and the learning process.

In a related study by Del Carmen Rivera Vélez (2018) which was "Study of Undergraduate
Nursing Students'' Perception on the Objective Structured Clinical Examination (OSCE) when
used in clinical simulations in nursing courses in Puerto Rico". It was possible to identify the
strengths, weaknesses, and recommendations to improve the use of the OSCE from the
perspective of the students thanks to their expressions, which were based on evidence that the
incorporation of this assessment method can help to identify the levels of competencies attained
by students in their curriculum. The results are consistent with the literatures available in this
research. Students consider the OSCE to be a stressful event and find it very useful for
evaluating a variety of aspects such as clinical skills, ethical behavior, theoretical knowledge,
and communication skills. The average scores obtained on the 5-point scale provided in the
questionnaire indicated that the students tended to agree with the items that stated positive
aspects of the OSCE. Considering these factors and the earlier investigation of students'
knowledge and practices can help reduce interferences in their performance when evaluated
through the OSCE since a significant number of respondents experienced it as stressful. They
identified factors that facilitate the OSCE such as: privacy, greater use of standardized patients,
10-15 minutes allotted time per station, greater practice and prior preparation before the OSCE,
among others.

Fisseha and Desalegn (2021) in the research study "Perception of students and examiners about
Objective Structured Clinical Examination in a teaching hospital". Which was carried out in
Ethiopia and the results of this study showed an overall positive perception of OSCE by students
and examiners. Among the 141 students and 39 examiners that participated in the study; OSCE
was recommended to be used in future exams compared to other assessments by (38.3%) of
students and( 51.3%) of examiners, (72.3%) of the participants agreed that OSCE revealed their
strengths and weaknesses. Similarly, (68.8 - 69.5%) agreed that it assesses a wide range of
knowledge and skills, and is a good reflection of the medical profession. On the other hand,
( 39.7–51.1%) considered OSCE to be stressful or intimidating, (56.1%) thought the time
allocated for the stations was adequate and (43.9%) agreed the sequence of stations was
appropriate. Mock sessions before exams were seen as essential by (80.1%) of the participants,
more female students (56.1%) agreed that OSCE reduced chances of failing compared to males
(42.5%). Similarly, females reported that instructors were polite and helpful (77.6% vs 66.7%),
and instructions of the exam were clear more than males (77.6% vs 67.5%) respectively.The
findings from this study show that OSCE is a good assessment method and is considered
acceptable by both students and examiners,OSCE needs to be supported and the challenges
identified should be mitigated by concerned bodies. In this way, the quality of OSCE and
satisfaction of students and examiners can be enhanced.Pre-examination orientation is important
for both students and examiners. Students can also be trained during routine clinical teaching
activities.

In a similar study carried out by Awad et al., (2019) on Perception of Undergraduate Nursing
Students towards Objective Structured Clinical Examination. A study method of cross sectional
descriptive design was conducted among the Faculty of Nursing, at Minia University, Egypt. The
study group was selected using a systematic random sample of 132 students in the third year, and
a structured self-administered questionnaire was used. Analysis of the respondents towards their
perception shows the majority of students (95.4%) agree that the examination was well
organized, well-structured and appropriately sequenced. The majority of students (85.5%) have
awareness about OSCE due to the information gathered from faculties and are enlightened
about OSCE prior to the exam. The information provided by faculties before the exam is quite
important. From this study OSCE should not become an exercise of how fast students can
perform the technique, but rather focus on how well they can perform it.

In a study by Onasoga et al., (2021) on assessment of perception and satisfaction with objective
structured clinical examination (OSCE) among undergraduate nursing students in Ilorin, Kwara
State. According to the study, the majority of respondents thought the time allotted for each
station was sufficient. This is consistent with a related study by Basgut and Abdi (2019), in
which a nearly identical percentage of respondents (77.3%) felt that the time allotted at each
station was sufficient. More than 60% of responders thought the OSCE test was fair since it
included simple, explicit instructions. More over half of the respondents said the OSCE was
thoughtfully organized and sequential. The majority of the respondents believed that OSCE
results are standardized, that OSCE is an impartial tool for evaluating clinical skills, and that the
format of the examination provides students with real-world experience.This corroborates the
studies conducted in Ethiopia and Nigeria where majority of the respondents preferred OSCE
and were positive about its examination structure (Fisseha & Desalegn, 2021; Sholadoye et al.,
2019).

During the academic year 2019–2020 at Aswini College of Nursing, Thrissur, a convenient
sampling method was used to select 237 students of various academic levels enrolled in the BSc
Nursing program. The questionnaire was then distributed through Google Forms after the
validity was assessed. The majority of the students gave positive responses to the OSCE's
organization, quality, validity, reliability, and exam; they also experienced the OSCE as not
frightening and frightful; and they partially agreed with using the OSCE more frequently in the
coming years. The majority of the students partially agree that the OSCE felt as real as well as
authentic and covered a wide range of clinical skills .
Sholadoye et al., (2019) In the study "Assessment and Comparison of the Strengths and
Weaknesses of Objective Structured Clinical Examination and Conventional Examination". A
cross sectional study was conducted from July 2018 to October 2018 in Ahmadu Bello
University Zaria, using a structured questionnaire. The results showed that only 36.1% of them
strongly believed that it was simpler to pass the OSCE, despite the fact that 64.7% of them
strongly agreed that it was the normal style of testing. More than half of the students said the
OSCE's material was suitable, comprehensive, objective, and paid attention to particular areas of
weakness. The majority of students (89.5%) enjoyed it and concur that it was better than a
traditional clinical test, but some (38.1%) believed that the OSCE process needed to be
improved, particularly in terms of time allocation.The medical students had a positive opinion of
the OSCE's framework and methodology. Students felt that the OSCE was less stressful and
more fair than the traditional clinical test, and that it provided a better assessment of structure
and level of co-operation.

2.3.2 Impact of OSCE

Solà-Pola et al., (2020) in the research study "The usefulness and acceptance of the OSCE in
nursing schools". The study revealed that students accepted and thought the OSCE was useful.
Students remarked that taking part in the OSCE gave them the opportunity to evaluate
themselves. The OSCE, they said, promoted students' self-awareness of their professional
competencies by allowing them to see how they performed in hypothetical settings and providing
extremely valuable information on their strengths and weaknesses.additionally enabled them to
put themselves to the test, grow in confidence, and prepare for actual nursing practice.
Ha and Lim (2023) found out in their research "The effect of objective structured clinical
examinations for nursing students" that OSCE makes communicating with patients, and solve
nursing problems easy in actual clinical settings.More Importantly, the knowledge gained during
the OSCE process enables nursing students to quickly transition from the classroom to the real
clinical setting once they graduate. This experience may also be crucial for new nurses to
develop confidence in their clinical performance in a real-world clinical setting.

Phetcharak (2021) in the study "The Effects of an Objective Structured Clinical Examination on
Perceived Nursing Competencies and Clinical Skills Among Maternal and Child Nursing
Students", the results showed that post-test mean scores for perceived maternal and infant
nursing performance and for maternal and infant nursing clinical skills were significantly higher
than pre-test scores (p.001). The mean score for perceived nursing competencies was at a
moderate level (= 3.00, SD = 0.91) while the mean score for maternal and child nursing clinical
skill was at a high level (= 9.20, SD = 1.11).It is advised that maternal and child nursing students
use OSCE to promote their perceived nursing competencies and clinical skills after this study's
findings showed that it helped them perceive their nursing competencies and maternal and child
nursing clinical skills.

A study by Alkhateeb et al., (2022) on "Objective structured clinical examination: Challenges

and opportunities from students’ perspective", was carried out in the College of Medicine,
Hawler Medical University, Iraq at the beginning of the 2018–2019 academic year . The study
revealed the role of the OSCE in boosting confidence, engagement, and motivation for learning,
achieving a higher level of learning; and raised a valuable suggestion on the continuous
involvement of the students in the process of feedback and development of the OSCE quality.
According to Thabet et al., (2021), as there is more motivation for nursing students, there will be
more feedback seeking behavior from them, the use of OSCE can foster and motivate students to
inquire about their performance, seek feedback on their clinical practice, and receive it.
Additionally, in accordance with the self-determination theory of motivation (intrinsic or
extrinsic), the use of OSCE can stimulate students to inquire about feedback and develop their
performance by internal or external forces.

2.3.3 Factors influencing the performance of undergraduate nursing students

According to Rushood and Al-Eisa (2020) , In order to give learners the best possible
educational environments for the best results in terms of knowledge retention, application, and
exam performance, it is crucial to study the factors related to students that affect their
performance. In their study on "Factors predicting students’ performance in the final pediatrics
OSCE", they found out that It is crucial to give students the necessary intervention at an early
stage to reduce failure rates because students' performance on in-training exams may predict
their final OSCE scores.
Gillan et al., (2022) in the research of the "Factors influencing nursing students’ ability to
recognise and respond to simulated patient deterioration", The results showed a lack of
situational awareness, incomplete patient assessments due to distractions, and a failure to
recognize deterioration are factors influencing performance. The use of a variety of simulation
modalities was effective in improving student performance. Repeated practice within a single
simulated learning experience, was shown to improve performance and situational awareness.
According to Opiah et al. (2022) in the study "Determinants Of OSCE Performance Among
Nursing Students In Department Of Nursing Science, University Of Calabar, Calabar, Cross
River State ",it reflected that a majority of respondents 92 (49.5%) strongly disagreed, 65
(34.9%) strongly agreed, 21 (11.3%), and 8 (4.3%) strongly agreed that I feel destabilized not
buying textbooks for exams because of money. a majority of respondents 128 (68.8%) strongly
agreed and 40 (21.5%) strongly disagreed that they feel so reluctant about studying and not
paying their tuition fees on time.It was determined that psychological aspects significantly
influence students' readiness.
Ataro et al. (2020) study on "Experience and Challenges of Objective Structured Clinical
Examination (OSCE)", the researchers found that factors like a lack of skill lab, excess cost, a
shortage of trained faculty, unfair task selection across competencies, increased stress,
inconsistent tools, a lack of standardized patients, a lack of assessor training, assessor
intimidation, and time constraints make OSCE implementation a problem in non-western
countries and even worse in some other developing countries,primarily in schools of developing
countries, which affect the performance of the students due to affected standard setting. In two
ways, students complained about the lack of preparation time before the OSCE exam: first, they
had little to no prior exposure to simulated environments and no experience with mock OSCEs,
which they preferred, the schedules were so tight that they were even rushed to take the OSCE
exam on the same day that they took other formats of exams like viva. Students frequently
mentioned that it was difficult for them to cope with such academic pressure.On the other hand, a
small number of students, mostly those with more prior OSCE experience, stated that they are
more comfortable with making themselves ready for OSCE than other assessment types if
practice time is properly scheduled in advance. The majority of students agreed that these
practices inhibited them from properly completing the assigned task and affected their
performance on the OSCE examination.Before the exam day, the OSCE team should schedule
meetings and training sessions to create the exam blueprint, design the stations, write the
scenarios, orient the examiners, set up the rooms and equipment, and address other management
concerns.
However, there is no data on how much time students should spend studying for the OSCE, so
decisions are typically based on the curriculum and school policies.
 CHAPTER THREE

RESEARCH METHODOLOGY

3.0 Introduction
This chapter provides an overview of the target population, research design, research setting,
sampling technique, instrument used, method of data collection, validity and reliability, method
of data analysis and ethical consideration.

3.1 Research Design

A descriptive research design will be used for this study which is aimed at assessing the
perception and challenges of objective structured clinical examination (OSCE) among
undergraduate nursing students in Ladoke Akintola University of technology, Ogbomoso, Oyo
state, Nigeria.

3.2 Research Setting

The study will be conducted among undergraduate nursing students in Ladoke Akintola
University of technology, Ogbomoso, Oyo state, Nigeria. Ladoke Akintola University of
Technology (LAUTECH) is a tertiary institution located in Ogbomoso, Oyo State, Nigeria. The
university enrolls over 30,000 students and employs more than 3,000 workers including contract
staff. The School Main campus is located at Ogbomoso North Local Government, Ogbomoso,
Oyo State, Nigeria with geographical coordinates 8° 8' 0" North, 4° 16' 0" East. The department
of Nursing Science was established in 2001, which was metamorphosed into the Faculty of
Nursing Science on the approval of the Senate and Council of the University.

3.3 Population of the Study

For this study, the research population will comprise undergraduate nursing students in 300 level
to 500 level in Ladoke Akintola University of Technology, Ogbomoso, Oyo State Nigeria. The
total number of students is 728.
3.4 Sample Size Determination
The total number of undergraduate nursing students in Ladoke Akintola University of
Technology across the Three levels to be used ( 300 level to 500 level) is 728. To calculate the
sample size "n" the formula below is used.
Slovin’s formula will be used to determine the sample size from the population.
Slovin’s formula is given as;
n = N
1+N (e)2
Where N = Population of study (728)
n = Sample size (?)
e = Level of significance at 5% (0.05)
1 = Constant

Therefore; n = 728 = 728 = 728

1 + 728(0.05)2 1+728(0.0025) 2.82

n = 728 = 258
2.83
n = 258
10% attrition rate = 10% of sample size
= (10/100) × 258
= 0.1× 258
= 26
Total sample size = Sample size (n) + 10% attrition rate
= 258+ 26
= 284
The sample size therefore is 284 respondents.
3.5 Sampling Technique
The sample for this study will be selected using multistage sampling technique. This is because it
allows division of the population into stages based on relevant criteria like year of
study,facilitates comparison(e.g., juniors vs. seniors),representativeness which improves the
generalizability of the finding ensuring a comprehensive understanding of their experiences and
challenges .These factors make it a robust method for investigating the perceptions of OSCE
among undergraduate nursing students and assessing its challenges.
3.5.1. Inclusion Criteria
The inclusion criteria for this research is being undergraduate nursing students in Ladoke
Akintola University of technology, Ogbomoso, across the 300 level to 500 level and is willing to
participate in the study.
3.5.2 Exclusion Criteria
The exclusion criteria for this research is undergraduate nursing students in 100 Level, 200 Level
and students from other departments in Ladoke Akintola University of Technology Ogbomoso
Oyo State.

3.6 Instrument for Data Collection

Questionnaires will be used as an instrument of data collection. It has four sections:
Section A – Sociodemographic characteristics of the respondent. It contains 5 items
Section B – perception of undergraduate nursing students on OSCE. This section contains 14
items eliciting information on respondents’ perception on OSCE.
Section C – Performance of undergraduate nursing students in OSCE : This section contains 5
items eliciting information on the performance of respondents in OSCE.
Section D – challenges of OSCE among undergraduate nursing students: Contains 15 items
eliciting information on the challenges of OSCE among undergraduate nursing students of
Ladoke Akintola University of Technology.
3.7 Pilot Study
A pilot study will be carried out by administering 10% of the estimated sample size and this
equals to 28 questionnaires. They will be administered to 28 undergraduate nursing students in
Bowen university teaching hospital, Ogbomoso Oyo State , which are not part of the sample size.
This is done to identify problems that may arise and solve them before going for the main study.

3.8 Psychometric Properties of Instrument

3.8.1 Validity of Instrument
The instrument will be constructed in line with the specific objectives after reviewing relevant
literature. In a bid to ensure that the research instrument measures what is intended, the
questionnaire will be given to my research supervisor who is an expert in medical research to
look for content validity before use for data collection.
3.8.2 Reliability of Instrument
Cronbach's alpha is the statistical tool that will be used to determine the internal consistency of
the instrument. This will be done by selecting questions related to the perception of OSCE and
its challenges among undergraduate nursing students and these questions will reflect the
construct to be measured. The questions will be administered to a sample of undergraduate
nursing students and responses of these students will be analyzed and a reliability coefficient of
0.75 will be used to judge the reliability of the instrument.

3.9 Method of Data Collection

Letter of introduction will be collected from the Faculty of Nursing sciences. The letter of
approval to carry out the research will also be collected from the ethical committee of the Faculty
of Nursing sciences and will be presented to the head of department of each level concerned
before the administration of the questionnaire. The questionnaires will be administered to the
respondents after obtaining consent and explaining each item in the instrument to them.Each
respondent will be informed of their right to withdraw from participation, and they will be urged
to complete the questionnaire honestly.
The questionnaire will be collected by the researcher immediately it is filled. Data collection will
be done physically by the researcher and an assistant for two weeks.
3.10 Method of Data Analysis
Data will be coded, cleansed and entered into Statistical Package of Social Sciences (SPSS) v27.
Data will then be analyzed using Statistical Package of Social Science (SPSS) v27. Descriptive
and inferential statistical tool will be used to compute the data. The descriptive statistics will be
conducted to display the frequency and percentage distribution of the variables contained in the
study, and the chi-square inferential statistics will be used to test the hypothesis.

3.11 Ethical Consideration

The following ethical issues will be considered:
3.11.1 Permission to conduct the study
A proposal for research will be submitted to the Faculty of Nursing Science, Ladoke Akintola
University of Technology, for permission to conduct the study, and then a written permission
will be obtained from the committee as an approval to conduct the study.
3.11.2 Informed Consent
Written consent will be obtained from the participants after adequate explanation and
information would have been given to them.
3.11.3 Confidentiality
Information provided by the respondents will not be divulged to others without express
permission. No name or any form of identity will be required from the participants so as to
ensure confidentiality and anonymity, thus protecting the privacy of respondents.
The respondents will be informed that they are free to withdraw their participation at anytime.
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 QUESTIONNAIRE

QUESTIONNAIRE ON PERCEPTION OF OSCE AND ITS CHALLENGES AMONG

UNDERGRADUATE NURSING STUDENT OF LADOKE AKINTOLA UNIVERSITY
OF TECHNOLOGY, OGBOMOSO, OYO STATE

This study is being carried out on the perception and its challenges of objective structured
clinical examination (OSCE) among undergraduate nursing students in Ladoke Akintola
University of technology, Ogbomoso, Oyo state, Nigeria. I humbly request your participation in
this study. Kindly and freely express your view and opinion by answering the questions that
follow. Be assured that all information provided is absolutely confidential, your name is not
required and it is basically for academic purpose.
Thanks for your anticipated cooperation.

Please tick [√] where necessary and fill in the gap appropriately.

Section A: Demographic Characteristics

1. Age: (a) 18-22 () (b) 23-27 () (c) 28-32 () (d) > 33 ()

2. Gender: (a) Male () (b) Female ()
3. Undergraduate level: (a) 300L () (b) 400L () (c) 500L ()
4. Marital status: (a) Single () (b) Married () (c) Cohabiting ()
5. Previous OSCE experience? (a) Yes () (b) No ()
Section B: Perception of OSCE
SD = Strongly Disagree, D = Disagree, A = Agree, SA = Strongly Agree

Question SD D A SA

6. OSCE is a form of examination limited to clinical practice.

7. OSCE test recall of knowledge.

8. OSCE is quite an easy examination.

9. OSCE tests details of the steps of a procedure.

10. OSCE is a purely practical examination.

11. OSCE assesses a wide range of clinical skills.

12. OSCE allows for compensation of poor performance in other stations

and/or other exams.

13. OSCE helps students to identify their deficiencies in clinical skills.

14. OSCE is a more challenging form of examination.

15. Nature of the examination makes students anxious.

16. Examination does not prepare students for real life situations because
life patients are not used.

17. It reflects the requirements of the nursing profession.

 18. Having similar questions and case scenarios for all students is a good
measure of competency.

19. Personality, ethnicity and gender will not affect OSCE scores.

Section C: Performance of undergraduate nursing students in OSCE

Good = 50 – 60, Very Good = 61 – 70, Excellent = 71 and Above

Question Good Very Excellent

Good

20. What has been your performance in OSCE .

21. Your time management skills in OSCE involving

questions on emergency nursing.

22. Your problem- recognition and problem-solving skill in

OSCE .

23. Your patient centered care in OSCE.

24. Following ethical practice of seeking consent before

procedures in OSCE.

Your perfrmance n OSCE ( a) Good ( 50 - 60) ( b) Very good (61 - 70) ( c ) 71 and
Section D : Challenges of OSCE
SD = Strongly Disagree, D = Disagree, A = Agree, SA = Strongly Agree
The following are the challenges of OSCE among undergraduate nursing students.

Question SD D A SA
25.OSCE is a stressful examination.

26. There is time limit to perform procedures.

27. Unfriendly examiners.

28. Nature of the examination is not good.

29. Unavailability of all necessary equipment.

30. Lack of enough time to prepare.

31.Grading and feedback received after OSCE is not

encouraging.

32.OSCE format and expectations is difficult to

understand.

33. Lack of confidence in your clinical skills.

34. Lack of a positive atmosphere during OSCE.

35. Revision on different types of clinical procedures is

not made before examination.

36. OSCE is not easy to practice and test my nursing skills

within a short duration.

37. OSCE requires a lot of preparation and mock training

sessions.

38. Too many stations.

39. Tasks asked to perform were not fair