Kibuuka Ronald, Mpasa Ferestas, Kanyike Andrew Marvin, Ndikom Chizoma Millicent, Kaminga Atipatsa Chiwanda, Owusu-Sekyere Samuel, Ogah Adenike, Kusi Amponsah Abigail, Kiyimba Kennedy, Obakiro Samuel Baker, Munthali Getrude, Msowoya Wanangwa Kenneth, Kibuule Dan, Phiri Etta Chimbe, Baluwa Masumbuko, Phiri Tamara, Katuramu Richard
Department of Pharmacology and Therapeutics, Busitema University Faculty of Health Sciences, Mbale, Uganda.
Department of Nursing and Midwifery, Mzuzu University, Mzuzu, Malawi.
Adv Med Educ Pract. 2025 Jun 28;16:1103-1127. doi: 10.2147/AMEP.S520065. eCollection 2025.
Objective Structured Clinical Examination (OSCE) is the gold standard for assessing clinical competencies. However, resource constraints and logistical challenges in Sub-Saharan Africa (SSA) hinder its effectiveness. This study investigated the perceptions and experiences of medical and nursing students and clinical instructors toward OSCE in Sub-Saharan Africa (SSA).
A mixed-methods sequential explanatory design was utilized involving 686 undergraduate health care students and 46 clinical instructors from Busitema University (Uganda), Mzuzu University (Malawi), University of Ibadan (Nigeria), Kwame Nkrumah University of Science and Technology (Ghana), and University of Zambia (Zambia). Quantitative responses were analyzed using IBM SPSS Statistics version 25, with comparisons between medical and nursing student responses made using chi-square test. Qualitative data were thematically analyzed.
A total of 686 students and 42 clinical instructors participated in the study. Majority of students 57.6% (n = 395, P-value < 0.001) and 71.8% (n = 33) instructors recognized OSCE as a comprehensive tool for assessing clinical skills and knowledge, respectively. Among students, 80.8% (n = 554, P-value = 0.031), 66.6% (n = 457, P-value = 0.001), 66.6% (n = 456, P-value = 0.020) and 61.4% (n = 421, P-value = 0.001) cited anxiety, station timing, examiners' behavior and content load as factors influencing performance. Of the clinical instructors 58.7% (n = 27) noted that it takes longer time to prepare scenarios, however 71.8% (n = 33) highlighted its objectivity. Students praised OSCE's objectivity but criticized insufficient time on some stations and organizational issues. Facilitators cited objectivity and competence assessment but noted resource insufficiencies and student stress. Suggestions for improvement included mock OSCEs, training of clinical instructors, mixed method assessment and feedback to improve performance.
In conclusion, while OSCE demonstrates significant strengths in promoting fairness in assessing clinical competencies, addressing logistical challenges, examiner variability, student anxiety, and timely feedback is crucial.
客观结构化临床考试（OSCE）是评估临床能力的金标准。然而，撒哈拉以南非洲（SSA）的资源限制和后勤挑战阻碍了其有效性。本研究调查了撒哈拉以南非洲（SSA）医学和护理专业学生以及临床教师对OSCE的看法和体验。
采用混合方法序列解释性设计，涉及来自布西泰马大学（乌干达）、姆祖祖大学（马拉维）、伊巴丹大学（尼日利亚）、夸梅·恩克鲁玛科技大学（加纳）和赞比亚大学（赞比亚）的686名本科医护学生和46名临床教师。使用IBM SPSS Statistics 25版对定量回答进行分析，使用卡方检验对医学和护理专业学生的回答进行比较。对定性数据进行主题分析。
共有686名学生和42名临床教师参与了该研究。大多数学生（57.6%，n = 395，P值<0.001）和71.8%（n = 33）的教师分别认为OSCE是评估临床技能和知识的综合工具。在学生中，80.8%（n = 554，P值 = 0.031）、66.6%（n = 457，P值 = 0.001）、66.6%（n = 456，P值 = 0.020）和61.4%（n = 421，P值 = 0.001）提到焦虑、考站时间、考官行为和内容量是影响表现的因素。58.7%（n = 27）的临床教师指出准备场景需要更长时间，然而71.8%（n = 33）强调了其客观性。学生们赞扬了OSCE的客观性，但批评了一些考站时间不足和组织问题。促进因素包括客观性和能力评估，但指出资源不足和学生压力。改进建议包括模拟OSCE、临床教师培训、混合方法评估和反馈以提高表现。
总之，虽然OSCE在促进临床能力评估的公平性方面具有显著优势，但应对后勤挑战、考官差异、学生焦虑和及时反馈至关重要。
