Nurse Education Today 31 (2011) 145–151

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Nurse Education Today

j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / n e d t

Best Practice Guidelines for use of OSCEs: Maximising value for student learning
D.D. Nulty a,⁎, M.L. Mitchell b, C.A. Jeffrey c, A. Henderson d, M. Groves e
a
Griffith Institute for Higher Education, Griffith University, Mount Gravatt, Brisbane, Queensland 4111, Australia
b
School of Nursing and Midwifery, Nathan Campus, Brisbane, Queensland 4111, Australia
c
School of Nursing and Midwifery, Griffith University Logan Campus University Drive Meadowbrook Queensland 4131, Australia
d
Nursing Practice Development Unit, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Queensland 4102, Australia
e
Faculty of Health Sciences, University of Queensland, Edith Cavell Building, Royal Brisbane and Women's Hospital, Herston, Qld. 4029, Australia

a r t i c l e i n f o s u m m a r y

Article history: Objective structured clinical examinations (OSCEs) are a regular component of Bachelor of Nursing (BN)
Accepted 4 May 2010 programs within Australia and internationally. OSCEs are a valuable strategy to assess ‘fitness to practice’ at
the students' expected level of clinical practice within a nursing context where the importance of accurate
Keywords: patient assessment is paramount. This report discusses the integration of seven proposed ‘Best Practice
Evaluation
Guidelines’ (BPG) into an undergraduate BN program in Queensland, Australia. A range of learning and
Assessment
Clinical performance
assessment strategies was introduced in accordance with the adoption of these guidelines to maximise
Nursing student engagement. There is some evidence that these strategies have directly assisted in enhanced student
Competency confidence around clinical practice and provide preliminary evidence of the effectiveness of BPG for OSCEs
OSCE within nursing programs internationally.
© 2010 Elsevier Ltd. All rights reserved.

Introduction
In the health professions, professional skills and attributes are
taught, learnt and assessed in a variety of ways. In nursing, students'
ability to demonstrate in action that they have acquired these skills and
attributes is assessed formatively and summatively whilst on clinical
practicum and via on-campus clinical laboratory summative assess-
ments such as objective structured clinical examinations (OSCEs).
OSCEs are a valuable strategy to assess clinical skill acquisition and
‘fitness to practice’ as long as they are applied at the students' expected
level of clinical practice. That is, for example, for first year students,
being able to perform accurate assessments of a healthy adult is an
important level of achievement to assess.
OSCEs were developed in the 1970s for the assessment of medical
students (Harden and Gleeson, 1979). They are designed to assess a
range of professional skills and knowledge involved in clinical practice
and are defined as “an approach to the assessment of clinical
competence in which the components of competence are assessed
in a well planned or structured way with attention being paid to
objectivity” (Harden, 1988, p.19). In medical programs where their
use is now widespread, they commonly consist of a series of short
tasks or “stations” designed to test discrete clinical skills (typically,
ten stations of 5–8 min each). In this format, they have proven to be a
⁎ Corresponding author.
E-mail addresses: d.nulty@griffith.edu.au (D.D. Nulty),
marion.mitchell@griffith.edu.au (M.L. Mitchell), c.jeffrey@griffith.edu.au (C.A. Jeffrey),
Amanda_Henderson@health.qld.gov.au (A. Henderson), m.groves@uq.edu.au
(M. Groves).
valid and reliable method of assessment (Roberts et al., 2006). OSCEs
are also increasingly being adapted for use in other health profes-
sional programs, commonly nursing and allied health, with many of
the variants focussing on integrated, rather than isolated, assessment
tasks which are considered to more accurately reflect real-life clinical
settings (Major, 2005).
OSCEs are gaining in popularity in undergraduate nursing
programs throughout the western world (Joy and Nickless, 2008)
and recent evaluations in Ireland identified a positive impact on all
stakeholders (Brosnan et al., 2006).
As reported by Mitchell et al. (2009, p. 399):
“An OSCE requires each student to demonstrate specific skills and
behaviours in a simulated work environment with standardized
patients. It typically consists of a series of short assessment tasks
(stations), each of which is assessed by an examiner using a
predetermined, objective marking scheme (Bartfay et al., 2004;
Major, 2005; Ward and Barratt, 2005)…. It is increasingly being
used as a method of assessment in nursing and allied health
curricula (Bartfay et al., 2004; Wessel et al., 2003).”
While there is considerable debate around this way of assessing
students' clinical competence, particularly in respect of reliability and
validity, evidence suggests that it “offers particular strengths in terms
of assessor objectivity and parity... for all students [and that not
withstanding some limitations] achieving high levels of reliability and
validity is possible” (Rushforth, 2007, p.488). Rushforth (2007) also
emphasises that research “makes very clear that each new OSCE
should be subject to rigorous scrutiny and piloting to ensure that the

0260-6917/$ – see front matter © 2010 Elsevier Ltd. All rights reserved.
doi:10.1016/j.nedt.2010.05.006
146 D.D. Nulty et al. / Nurse Education Today 31 (2011) 145–151
reliability and validity of that particular assessment is maximized”
(Rushforth, 2007, p.488).
Although OSCEs are expensive and labour intensive, there is
evidence that they enhance the quality of health professional
education (Mitchell et al., 2009). What is not well reported is how
they may best be integrated into the curriculum to support quality
outcomes. This paper begins to explore how these assessments can
demonstrate procedural, professional and educational efficiency and
effectiveness. For example, the concepts of “alignment” of curricular
components (i.e. teaching, learning and assessment), and “authentic-
ity” (especially in assessment) are critical to good curriculum design
and effective learning, particularly with adult learners because both
promote student engagement in behaviours that correlate with the
achievement of deep learning outcomes (Biggs, 2003; Cohen, 1987;
Meyers and Nulty, 2009; Toohey, 1999). Simulated clinical situations
such as OSCEs are intrinsically aligned and authentic, and should also
promote student engagement and the achievement of desired learning
outcomes. This justifies their use as a learning/assessment tool.
This paper reports on preliminary evidence of the effectiveness of
teaching and assessment practices that were modified in accordance
with the guidelines proposing the best use of OSCEs.
The contribution of OSCEs
Increasingly, workforce issues within the healthcare sector mean
that some approaches to clinical education and assessment (e.g.
clinical placements) are becoming difficult to sustain (Rischbieth,
2006). This is exacerbated by simultaneously escalating student
numbers in some instances. These changes significantly limit the
ability of universities to provide high quality clinical training for
nursing students, thereby increasing the imperative to develop
alternative and innovative learning opportunities.
Universities need to respond to these challenges/limitations in a
way that is both acceptable to the health professions and to other
stakeholders (Feingold et al., 2004; Tanner, 2006). Better use of
simulated learning has the capacity to reduce clinical placement
demands and improve the preparation for new graduates as
controlled pre-set learning can expose students to quality clinical
material not always possible in hospital settings (Tanner, 2006; The
Nurse Policy Branch of the Victorian Government of Human Services,
2006).
To date, learning through simulated clinical experiences has been
limited, with OSCEs being used almost exclusively for assessment pur-
poses. However, we argue that OSCEs present one viable educational
strategy to promote student engagement and the achievement of
desired learning outcomes, notably including clinical competence, and
to thereby meet the challenges arising out of the restricted access to
clinical areas as just described (Tanner, 2006). In this way all students
can experience learning, practice and assessment of core skills prior to
clinical placement.
The importance of feedback for performance improvement has
been long recognised, originally known as ‘The law of effect’
(Thorndike, 1911). As well, learners' motivation has also been noted
as of critical importance (McKeachie, 1974, 1990). McKeachie (1974)
also argued that, for feedback to improve students' learning, it should:
have an impact on students' motivation, carry information about the
learners' performances, and information about ways in which these
performances can be improved. In this more sophisticated form, the
value of feedback on learning has substantial contemporary support
(Brown and Knight, 1994; Race, 2005, 2008). As such, it has been
argued that feedback is more effective when provided with minimal
delay (Marton et al., 1984; Childs and Sepples, 2006). In the authors'
experiences and elsewhere, feedback during or immediately follow-
ing student performance is not always structured into each student's
assessment time due to the associated staffing costs (White et al.,
2009).
In this paper we argue that the OSCE can be viewed as a method
which intrinsically offers the opportunity for feedback (at the very
least, through self-reflection) by virtue of the in vivo self-assessment
which is implicit in participation as students are required to ‘talk
through’ how their knowledge is applied to the situation. This is
another way in which student engagement is boosted, and higher
quality learning outcomes achieved.
Specifically, research literature is unequivocal on the point that
assessment activities are both a way for and a driver of students' study
behaviours (Biggs, 2002, 2006; Ramsden, 2003; Rowntree, 1977;
Sadler, 1987). In this respect, we argue that the participant-observer
nature of students' involvement in OSCEs axiomatically develops their
skills in self-reflection — and thus, engagement in learning.
As with other types of assessments OSCEs need to be rigorous with
standardisation and objectivity being principal aims (Ebbert and
Connors, 2004). Checklist style marking has been found to be useful
when OSCEs are used for formative assessment (Regehr et al., 1998).
These can provide specific feedback and reduce inter-rater variability.
However, the same research suggests that in summative assessment
global rating scales are more valid and reliable (Regehr et al., 1998).
This is because global or ‘holistic’ judgements reflect the nature of
human judgement and the appraisal of complex tasks for which it is
inappropriate to specify components as if they were discrete (Sadler,
2009).
Development of Best Practice Guidelines for OSCEs
Extensive literature reviews (Mitchell et al., 2009), the trialling and
piloting of local initiatives, and consideration by experienced nurses,
educators, and academics resulted in the development of seven Best
Practice Guidelines (BPG) for OSCEs.
The BPG recommendations following this comprehensive process
were that the OSCE should:
BPG1 Focus on aspects of practice related directly to delivery of
safe client/patient care;
BPG2 Focus on aspects of practice which are most relevant and
likely to be commonly encountered;
BPG3 Be judged via a holistic marking guide to enhance both the
rigor of assessment and reliability. (This allows judgements
of students' performance to be related to clinical practice as
a whole, rather than as a collection of discrete independent
actions.)
BPG4 Require students to perform tasks in an integrated rather
than piecemeal fashion by combining assessments of
discrete skills in an authentic manner;
BPG5 Be structured and delivered in a manner which aligns
directly with mastery of desired knowledge and skill. This
alignment should be both internal to the course and (in
keeping with #2) aligned prospectively with clinical tasks
likely to be encountered;
BPG6 Be appropriately timed in the sequence of students' learning
to maximise assimilation and synthesis of disparate course
content and to minimise the potential for students to adopt
a piecemeal, superficial learning approach;
BPG7 Allow for ongoing practice of integrated clinical assessment
and intervention skills, thereby also ensuring the appropriate
and timely use of feedback to guide students' development.
From these guidelines, the first year OSCE was revised with the aim
not only of enhancing students' awareness of the importance of
patient assessment (Clark et al., 2009) but also of increasing their
ability to effectively undertake a preliminary assessment during the
initial patient interaction. The ‘patients’ in the context of the OSCEs
were a mixture of the assessed student's family, friends or a fellow
student. The restrictions placed on this choice were that the patient
 D.D. Nulty et al. / Nurse Education Today 31 (2011) 145–151
had to be: 16 years of age or over; be in relatively good health; and if
the student was assessing a fellow student (i.e. using each other as
patients) then these assessments would be required to take place at
least 1 h apart.
Adaptation of the OSCE based on the Best Practice Guidelines
BPG1 Focus on aspects of practice related directly to delivery of
safe client/patient care.
The patient assessment, rather than being focussed on a single
body system, reflected the real clinical work of a holistic review of an
individual. Specifically, the OSCE was changed to the comprehensive,
integrated assessment of a healthy adult that incorporated all aspects
relevant to general nursing practice. The revised OSCE commenced
with an initial client assessment designed to evaluate students' ob-
servational skills. Students were encouraged to discuss gait, posture,
height, weight, appearance and vital signs, including any obvious de-
viations from the norm. The manner in which the student interacted
with the client was also part of the OSCE and covered communication,
consent, confidentiality and privacy issues.
BPG2 Focus on aspects of practice which are most relevant and
likely to be commonly encountered.
A complete patient assessment was deemed most relevant as it is
a task that nurses undertake many times each day during normal
clinical practice. It is increasingly being recognised as that task that is
most poorly performed thereby increasing risks to patients particu-
larly when associated with poor communication (Clark et al., 2009).
BPG3 Be judged via a holistic marking guide to enhance both the
rigor and reliability of the assessment. This allows judge-
ments of students' performance to be related to clinical
practice as a whole, rather than as a collection of discrete
independent actions.
The previous marking guide revealed an overly prescriptive ap-
proach with allocation of marks to each item of each area being assessed.
The revised marking guide allocated marks to each area, allowing a
global judgement for each, thereby improving both construct and
concurrent validity (Regehr et al., 1998) [refer Appendix A]. Inter-rater
reliability was supported by organising discussions among assessors
prior to, throughout and on completion of the OSCE examination period.
BPG4 Require students to perform tasks in an integrated rather
than piecemeal fashion by combining assessments of dis-
crete skills in an authentic manner.
This was achieved through the nature of the selected assessment,
through the marking guide, and through preparation of the exam-
iners. Combined, these factors ensured that the task was approached
and marked in an integrative fashion.
BPG5 Be structured and delivered in a manner which aligns
directly with mastery of desired knowledge and skill. This
alignment should be both internal to the course and (in
keeping with #2) aligned prospectively with clinical tasks
likely to be encountered.
While the same course content was taught as in previous years, the
timing of the release of information about possible topics for
assessment was changed: students were told after nine weeks of
teaching, instead of at the beginning of the course. Students were then
encouraged to practice the OSCE in the remaining three weeks of
147
semester. This strategy was implemented to allow students to develop
a sound understanding of the discipline content prior to the release
of possible topics designed to encourage them to integrate and
synthesise their learning.
BPG6 Be appropriately timed in the sequence of students' learning
to maximise assimilation and synthesis of disparate course
content and to minimise the potential for students to adopt
a piecemeal, superficial learning approach.
It was considered that the early release of information about the
OSCE may detract from what was otherwise an integrated sequence of
constructing meaning for students one ‘piece’ at a time. This revised
approach facilitated integration and synthesis as students now were
provided with the ‘big picture’ and were able to see how the infor-
mation fitted into this.
BPG7 Allow for ongoing practice of integrated clinical assessment
and intervention skills, thereby also ensuring the appropriate
and timely use of feedback to guide students' development.
The availability of extra guided sessions during the course was
deemed to be essential to support students' learning through
continuous practice. Informal feedback during these sessions highlight-
ed student's strengths and weaknesses and areas for improvement.
Value of the adaptations derived from student feedback
Our university, like many other educational providers worldwide,
seeks student feedback on both subject content and assessment. The
standard student evaluation form (which asks students for feedback
on their subjects) when compared across two years (before the
adaptations and afterwards), indicated that those students who were
repeating the subject for whatever reason (some may have failed or
withdrawn from the subject the previous year) perceived the new
format of the course and its assessment better suited their needs to
prepare them for practice. Student feedback is given below according
to the BPG to which they have the greatest relevance.
Fifty-eight students responded anonymously (45% of cohort,
n = 150) to the standard questionnaire — Student Evaluation of Course
(SEC) questionnaire, and a custom questionnaire used as an adjunct. The
latter asked specific questions about the impact of the OSCE on students
and is reported below. (The SEC consists of 10 standard items which
student's rate on a seven point Likert scale. The scale has the following
descriptors as anchors: 1 = “unacceptable”, 2 = “very poor”, 3 =
“poor”, 4 = “average”, 5 = “good”, 6 = “very good” and 7 =
“excellent”.)
Quantitative comparison of scores from the previous and current
year's SEC suggest that students regard the revised OSCE as an
improvement over previous practice. Of the ten items in that survey,
the three listed below are relevant to the aims of this project. In
each case a substantial increase was seen between the two year
evaluations.
Question 5 How effective were the assessment tasks in this course in
helping you with what you were expected to learn?
(increased by 0.9 from 5.4 to 6.3)
Question 6 How clear were the assessment guidelines at explaining
how assessment tasks would be marked? (increased by 0.8
from 5.4. to 6.2)
Question 10 Overall, how effective was this course in helping you to
learn? (increased by 0.9 from 5.5 to 6.4).
The additional customised set of nine questions specific to the
adaptation of the OSCE is outlined in Appendix B. The student
148 D.D. Nulty et al. / Nurse Education Today 31 (2011) 145–151
responses were number coded for reporting purposes. Ethical
approval was received by the university ethics committee.
The following students' comments indicate improvements around
developing safe (BPG1) and relevant (BPG2) practice.
“Compared to last year's OSCE,… this was a much better & fairer… I
felt confident that I knew all assessments & the reason for doing the
assessment, rather than just memorising everything.” Student 10.
“I didn't feel I was expected to know stuff that would rarely/never
use in practice.” Student 23.
These comments are important because they identify that the
changes around increased safety and relevancy have arguably im-
proved the meaningfulness of the activity to the student rather than
implicitly supporting students' engagement in the form of simply
memorising.
Evidence around the value of the revised marking guide (BPG3 and
BPG4) was demonstrated as follows:
“The un-ambiguity of the study guide and the fact that we knew
in advance that it covered all we needed to know.” Student 3.
BPG5 was interested in the delivery that would facilitate maxi-
mum performance of the student. In part, success in this area was
evidenced through comments such as:
“The way the OSCA was set out, i.e. head to toe, made it much
easier to assess the person as the systematic approach was easy to
remember.” Student 45.
Findings that revealed that only a small percentage of students
(12%) thought that being anxious helped, and nearly 80% felt put at
ease by their examiner (Question 4, see Fig. 1), indicated that the
focus on practice and developing mastery as opposed to demonstrat-
ing perfection had a positive effect on student anxiety. Despite this
finding, 88% of students indicated that their nervousness was one of
the worst aspects of the OSCE (Question 5, Fig. 2) suggesting that
Fig. 1. The best aspects of the OSCE.
removing anxiety from the examination process is difficult even when
additional practice and feedback sessions are incorporated.
The impact of the BPG5, 6 and 7 was better addressed through
the customised questions (Appendix B). The questions focussed on
students' study behaviours and their reactions to the OSCE (i.e. stu-
dent engagement). The BPG5, 6 and 7 were focused on facilitating
students' development of study practices through establishing a
process whereby they were more likely to engage in the learning
content. Questions 1 and 2 of the customised questions asked stu-
dents about the study behaviours they ‘should’ enact when preparing
for the OSCE and those they said they ‘did’. The purpose here was to
determine if students realised the merit of engaging in study
behaviours that were geared toward deeper understanding, and if
they were subsequently able and motivated to do so. Results (Fig. 3)
revealed that students' actual study behaviour was always less than
they thought they ‘should’ do, but that this discrepancy was smallest
for those behaviours that students most favoured. Thus, 88% of
students indicated they should ‘use the marking criteria and notes
regarding the OSCE as a guide’, and almost all of these (77%) said they
did. At the opposite end of the spectrum, 42% of students said they
should ‘read through lecture and lab notes to memorise as much as
possible’ but relatively few (21%) did so.
This paper reports on preliminary evidence of the effectiveness of
teaching and assessment practices that were modified in accordance
with the guidelines proposing the best use of OSCEs.
Comments that reflected that the implementation of the OSCE
succeeded in its aim to improve learning and assessment practices
was evidenced where students could make the connection between
the performance of this OSCE and nursing practice, thereby increasing
their confidence:
“The labs were great and supported the content of the course. The
end of semester OSCE was relevant to the requirements of a
nurse.” Student 55.
“Doing this OSCA has increased my confidence for what may come
next year…” Student 12.
“I feel more confident because I can actually demonstrate the basic
 D.D. Nulty et al. / Nurse Education Today 31 (2011) 145–151 149

Fig. 2. The worst aspects of the OSCE.

assessment skills, which will become my grounding for second year
courses. I feel this course & OSCA above other courses has prepared
me more for my 2nd year & also for my 1st year clinical placement.”
Student 18.
Furthermore, although an admittedly crude indicator, the final
question in the additional questions explored whether participa-
tion in the OSCE affected their confidence. After the OSCE, 58% of
students reported feeling more confident about entering second
year.
Overview
The ways students are assessed is widely regarded as the single most
important aspect of the curriculum in determining what, and how,
students learn (i.e. student engagement) (Biggs, 2003; Ramsden, 1992;
Rowntree, 1987). It has been shown that the assessment regime can give
students de facto ideas about curriculum content and learning
requirements, and that these may not match what is stated elsewhere
(Snyder, 1971) — the so called ‘hidden curriculum’. Related ideas have
been expressed by Rowntree (1977), who argued that it is through
assessment, rather than by any other means, that we know our students.

Fig. 3. Preparation strategies used.

150 D.D. Nulty et al. / Nurse Education Today 31 (2011) 145–151
Related to this is the concept of ‘backwash’ (Biggs, 2002, 2006). This idea
is that students' engagement in study behaviours, and the nature of
their cognitions, is influenced by messages they perceive from their
interpretation of the assessment requirements. These messages may not
be messages we wish to convey, and may be contrary to what is
conveyed by other parts of the curriculum. This is partly why Biggs
(2006) argued for constructive alignment of all curricular components
and for all curricular components to be regarded as parts of an
integrated system. It is also why clarity and authenticity in assessment
purposes is important — it relates directly to the students' patterns of
engagement, and the quality of their learning outcomes.
Notwithstanding questions about the intrinsic authenticity of
OSCEs compared with the use of real patients, and ongoing concern
about maximising the predictive validity of OSCEs in relation to the
clinical practice of nurses (e.g. Rushforth, 2007), this modification and
trial application of BPG for OSCEs derived from consideration of
research literature and the considered views of an expert advisory
panel provides affirmative evidence that makes a provisional case for
the effectiveness of these guidelines.
However, consistent with Rushforth's (2007) cautionary notes, this
exercise shows equally that the application of the BPG alone does not
guarantee positive student learning outcomes (many other variables
including the students' ability are inevitably at work). Accordingly, further
research is required to determine the relationship between the revised
OSCE, student learning outcomes and clinical practice performance, as
well as to explore the applicability of the BPG to OSCEs in other institutions
or health programs internationally with different contextual and cultural
features. Such work could also explore more directly the potential for
OSCEs to aid learning rather than to be used purely for assessment.
Conclusion
Generic education strategies in the form of BPG for OSCEs have been
proposed that are potentially applicable across a range of clinically based
health professional education. Further research will support refinement
of the guidelines, and provide examples of successful cases from other
institutions to help guide others in the reform and enhancement of their
assessment practices.
Appendix A. Excerpt of marking guides
Excerpt of prescriptive marking guide — 2006
Assessment test Marks Marks Comments
possible awarded
Assess abdomen
Inspect abdomen 4
Auscultate abdomen in 4 quadrants 4 Question 4
(provide rationale)
Percuss abdomen — 4 quadrants 4
Percuss liver (indicate size) and stomach 4
Palpate abdomen in 4 quadrants 4 aspects? Please tick as many as apply to you.
Palpate liver 4
Palpate for aortic pulsation 2
Total marks
Excerpt of global marking guide — 2007
Assessment test Comments and
marks awarded
Digestive system
Auscultation of abdomen (4 quadrants in correct order)
States frequency and character of sounds heard in abdomen
States rationale for sequence: not to disturb bowel and
to avoid causing more pain if are already tender
Percussion lower border (RUQ) of liver, finding by
describing difference in sounds tympany to dullness
Percussion over stomach (LUQ) moves over gastric bubble
describing sounds
Total marks /15
Appendix B. Custom evaluation of OCSE survey
Question 1
Thinking about the course as a whole, the impression I got about
what I should be doing to prepare myself for the OSCE was:
Please tick as many as apply to you, don't worry about what you
actually did — that's the next question.
□ To rely mostly on the extra “practice sessions”
□ To use the marking criteria and notes regarding the OSCE as a guide
□ To read through my lecture and lab notes to memorise as much as
possible
□ To consult with the lecturer in regard to review of OSCE skills
□ To rely mostly on the labs which are conducted each week
□ To practice skills by using the labs at times which are additional to
the timetabled sessions
□ To think about the theory behind the skills while practicing them
□ To draw on the experiences gained through my clinical prac.
Question 2
We recognize that many factors impact on the choice of the actual
study behaviour you would engage in. Please select the top three study
methods from the list below which most closely match what you actually
did to help you prepare for the OSCE.
What I actually did to prepare for the OSCE was:
□ To rely mostly on the extra “practice sessions”
□ To use the marking criteria and notes regarding the OSCE as a guide
□ To read through my lecture and lab notes to memorise as much as
possible
□ To consult with the lecturer in regard to review of OSCE skills
□ To rely mostly on the labs which are conducted each week
□ To practice skills by using the labs at times which are additional to
the weekly labs
□ To think about the theory behind the skills while practicing them
□ To draw on the experiences gained through your clinical prac.
□ Other? E.g. practice skills on friends, family, etc? (Please specify
below)
Question 3
Please explain the main reason for any difference between your
answer to question 1 and 2. (e.g. you may have been too busy with
other courses to use the strategies)
Thinking back to the OSCE, which of the following were the best
□ I finished in the allocated time
□ I had the chance to show my knowledge
□ The OSCE was just as I had expected it to be
□ I really felt it all came together for me
□ My nerves actually helped me
□ The examiner made me feel at ease
□ Other? (Please specify below)
Question 5
Thinking back to the OSCE, which of the following were the worst
aspects? Please tick as many as apply to you.
□ I did not have enough time to finish
 D.D. Nulty et al. / Nurse Education Today 31 (2011) 145–151
□ I was very nervous
□ I did not feel well prepared
□ It was nothing like I thought it would be
□ I did not feel I was able to show my knowledge
□ The examiner did not make me feel at ease
□ Other? (Please specify below)
Question 6
We would like to know whether you think that you were given
enough information about the OSCE and the manner in which you
would be marked?
Please circle one number on the scale below to indicate your answer.
The amount of information I was given about the OSCE and the
manner in which I would be marked was:
1 2 3 4 5 6 7 Rischbieth, A., 2006. Matching nurse skill with patient acuity in the intensive care units:
Unacceptable Very poor Poor Average Good Very good Excellent
Question 7
Thinking back to the OSCE, do you have anything else you would
like to tell us or any suggestions?
Please explain your answer.
Question 8
Finally, although you do not know your OSCE result, we are
interested to find out if completing the OSCE has had any effect on
how confident you feel about entering the second year. Please indicate
by ticking one of the following.
□ Lower confidence □ No effect □ Higher confidence
Question 9
Please explain your answer to Question 8.
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Dr. Nulty is Senior Lecturer in the Griffith Institute for Higher Education at Griffith
University, Queensland Australia. He has more than a decade of experience in teaching,
course and program evaluation obtained in several large universities. He has also
conducted many educational evaluation consultancies in Australia and overseas.
Dr. Mitchell is a Senior Research Fellow at Griffith University and Princess Alexandra
Hospital. Her previous appointment was Deputy Head of School, Logan Campus,
Griffith University, Brisbane, Australia. She is instrumental in the development and
implementation of innovative educational initiatives designed to improve educational
outcomes for graduate nurses from Griffith University.
Carol Jeffrey is in her third year as an Associate Lecturer in the Undergraduate Nursing
Degree program at Logan Campus teaching across the three years of the degree. Carol
comes from an extensive clinical background and is enrolled in a PhD.
Professor Henderson is the Nursing Director (Education) at the Princess Alexandra
Hospital, Brisbane, Australia, where she is actively involved in maximising clinical
learning opportunities and practices for both undergraduate students and nurses
within the workplace. She has an extensive background in clinical nursing, education
and research and holds a clinical title of professor at Griffith University, Queensland,
Australia.
A/Prof Michele Groves is Associate Dean, Teaching & Learning for the Faculty of
Health Sciences at the University of Queensland. She has wide experience in medical
education with particular emphasis on clinical reasoning, problem-based learning and
medical student selection. Other research interests include inter-professional educa-
tion, work-based learning and assessment.