Volume 25 Number 4 – SUMMER 2012 14 Using OSCAs to assess graduate perioperative nurses: an exploration and analysis of the literature Introduction This literature review aims to answer the question “is the objective structural clinical assessment (OSCA) an appropriate method of assessment for graduate perioperative nurses?” Specifically, the aim is to answer whether it is appropriate to assess clinical competency using the OSCA and whether the measurement instruments that form the basis of OSCAs are supported by evidence. The OSCA can be defined as “an objective method of assessing a student’s clinical competence where the areas tested and the evaluation criteria are determined in advance from course content and objectives” 1 . As an assessment tool, OSCAs are designed to allow areas of different clinical skills, attitudes, problem-solving abilities and factual knowledge to be defined and assessed in an objective fashion 1 . Methods This review reports only the articles relevant to the assessment of graduate nurses’ clinical skills in their first year of work; the utilisation of OSCAs as an assessment tool for graduate nurses in the clinical setting; and defining “clinical competence” in the graduate nurse. A search for literature was conducted and search terms were entered into the CINAHL, Medline and ScienceDirect databases. Literature between January 2001 and August 2011 was retrieved using the following search terms: OSCE; OSCA; competenc* AND nurs* assess*/measure*/evaluat*; graduate nurse assess*; Benner AND assess* and Bondy rat* scale. Only the abstracts of research papers in English were reviewed; non-research papers were excluded. The literature review initially yielded 229 results between CINAHL and Science Direct. After removing duplications, 36 papers were relevant to the review. Subsequently, the following inclusion criteria were used: •฀ The฀main฀focus฀of฀the฀research฀was฀general฀clinical฀competence. •฀ The฀research฀related฀to฀the฀assessment฀of฀nursing฀graduates฀and/or฀ nurses. •฀ The฀study฀samples฀were฀nursing฀graduates฀or฀nurses. •฀ The฀ research฀ was฀ related฀ to฀ non-simulation-based฀ nursing฀ performance. Following this, 18 were assessed as being appropriate for this review. Only 10 were available as full text. Results From the review, two main issues dominated the literature. The need to define clinical competence (n=8) and the lack of appropriate measurement instruments used in OSCAs (n=8); specifically, the reliability, validity and establishment of more rigorous methods used to define success in OSCAs. Articles on OSCAs and clinical competence accounted for the majority of literature (n=9) whilst papers focusing on the student experience in OSCAs represented the smallest proportion (n=2). The dominant form of study designs used in the articles reviewed was equally represented by cross-sectional studies and systematic reviews (n=5). Discussion Defining clinical competence In 2005, the National Competency Standards for the Registered Nurse, were developed to clarify the definition of clinical competence 2 . The standards were developed and represent “a combination of skills, knowledge, attitudes, values and abilities that underpin effective and/or superior performance in a professional/occupational area” 2 . Firm statements on competency such as ANMC’s can be viewed as moving with a degree of boldness due to the philosophical differences surrounding the notion, not to mention the abstruseness of the available research on clinical competence. According to the literature, attempts to define clinical competence have resulted in the emergence of vague concepts that are lacking in unanimity among PEER REVIEWED ARTICLE Nicholas Ralph • Learning and Teaching Education Research Centre, Lecturer in Nursing, School of Nursing & Midwifery, CQUniversity, Noosaville, QLD Philip Norris • Learning and Teaching Education Research Centre, Registered Nurse, Princess Alexandra Hospital, Woolloongabba, QLD Abstract This literature review aims to explore the appropriateness of the objective structural clinical assessment (OSCA) as method of assessment for graduate perioperative nurses. The methodology used involved searches of the following databases: CINAHL and Science Direct. The terms used in the search were: OSCE; OSCA; competenc* AND nurs* assess*/measure*/evaluat*; graduate nurse assess*; Benner AND assess* and Bondy rat* scale from January 2001 to August 2011. Strict inclusion and exclusion criteria were applied. This resulted in the inclusion of 10 papers. These papers predominantly addressed the need to define clinical competence, the lack of appropriate measurement instruments used in OSCAs – specifically; the reliability, validity and establishment of more rigorous methods used to define success in OSCAs. The paper concludes by finding that the literature does not achieve consensus regarding the definition of competence nor does it identify appropriate measurement instruments. Gaps and contradictions in the literature are evident, leaving doubts over the reliability of using OSCAs as a means to determine the notion of “clinical competence”. Longitudinal studies are needed to define clinical competence and to track the use and relevance of OSCAs in the clinical setting.