primary health care | Vol 15 No 10 | December 2005 37 nurse practitioners T here has been a recent emphasis in primary health care upon nurses, in particular nurse practitioners, being involved in the delivery of medical care for the management of both acute and long-term health problems (Long et al 2004). In providing this medical care, nurse practitioners perform a clinical role similar to that of general practitioners. They use advanced clinical practice skills, such as physical assessment, interpretation of test results and the prescription or supply of medi- cines, in conjunction with effective communication skills and patient health education (Barratt 2005). Moreover, the long-term nature of this role transi- tion has been confirmed through the Nursing and Midwifery Council (2004) seeking to regulate nurs- ing practice beyond initial registration, via advanced clinical practice, to ensure competent practitioners are providing this level of practice. Given this recent regulatory interest in advanced practice compe- tence, the methods used in universities for the practical assessment of this competence among advanced practice students are now of paramount importance. This article presents an account of the use of a practical assessment method of advanced clinical practice competence. Registered nurses who wish to practise at a point beyond that of initial registration, such as nurse practitioners, will normally undertake a specific undergraduate or postgraduate study course related to advanced clinical practice. A key element of these advanced practice courses is the acquisition of advanced clinical practice skills by students and subsequent assessment of their advanced practice competence, often using university-based practical examinations. This article offers a case study of the use of such a practical examination in a university, and analyses the use of an objective structured clini- cal examination (OSCE) for the assessment of the advanced clinical practice skills acquisition of trainee nurse practitioners nearing comple- tion of an undergraduate nurse practitioner (primary health care) degree at London South Bank University (LSBU). The historical develop- ment of the OSCE will be presented, followed by a description of the LSBU OSCE, the preparation of OSCE student candidates and OSCE examin- ers, as well as a consideration of the validity and reliability of the OSCE as a practical assessment method of advanced clinical practice skills. OSCE historical development The OSCE was first developed as a method to assess the clinical competence of medical stu- dents (Harden and Gleeson 1979). The OSCE has been defined as a ‘circuit of assessment sta- tions, where a range of practical clinical skills are assessed by an examiner using a previously deter- mined, objective marking scheme’ (Selby 1995). While the literature suggests that the OSCE is a well-established method of clinical assessment within the medical profession, and is increas- ingly used as a practical assessment within other health professions, such as dentistry and radiog- raphy, it is a relatively new method of practical assessment within nursing. But it is one which has gained popularity with the recent primary health care policy emphasis upon nurses using advanced clinical practice skills (Prislin et al 1998, Duerson et al 2000, Holis et al 2000, Khattab and Rawlings 2001). Few studies exist in rela- tion to the use of the OSCE as an assessment of advanced clinical practice competence among nurses. This paper seeks to redress this imbalance by explaining how the OSCE can be used as a method for the assessment of the accomplish- ment of advanced clinical practice competence among nurse practitioner students. The LSBU nurse practitioner OSCE In 1992 the RCN Institute nurse practitioner programme pioneered the use of the OSCE as a summative examination to assess the attain- ment of advanced clinical practice skills by nurse practitioner students, as taught and developed throughout the programme. The RCN Institute nurse practitioner programme subsequently trans- ferred to LSBU in 2000, where it continues to be successfully provided as both an undergraduate degree and postgraduate diploma and degree, all with RCN accreditation. This nurse practitioner course was one of the first nursing programmes Assessment of nurse practitioner advanced clinical practice skills: using the objective structured clinical examination (OSCE) Helen Ward and Julian Barratt examine how OSCEs can be developed to ensure a robust assessment of clinical competence