Advances in Medical Education and Practice (Jun 2025)
Perception of Medical and Nursing Students Plus Clinical Instructors Towards Objective Structured Clinical Examination: A Case Study of Five Health Training Institutions in Sub-Saharan Africa
Abstract
Ronald Kibuuka,1 Ferestas Mpasa,2 Andrew Marvin Kanyike,1 Chizoma Millicent Ndikom,3 Atipatsa Chiwanda Kaminga,2 Samuel Owusu-Sekyere,4 Adenike Ogah,5 Abigail Kusi Amponsah,6 Kennedy Kiyimba,1 Samuel Baker Obakiro,1 Getrude Munthali,2 Wanangwa Kenneth Msowoya,2 Dan Kibuule,7 Etta Chimbe Phiri,2 Masumbuko Baluwa,2 Tamara Phiri,2 Richard Katuramu8 1Department of Pharmacology and Therapeutics, Busitema University Faculty of Health Sciences, Mbale, Uganda; 2Department of Nursing and Midwifery, Mzuzu University, Mzuzu, Malawi; 3Department of Nursing, College of Medicine, University of Ibadan, Ibadan, Nigeria; 4African Forum for Research and Education in Health, Kumasi, Ghana; 5Department of Pediatrics and Child Health, School of Medicine, University of Zambia, Lusaka, Zambia; 6Department of Public Health Nursing, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; 7Office of the Dean, Busitema University, Faculty of Health Sciences, Mbale, Uganda; 8Department of Internal Medicine, Busitema University Faculty of Health Sciences, Mbale, UgandaCorrespondence: Ronald Kibuuka, Email [email protected]; [email protected]: 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.Plain Language Summary: 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.Keywords: OSCE, health care professions education, Sub-Saharan Africa, medical assessment
