Nurses Reveal What the OSCE Exam Really Feels Like on the Hospital Floor

The Objective Structured Clinical Examination, better known in medical education circles as the OSCE, has long been treated as the gold standard for testing whether a clinician can actually do the job rather than merely describe it. In an OSCE, candidates rotate through a circuit of timed stations, each designed to probe a specific skill, from taking a patient history to performing a sterile procedure, while trained examiners score them against standardized checklists. The format was engineered to strip away the subjectivity of traditional oral exams and the artificiality of written tests, replacing both with a controlled simulation of real clinical work. Yet for all its methodological rigor, the OSCE is ultimately experienced by human beings under pressure, and a new study argues that those lived experiences matter just as much as the psychometric machinery behind the exam.

Researchers at Kermanshah University of Medical Sciences in Iran set out to capture exactly how practicing nurses perceive this structured evaluation, publishing their findings in BMC Nursing. Rather than measuring pass rates or checklist scores, the team took a qualitative approach, conducting semi-structured face-to-face interviews with fourteen registered nurses at Imam Reza Hospital in Kermanshah. Participants were selected through purposeful sampling with maximum variation, a deliberate strategy to ensure the sample spanned differences in clinical background, experience level, and perspective rather than reflecting a single narrow viewpoint. Each interview was transcribed verbatim and then subjected to conventional qualitative content analysis, an inductive method in which themes emerge from the data itself rather than from a predetermined framework. The researchers used MAXQDA software to organize and manage the growing body of coded material, and they reported their work according to the COREQ criteria, the consolidated standards for transparency in qualitative research.

What emerged from the analysis was a remarkably rich map of how nurses actually relate to the OSCE. The data resolved into eight main themes: the meaning of the OSCE, personal experience with the exam, its impact on professional performance, the challenges of its implementation, its role in the teaching-learning process, its advantages and disadvantages, the expectations nurses hold of it, and their suggestions for improvement. That structure alone tells a story. Nurses do not experience the OSCE as a single event but as something layered, simultaneously an assessment, a learning opportunity, a source of stress, and a mirror held up to their own competence.

The most striking finding is the tension at the heart of that experience. On one hand, participants consistently described the OSCE as a highly comprehensive and educational tool, one that forces the integration of theoretical knowledge with hands-on clinical practice. In an era when nursing education is frequently criticized for producing graduates who can recite pathophysiology but freeze at the bedside, that bridging function is precisely what performance-based assessment is supposed to deliver. Nurses in the study valued the exam as a way of reviewing clinical knowledge and verifying competencies they might otherwise take for granted, effectively using the stations as a rehearsal space for the realities of ward work.

On the other hand, the same nurses identified significant operational challenges that eroded the exam’s value. Physical fatigue featured prominently, a consequence of the sheer duration and intensity of moving through a multi-station circuit while being continuously evaluated. Long waiting times between or before stations compounded the problem, leaving candidates idle and anxious in ways that may have little to do with their actual clinical ability. Stress related to station scheduling added a further layer of difficulty, since the order in which a nurse encounters stations can shape confidence, pacing, and performance. These are not trivial complaints. Assessment science has long recognized that anxiety and fatigue can degrade performance independently of competence, which means poorly organized OSCEs risk measuring endurance and stress tolerance rather than clinical skill.

The researchers conclude that the effectiveness of the OSCE is heavily influenced by scheduling, organization, and station design, and they point to a specific remedy: aligning stations with the clinical demands of the wards where nurses actually work. This is a deceptively powerful recommendation. A generic OSCE station on, say, pediatric assessment may be appropriate for nursing students, but for practicing nurses on an adult intensive care unit, the assessment gains both validity and motivational force when the scenarios mirror the procedures, equipment, and patient populations they face daily. Contextualized station design transforms the exam from an external hurdle into a genuine rehearsal of professional reality, which in turn amplifies its educational payoff.

The study’s implications extend well beyond a single hospital in western Iran. The OSCE is used across medicine, dentistry, pharmacy, and nursing worldwide, and its adoption continues to grow as regulators seek defensible ways to certify clinical competence. But the method’s strengths are conditional. A well-run OSCE can provide objective, reproducible measurement of skills that written exams cannot touch. A poorly run one can exhaust candidates, introduce noise through logistical chaos, and squander the goodwill of the very professionals it is meant to develop. The Kermanshah findings suggest that institutions should treat the OSCE not as a fixed protocol to be replicated but as a system to be engineered, with attention to pacing, waiting environments, station sequencing, and the physical demands placed on participants.

There is also a broader lesson about whose voice counts in assessment design. Examiners and educators typically decide what competence looks like and how it should be measured, while the people being assessed are rarely consulted in a systematic way. By treating nurses’ lived experiences as legitimate data, this study flips that hierarchy and reveals insights that would be invisible from the examiner’s side of the checklist. Fatigue, waiting, and scheduling stress are administrative details from one perspective and decisive performance variables from another. Qualitative research of this kind functions as a feedback loop, converting the subjective experience of test-takers into actionable design parameters.

For nursing leaders and educators, the practical takeaways are concrete. Schedule OSCEs to minimize waiting and avoid stacking them against heavy clinical shifts. Design stations around ward-specific competencies so that preparation doubles as professional development. Monitor fatigue as seriously as scoring accuracy, because an exhausted candidate is not a valid measurement subject. And keep listening: the same qualitative methods that surfaced these challenges can be used iteratively to refine the exam over time. The OSCE’s promise, as this study makes clear, is real but conditional. It succeeds as an educational and assessment instrument only when the human beings moving through its stations are treated not just as examinees, but as professionals whose experience of the exam is itself a measure of its quality.

Subject of Research: Nurses' lived experiences of the Objective Structured Clinical Examination as an assessment of clinical competence

Article Title: Exploring nurses’ experiences of the OSCE exam: a qualitative study

Article References: Majidipour, P., Shourani, S. J., Asadi, P., Rahmani, A., & Parsa, H. (2026). Exploring nurses’ experiences of the OSCE exam: a qualitative study. BMC Nursing. https://doi.org/10.1186/s12912-026-05305-4

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05305-4

Keywords: OSCE, nursing education, clinical competence, qualitative research, content analysis, objective structured clinical examination, assessment design, nurse experiences, medical education, BMC Nursing, Iran, performance-based assessment