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Overcoming OSCE anxiety

02 May 2022
9 min read
Volume 33 · Issue 5


Objective structured clinical examinations (OSCEs) can generate more anxiety than other forms of assessment. Ginny Chappell looks at methods of overcoming this

Objective structured clinical examinations (OSCEs) are used to assess competency in advanced practice programmes. OSCEs generate more anxiety than other forms of assessment, which can be helpful to motivate studying but 20% of students find their performance is affected. OSCE anxiety may activate the sympathetic nervous system (flight for fight response). Worrying and catastrophising can lead to negative self-talk and increase stress levels further. These thought patterns and behaviours can be overcome using mindfulness techniques (including deep breathing exercises and grounding techniques), thought reframing or cognitive behavioural therapy (CBT), and with careful preparation for the examination. Mindfulness reduces the sympathetic response and CBT retrains the brain to increase the positive self-talk. Together these techniques help students overcome OSCE anxiety and give their best performance in the examination.

Objective structured clinical examinations (OSCEs) were developed 50 years ago to objectively assess the competency of medical students' clinical skills (Harden, 2016). A standardised patient scenario is used to examine clinical and communication skills, which are assessed against a marking criteria. OSCEs have become a widely accepted form of assessment in many professions including nursing, due to their reliability and validity (Taylor et al, 2019). OSCEs are used in post-graduate programmes such as non-medical prescribing and advanced practice to assess history taking, physical assessment and decision-making skills (Núñez-Peña et al, 2016). Some students report higher levels of anxiety and stress before OSCEs compared with other assessments (Nulty et al, 2011; Barry et al, 2012). As a high stakes examination, the pressure to pass and complete the programme adds to the OSCE being anxiety provoking (Martin and Naziruddin, 2020).

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