Online OSCE for Nursing Education

Objectives of the activity

• Provide a practical solution for an online OSCE in a secure and reliable manner
• Provide healthcare educators with an adaptable solution to conduct an online OSCE that can be contextualised to different disciplines
• Overcome location barriers for students who are unable to attend on campus assessment

Suitable for

• Nursing
• Midwifery
• Pharmacy
• Physiotherapy

Assessment type

Summative

Time required

Build	Teach	Assess
3 hours	40 minutes	2 hours

What tools you can use

• Zoom (breakout rooms)
• Quizzes in the LMS
• Booking Tool (Doodle or MS Bookings)
• Instant messaging app (alternatively Traffic light tracker using Google Sheet)

Guiding principles

• #5 Clearly communicate expectations to students
• #6 Clearly communicates subject learning outcomes and learning objectives
• #8 Comply with UTS policies and legislative requirements

Creating online OSCE

The goal of the OSCE is to provide students with the opportunity to demonstrate their ability to synthesise and interpret clinical information, and articulate and justify decision making. Similar to a physical space,  conducting an OSCE in an online environment requires careful design and preparation. The following sections provide the essential steps for designing and implementing an online OSCE.

Three weeks before exam

Step 1: setting up the subject site in the LMS

Under assessment area, provide complete instructions for students about the online OSCE. Include the instructions; clear guidance on the assessment in the online environment, list of FAQs, academic integrity resources and a discussion board to allow students the opportunity to ask questions before the exam. (See example of content area in the LMS in Appendix A).

Step 2: creating the online OSCE stations using a video conferencing tool

Although there are a number of video conferencing tools available, Zoom is used in this resource. To benefit from the affordances of Zoom, several functionalities can be repurposed to serve the design of the assessment including:

• Meeting settings
  • Ensure meeting settings are correct and adjusted to the requirement of the test. You can check through Zoom profile settings.
• Breakout rooms
  • Zoom breakout rooms simulate the OSCE stations. The host needs to rename breakout rooms to ‘Stations’ as in the image below. This can be done before the exam session, however allocation of students to the stations will be during the exam, so it’s not recommended to pre-assign students to stations before the exam. In this Nursing OSCE, four breakout rooms simulate the four stations.

Step 3: create a debrief room

Create a separate meeting for the debrief room. This is an essential last stop where students reflect on their experience during the OSCE. A good teaching practice is to set up the debrief session straight after an assessment or at least on the same day of the online OSCE. This will help them unpack their learning skills, prepare, and practice for the assessment. It’s recommended to have 3-4 students in a debrief room to to allow adequate time per student. 

The purpose of the debrief room is to get students’ perspective on how they managed during the OSCE and ensure that students didn’t go away feeling anxious or concerned about their performance. Hence, starting with statements that calm their anxiety can be a good start. Ask students a question like: ‘is there anything that you might do differently now that you have had some time to reflect?’.  This question will provide an opportunity for students to reflect on what they did. In some subjects this is usually linked to Course Intended Learning Outcomes. This might assuage anxiety as it provides an opportunity to ‘rewrite’ what happened, even if it doesn’t change the outcome.

Then the debrief host will ask more specific questions, such as questions about the authenticity of the set up, and give them the opportunity to reflect on their quick thinking and responsiveness. Questions such as ‘what did you learn from your own responses to a challenging situation?’ and ‘how did you calm your nerves and think logically about the questions you were asked to do?’ will help students think about the self-care that they would need as nurses in stressful situations.

If applicable, ask examiners in different stations to provide some feedback on each of the students.

Step 4: scheduling students attendance to the online OSCE using MS Bookings or Doodle

Provide students with the opportunity to book their OSCE starting time. This will offer students convenience as they may need to arrange their hospital shifts in advance. Use MS Bookings (e.g. MS Bookings Online OSCE Booking) or Doodle (e.g. Doodle Online OSCE Booking) to manage students’ arrival to the exam session.

Step 5: examiners, simulated patients and quizzes in stations

The next step is for the examiners/instructors to be assigned to the OSCE stations. Examiners will need to maintain a check list of students’ completion of the assessment in each station and enter feedback straight into LMS. For example use SpeedGrader in Canvas and add ‘Grading Notes’ in Blackboard (UTSOnline) Grade Centre. Make sure these are created before the exam. Setting up the quizzes requires adjusting the test options to be suitable for students to attempt the quiz while they are in the Zoom session. While students may not need to interact with the examiner in the station, it’s important that they are able to attempt the quiz in a timely fashion. Here are important things to consider:

• Deploy the quiz into the ‘Content area’ in Blackboard, or under ‘Assignments’ in Canvas. This will ensure that students’ attempts are recorded and automatically graded to be included in the final mark.
• Ensure that students have sufficient instructions to answer the questions. Allow students to backtrack to previous questions (unless previous questions contain clues).
• Use high-resolution digital photos for medical images (e.g. ECG image) so students can easily read the details.
• Allow time for students to ask questions before starting the quiz.
• Before starting the OSCE, ask students to ensure the quiz page on the subject site in the LMS is open and ready for them to attempt the quiz. This can save students time during stations 3 and 4.

Step 6: mock OSCE

Prepare a mock exam and invite students to experiment with the online OSCE. This step is important and essential to decrease anxiety and uncertainty of the exam. Practicing the online exam will enable students to identify any technical issues (e.g. speakers, volume, screen, access to LMS) and address them in good time.

During the exam

Logistics

Running the OSCE in an online environment requires managing logistics and communication between stations. The main host can moderate students’ access to the stations using the ‘Breakout rooms’ assignment function. The main host will be:

• Admitting students to the main room.
• Allocating students to stations and rotating them between stations.  
• Keep track of the time each student spends in each station.

Communications

During the OSCE session communications between stations and the main host of the Zoom session are limited to the affordances of the video conferencing tool. Among the options that can be used to manage communications:

• Create a WhatsApp group so examiners in the four stations can communicate between each other and with the main host.
• Examiners in the stations can use a traffic light system that can be created using a shared google docs or google sheet (e.g. OSCE traffic light).

Students

Managing student’s expectations

Student anxiety is considered to be high with any assessment and can be more complicated with viva assessments. Subject coordinators are encouraged to provide supporting materials for students about what to expect, how to conduct yourself and how to prepare. 

You may also need to check the quiz questions and ensure that questions are unambiguous, clear and relevant. A trial quiz can help students learn what to anticipate in a station and how they will be able to manage their time as they respond to questions in the LMS.

Tips for students

• Allow time for students to practice the online OSCE
• Add alternative host when scheduling the meetings
• Remind students to use a computer device and avoid smartphones or tablets. 
• Add a password to the quizzes
• In the main room the meeting host can have a co-host to help with managing logistics
• Ensure students have access to reliable internet connect, audio and video devices
• Assess students over a few days rather than the whole cohort at once

Example

Here are some instructions that can be used to implement the online OSCE in the LMS: 

Also, adding frequently asked questions pages can minimise the volume of individual student emails. Use this example for tips in creating FAQ pages on the subject site. Remind students about academic integrity and code of ethics in the nursing profession. Check Appendix A for screen shots from the subject site in UTSOnline. 

What research tells us

The objective structured clinical examination (OSCE) is used in nursing education to assess clinical skill proficiency at pre-registration and postgraduate level. The test aims to help students gain confidence to use their skills in their clinical work. The test is normally performed in a simulated clinical unit where students are required to demonstrate their skills and abilities to analyse and synthesis input. OSCEs generally feature a number of skills stations (Kelly, et. al, 2016), in this resource there are 4 stations with 20 minutes allowed per station. 

The aim of the resource is to provide guidance to healthcare educators who need to prepare and develop a suitable solution to clinical skills examinations under certain constraints, for example, students are unable to attend due to travel barriers or pandemic situations similar to COVID19. The online OSCE for Nursing Education illustrates how it is possible to design and implement nursing skills examinations (OSCEs) to ensure the validity and reliability of high-stakes performance assessments whilst protecting the safety of all participants, minimising risk and maintaining defensibility to key stakeholders (Boursicot, et al., 2020).

References

Boursicot, K., Kemp, S., Ong, T. H., Wijaya, L., Goh, S. H., Freeman, K., & Curran, I. (2020). Conducting a high-stakes OSCE in a COVID-19 environment. MedEdPublish, 9.

Kelly, M. A., Mitchell, M. L., Henderson, A., Jeffrey, C. A., Groves, M., Nulty, D. D., … & Knight, S. (2016). OSCE best practice guidelines—applicability for nursing simulations. Advances in Simulation, 1(1), 10.

Additional resources

Citation and attribution

Fatayer, M., Garratt, L., Forrest, G., Wilson, A (2020). “Online OSCE for Nursing Education” in Reusable Activities for Teaching with Technology, LX.lab, Institute for Interactive Media & Learning, University of Technology, Sydney.

“Online OSCE for Nursing Education” by School of Nursing and Institute for Interactive Media & Learning, University of Technology, Sydney. Available from lx-dev.uts.edu.au/collections/adaptable-resources/resources/online-osce-for-nursing-education/ under Creative Commons Licence Attribution-NonCommercial-ShareAlike 4.0 International