
==== Front
J Educ Health Promot
J Educ Health Promot
JEHP
J Edu Health Promot
Journal of Education and Health Promotion
2277-9531
2319-6440
Wolters Kluwer - Medknow India

JEHP-13-178
10.4103/jehp.jehp_1511_23
Original Article
Attitude and level of satisfaction on objective structured practical examination and traditional practical examination among undergraduate nursing students
Sharvan P Muhammad
Ullas Anju
Vasanth Indumathi
Department of Medical Surgical Nursing, Yenepoya Nursing College, Yenepoya (Deemed to be University), Mangaluru, Karnataka, India
Address for correspondence: Dr. Anju Ullas, Department of Medical Surgical Nursing, Yenepoya Nursing College, Yenepoya (Deemed to be University), Mangaluru, Karnataka, India. E-mail: anjuullas@yenepoya.edu.in
2024
05 7 2024
13 17821 9 2023
04 12 2023
Copyright: © 2024 Journal of Education and Health Promotion
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
BACKGROUND:

Objective structured practical examination (OSPE) and traditional practical examination (TPE) are two different methods used to evaluate the theoretical and practical skills among students. The present study assessed the attitude and level of satisfaction of undergraduate nursing students toward OSPE and TPE.

MATERIALS AND METHODS:

A comparative research design study was conducted at Yenepoya Nursing College in 2022. The samples were 4th year B.Sc nursing students who have experienced both types of examination system and are selected by using the non-probability purposive sampling technique. The selected 102 students are further divided into two groups (51 students in each group) by the chit method: one group for assessing the attitude and level of satisfaction toward OSPE and the other group for assessing the attitude and level of satisfaction toward TPE. The tools used were demographic proforma, structured attitude, and satisfaction scale. The collected categorical data were represented as frequency and percentage, and quantitative data are represented in terms of mean and standard deviation. The Mann–Whitney U test was used to compare the attitude and level of satisfaction between the two groups.

RESULTS:

The majority [32 (65.7%)] of the participants had positive attitude toward the OSPE, and the majority [30 (61.5%)] of the samples had neutral attitude toward TPE. Most of the students [27 (55.3%)] had a good level of satisfaction toward the OSPE. The majority [28 (56.3%)] of the samples had an average level of satisfaction toward TPE. The median of attitude score was 48.32 with 3.35 inter-quartile range (IQR) on OSPE and 44.40 with 3.35 IQR on TPE. The median of level of satisfaction was 50.95 with 1.69 IQR on OSPE and 46.05 with 1.69 IQR on TPE.

CONCLUSIONS:

The study concluded that the students have positive attitude and a good level of satisfaction toward OSPE and neutral attitude and an average level of satisfaction toward TPE. The results provide important implications for choosing a different examination strategy and increasing the standard for the educational and evaluation systems.

Attitude
level of satisfaction
objective structured practical examination
traditional practical examination
undergraduate nursing students
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pmcIntroduction

Clinical skills are important in the nursing field. The success of trainees depends on what they memorize and perform.[1] Effective and accurate clinical evaluation should be of concern in the nursing field.[2] Students need to know very clearly delineated the specific objectives by which they are being evaluated, which is termed as performance-based assessment.[3]

Objective structured practical examination (OSPE) refers to a multi-system analysis using actual or virtual patients to assess clinical abilities, behaviors, and cognitive skills.[4] OSPE is performed at different stations. Theoretical expertise is often tested in addition to practical and problem-solving skills.[5]

The traditional practical examination (TPE) refers to the method which includes writing comprehensive procedures of one or two practical assessments. It is accompanied by un-observed self/subject results.[4] The TPE assessment and evaluation is made based on global performance rather than the candidate’s individual competency. Many of the concerns inherent in the traditional practical review of patients involve the variability of the investigator and examiner, which greatly affects the scoring.[5]

A study conducted in New Delhi, India, reported that 58% of the samples had a negative attitude toward nursing clinical examination and 57% of the samples suggested some changes in the examination pattern.[5] Another study also stated that 74.4% of the students strongly agreed that OSPE is fairer in comparison to TPE. 90.5% students strongly agreed that variability of the examiner and patient can be removed to a large extent by OSPE.[6]

A steady increase in number of students enrolled for the nursing program might increase the chances of malpractice that compromise the patient’s care. In addition to that, limited resources from clinical areas might hinder the opportunity of students to practice on patients.[7]

Hence, the researcher felt the need to identify the attitude and level of satisfaction of nursing students toward OSPE and TPE. The study aimed to assess and compare the attitude and level of satisfaction of undergraduate nursing students toward OSPE and TPE.

Materials and Methods

Study design and setting

A descriptive comparative research design was used to conduct this study at Yenepoya Nursing College in 2022.

Study participants and sampling

The samples were 4th year B.Sc nursing students who have experienced both types of examination system and are selected by using the non-probability purposive sampling technique. The selected 102 students are further divided into two groups (51 students in each group) by the chit method: one group for assessing the attitude and level of satisfaction toward OSPE and the other group for assessing the attitude and level of satisfaction toward TPE.

Data collection tool and technique

The tools used were demographic proforma, structured attitude, and satisfaction scale. Reliability of the tool is tested by the test–re-test method using Cronbach’s alpha coefficient. The reliability of the structured attitude and satisfaction scale was 0.82 and 0.85, respectively. The time taken to complete the tool by individuals was approximately 15–20 minutes.

Ethical consideration

After the development of the tool and proposal, ethical clearance was obtained from the concerned ethics committee. Permission was obtained from the respective authorities; individual informed consent was taken from the participants before data collection, and they are assured about the confidentiality of the information they provided.

Statistical analysis

The collected categorical data were represented as frequency and percentage, and quantitative data are represented in terms of mean and standard deviation. The Mann–Whitney U test was used to compare the attitude and level of satisfaction.

Results

In the OSPE group, the majority of the samples were in the age group of 21 years and the majority of the samples were females. In the TPE group, the majority of the samples were in the age group of 21 years and most of them were females. The participants’ demographic characteristics are shown in Table 1.

Table 1 Frequency and percentage distribution of samples based on demographic characteristics n= 51+51

Variables	OSPE	TPE	
Frequency (%)	Frequency (%)	
Age in years	
  20	12 (23.5)	8 (15.6)	
  21	24 (47.1)	24 (47.0)	
  22	15 (29.4	19 (37.4)	
Gender	
  Male	13 (25.5)	8 (15.7)	
  Female	38 (74.5)	43 (84.3)	
Exposure to OSPE method	51 (100.0)	51 (100.0)	
Exposure to TPE method	51 (100.0)	51 (100.0)	

The data in Table 2 indicate the distribution of attitude scores for OSPE and TPE. The majority of the samples have positive attitude toward OSPE, whereas the majority had neutral attitude toward TPE.

Table 2 Frequency and percentage distribution of samples based on attitude score on OSPE and TPE n=51+51

Grading	Score (%)	Attitude score on OSPE (n=51)	Attitude score on TPE (n=51)	
Frequency	Percentage	frequency	percentage	
Negative	16-26	-	-	14	27.5	
Neutral	27-37	19	37.3	30	58.8	
Positive	38-48	32	62.7	7	13.7	

The data in Table 3 show the distribution of level of satisfaction scores for OSPE and TPE. The majority of samples have a good level of satisfaction toward OSPE, whereas the majority had an average level of satisfaction toward TPE.

Table 3 Frequency and percentage distribution of samples based on level of satisfaction score on OSPE and TPE n=51+51

Grading	score	OSPE (n=51)	TPE (n=51)	
frequency	percentage	frequency	percentage	
Low satisfaction	10-20	-	-	10	19.6	
Average satisfaction	21-30	4	7.8	28	54.9	
good satisfaction	31-40	27	52.9	12	23.5	
very good satisfaction	41-50	20	39.2	1	2	

Table 4 depicts students’ response on each item in the attitude scale toward TPE and OSPE.

Table 4 Students’ response toward attitude scale on TPE and OSPE n=51+51

	Items	TPE (n=51)	OSPE (n=51)	
3-A	2-N	1-D	3-A	2-N	1-D	
1	A meaningful way for assessing my clinical skills	11	31	9	24	23	4	
2	Reflected real-life clinical conditions	12	28	11	20	28	3	
3	A fair method of assessment	14	29	8	19	27	5	
4	Provided me with an opportunity to show my clinical knowledge	12	29	10	17	28	6	
5	Provided me with an opportunity to show my practical skills	13	30	8	19	28	4	
6	Took placed in a suitable environment	6	36	9	16	30	5	
7	Is helpful in increasing the students’ confidence in clinical practice	9	31	11	21	24	6	
8	The examiner made me feel comfortable	11	30	10	14	34	3	
9	The guidelines I got were helpful for preparation	9	35	7	17	29	5	
10	The stations have benefited me in developing my knowledge and skills	9	33	9	15	33	3	
11	I was confident during the station’s performance	12	31	8	21	26	4	
12	I did not understand the purpose of the stations	13	28	10	14	24	13	
13	The skills being evaluated in the stations were not reflective of those required in clinical practice	9	30	12	9	34	8	
14	I did not feel prepared for the stations	7	33	11	11	31	9	
15	I was not very nervous during the stations	10	30	11	6	29	16	
16	I found the stations very stressful	11	32	8	13	32	6	
A: agree, N: neutral, D: disagree

Mann–Whitney U test is used to compare the attitude score between the OSPE group and TPE group. Table 5 shows that the obtained P value is 0.067. Since P > 0.05, there was no significant difference between attitude scores on OSPE and TPE.

Table 5 Comparison of attitude score on OSPE and TPE n=51+51

	Maximum score	Median	IOR	p	
OSPE	48	48.32	3.35		
TPE	48	44.40	3.35	0.067	
Mann–Whitney U test, P<0.05 level of significance

Table 6 depicts students’ response on each item in the level of satisfaction scale toward OSPE.

Table 6 Students’ response toward level of satisfaction scale on OSPE n=51

	Items	OSPE	
SD-1	D-2	N-3	A-4	SA-5	
1	Assessment with OSPE is more uniform as compared to traditional method	0	2	20	12	17	
2	Assessment with OSPE is more objective as compared to traditional method	0	0	19	29	12	
3	OSPE covered a wider range of knowledge as compared to the traditional method	0	0	23	14	14	
4	OSPE is a more objective way of assessment as compared to the traditional method	0	3	16	22	10	
5	Traditional method is more stressful as compared to the OSPE	0	2	22	14	13	
6	OSPE should be extended to other subjects as well as a method of assessment of practical skills	0	5	14	23	9	
7	I feel more confident in performing practical tests after OSPE	0	1	19	17	14	
8	I feel more satisfied with my assessment with OSPE as compared to the traditional method	0	1	20	14	16	
9	There is no difference in assessment with OSPE or TPE	2	7	16	21	5	
10	Both OSPE and traditional method should be used for assessment of practical skills	0	3	22	15	11	
SD-strongly disagree, D-disagree, N-neutral, A-agree, SD-strongly agree

Table 7 depicts students’ response on each item in level of satisfaction scale toward TPE.

Table 7 Students’ response toward level of satisfaction scale on TPE n=51

	Items	TPE	
SD-1	D-2	N-3	A-4	SA-5	
1	Assessment with traditional method is more uniform as compared to OSPE	3	9	24	10	5	
2	Assessment with traditional method is more objective as compared to OSPE	2	12	19	16	2	
3	Traditional method covered a wider range of knowledge as compared to the OSPE	0	10	25	13	3	
4	Traditional method is a more objective way of assessment as compared to the OSPE	4	9	22	13	3	
5	OSPE is more stressful as compared to the Traditional method	6	9	23	13	0	
6	Traditional method should be extended to other subjects as well as a method of assessment of practical skills	5	5	22	18	1	
7	I feel more confident in performing practical tests after Traditional method	3	8	23	14	3	
8	I feel more satisfied with my assessment with Traditional method as compared to the OSPE	2	10	25	14	0	
9	There is no difference in assessment with Traditional practical examination or OSPE	3	10	23	15	0	
10	Both Traditional method and OSPE should be used for assessment of practical skills	1	8	27	11	4	
SD-strongly disagree, D-disagree, N-neutral, A-agree, SD-strongly agree

Mann–Whitney U test is used to compare the levels of satisfaction score between the OSPE group and TPE group. Table 8 shows that the obtained P value is 0.089. Since P > 0.05, there was no significant difference between levels of satisfaction score on OSPE and TPE.

Table 8 Comparison of level of satisfaction on OSPE and TPE

	Maximum score	Median	IOR	p	
OSPE	50	50.9	1.69		
TPE	50	46.05	1.69	0.089	
Mann–Whitney U test, P<0.05 level of significance

Discussion

The present study shows that the majority of the samples [32 (65.7%)] had positive attitude, and 19 (35.3%) had neutral attitude toward the OSPE. The majority [30 (61.5%)] of the samples had neutral attitude, 7 (38.5%) had positive attitude, and 14 (23.9%) had negative attitude toward the TPE. The study revealed that there is not much difference in attitude of students on OSPE and TPE. A contradictory result was drawn among MBBS students by Relwani N et al. and Wani P et al., which states that attitude toward the OSPE was fairer in comparison to TPE.[8,9] According to Malik SL et al.,[10] the majority of the medical students showed a positive attitude to OSPE, and high-rank students had a greater intensity of positive attitude to OSPE. Mir MA et al.[11] state that the perception of medical students toward OSPE was well acceptable.

The present study shows that the majority [27 (55.3%)] of the samples had a good level of satisfaction, and 20 (36.4%) samples had a very good level of satisfaction toward the OSPE. The majority [28 (56.3%)] of the samples had an average level of satisfaction, and 10 (16.6%) had a low level of satisfaction toward TPE. The findings were supported by a quasi-experimental study by Rani V et al.,[12] which shows that majority of samples [26 (87%)] had good satisfaction on the OSCE method of evaluation. This finding complies with the findings reported by Mard SA and Ghafouri;[13] students are having good satisfaction toward OSPE.

According to the present study, the median and IQR of attitude score and level of satisfaction were higher toward OSPE as compared to TPE. Mann–Whitney U test was used for the comparison of attitude scores of OSPE and TPE. Most of the similar studies show OSPE is better than TPE.[3,14] Prasad et al.[15] suggest that the OSPE format was perceived better by the students and resulted in a higher average score. According to Malhotra SD et al.,[16] OSPE was considered as an objective and unbiased test as compared to conventional practical examination (CPE) by undergraduate medical students and concluded that OSPE is feasible for formative assessment in the undergraduate pharmacology curriculum.

Limitation and Recommendation

On the basis of the present study, the following recommendations have been made for future research:

A similar study can be conducted in larger samples.

A similar study might be carried out on students at different professional colleges.

A comparative study can be conducted to find the effectiveness of different types of evaluation techniques.

Conclusion

In conclusion, the choice between OSPE and traditional practical exams in nursing education should be based on a careful consideration of the educational goals, available resources, and student preferences. Both assessment methods have their merits and limitations, and a blend of both approaches may be the most effective way to prepare nursing students for their future clinical practice.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Acknowledgement

We thank the authorities for providing all the technical and other support for the completion of this research work.
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