Background: 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).
Methods: 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.
Results: 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.
Conclusion: 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.
Keywords: OSCE; Sub-Saharan Africa; health care professions education; medical assessment.
This study explored the perception of medical and nursing students and clinical instructors Objective Structured Clinical Examination (OSCE) in five sub-Saharan African health training institutions (Uganda, Malawi, Nigeria, Ghana, Zambia). We used questionnaires among 686 students and 46 clinical instructors, focused group discussions, and key informant interviews to find out their perception. Both students and clinical instructors mostly preferred OSCE because it is fair, organized, and tests real healthcare skills more than the conventional methods like long case. But students said the time on some stations was too short, stressful, and noted challenges during OSCE such as lack of some materials on some stations. Teachers agreed that OSCE is helpful but hard to do due to insufficient staffing and space. Both suggested more practice sessions through Pre OSCE, better training for teachers, and feedback to help students improve. The study confirms that OSCE is the most efficient way to evaluate nursing and medical students, however the study also highlights that a mixed method evaluation would be the best option for evaluation of clinical competence.
© 2025 Kibuuka et al.