Date of Award

Spring 5-3-2024

Level of Access Assigned by Author

Open-Access Dissertation

Language

English

Degree Name

Doctor of Philosophy (PhD)

Department

Interdisciplinary Program

Advisor

Kelley Strout

Second Committee Member

Janet Fairman

Third Committee Member

Carla Nye

Additional Committee Members

Patricia Poirier

Kathryn Robinson

Abstract

Objective Structured Clinical Examinations (OSCE) are a promising teaching tool to address competency development and evaluation in Family Nurse Practitioner (FNP) education. This three-manuscript dissertation aimed to explore and improve the state of OSCE simulation science in FNP education within the current climate of adopting a competency-based framework in nursing education. The first manuscript is a systematic review designed to compare OSCE and standardized patient simulation to standard teaching and learning methods in FNP programs. After applying inclusion criteria, no research studies experimentally addressed the inclusion criteria. There were relevant studies in other advanced nursing practice disciplines, uncovering the lack of, and challenges with, empirical investigation within FNP education. The second manuscript is a short communication calling for the inclusion of learning theories and other relevant theoretical frameworks for FNP simulation research and curricular integration. The third manuscript presents an original phenomenological qualitative study. The aims of the study were to explore recent FNP graduates’ perceptions of using OSCEs to develop and evaluate competency behaviors, and how learners relate OSCEs to preparing for clinical learning and later clinical practice. The researcher employed thematic analysis methods using interview data from nine recent FNP graduates across the U.S. Four themes emerged: becoming competent and “making it stick,” design impacts reactions and learning, “dress rehearsal” for clinical experiences, and establishing routines for practice. The results of this study support current science highlighting positive reactions of learners and the utility of OSCEs to provide concrete experiences for application of learning and development of cognitive frameworks. Recommendations from the analysis urge faculty to adopt OSCE best-practice guidelines to ensure positive reactions and therefore learning. Also, FNP students described transferring behaviors from OSCEs to clinical learning and early practice which supports successful transitions. Overall, the dissertation calls attention to the lack of FNP-specific research on the topic of OSCEs. Future research needs to explore the integration and experimental outcomes of psychometrically-sound OSCE rubrics, theoretical frameworks supporting simulation programming and research, and address concerns of OSCE return on investment by exploring behavior change and outcomes beyond graduation.

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