An implementation framework for using OSCEs in nursing curricula

Objective Structured Clinical Examinations (OSCEs) are widely used across health education to determine that students are able to assimilate and apply theoretical knowledge in practice. A systematic review by Mitchell et al. (2009) identified a number of papers discussing OSCEs; they invariably provide explicit details about what constitutes their effective use. However, there is often little discussion about the pragmatics, namely, how OSCEs have been implemented into curricula. This situation parallels the difficulty that clinicians have in the clinical setting of integrating strong evidence into practice (Winch et al., 2005). One critical success factor for implementing best practice is the effective facilitation of change processes (Kitson et al., 2008). There is little clarity about what constitutes effective facilitation. Successful ‘facilitation’ processes are largely unexplored (Helfrich et al., 2010) however crucial factors include best practice being shaped or modified to suit the specific context (Winch et al., 2005). OSCEs are a regular component of nursing, midwifery and medical programmes in Australia and internationally. Best practice guidelines have been established to assist with their incorporation into the curriculum (Nulty et al., 2011). They can be a valuable strategy for determining ‘fitness to practice’ in the clinical setting, however, there is little guidance about how to effectively implement them. This commentary draws on the experience of trialling best practice guidelines that were used to review OSCEs currently being used across three diverse education programmes (post registration rural and remote nursing, undergraduate midwifery, and undergraduate nursing). Trialling of guidelines was funded by the Australian Learning and Teaching Council (Australian Government Office of Learning and Teaching, 2012). The proposed implementation framework emerged through shared experiences of the project leader, project officer, participating leads from education facilities offering the programmes, and observations and feedback from project members familiar with OSCEs. The framework was derived from exploring and describing the processes and situations that contributed to the success of the trial. The framework comprises four stages defined as Opportunity, Organisation, Oversight, and Outcomes (the Four Os)