The Differential Impact of High-Stakes Versus Routine OSCE Stations on Nursing Students' Stress Levels and Clinical Competency: An Experimental Study

Abstract Background: Objective Structured Clinical Examinations (OSCEs) are vital for assessing nursing competence. However, the design of OSCE stations, particularly comparing critical (high-stakes) versus routine (low-stakes) scenarios, may differentially impact student stress and clinical performance. This experimental study compared these effects to inform the optimal design of assessments.

Methods: This 2024 experimental study at Torbat Heydariyeh University randomly assigned 78 final-year nursing students to two groups (n=39 each). The Intervention Group faced a critical CPR station where failure resulted in exam disqualification, while the Control Group faced a standard routine station. Both groups received identical Basic Life Support (BLS) training in accordance with the 2020 AHA guidelines. Outcomes were assessed using: (a) the PSS-10 stress scale (α=0.85); (b) a 20-item BLS knowledge test; and (c) a 17-item CPR skills checklist, with performance metrics (depth, rate, ventilation) recorded objectively by a Laerdal QCPR® manikin. Data were analyzed using independent t-tests and the Mann-Whitney test to achieve 80% power.

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Key information

Conditions

Medical Education

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Torbat Heydarieh university of Medical Sciences

Torbat Heydarieh, Iran

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

The inclusion criteria included nursing students in their eighth semester who had given their consent to participate in the study

Exclusion criteria

Exclusion criteria were nursing students who were unwilling to participate, absence in any of the intervention sessions, and those who, for reasons such as acute stress, did not have the necessary mental or psychological readiness to perform cardiopulmonary resuscitation skills. Additionally, students taking medications that could attenuate the stress response (e.g., beta-blockers, central nervous system depressants) were also excluded.

Treatment and study plan

High-Stake OSCE

Other

In this intervention, students had to pass more challenging OSCE in comparison with contol-group

Primary outcomes

Stress of students in OSCE exam

Time frame: 1 day

stress of students was measured by pss-10 questionnaire Stress levels were quantified using the Persian version of PSS-10 (α=0.85), administered via OSCE.
BLS knowledge

Time frame: 1 day

Basic life support knowledge To assess students' knowledge and clinical reasoning in mechanical ventilation, a researcher-developed, mixed-format questionnaire was used. The tool included 20 items such as multiple-choice questions, clinical scenarios, calculation-based items (e.g., RSBI, ventilator settings), and graphic interpretation tasks. Content areas covered ventilator modes, complications, alarm settings, ABG analysis, and weaning criteria, designed in alignment with recent guidelines including the American Heart Association (2023). Content validity was confirmed by six experts in critical care and nursing education (CVI ≥ 0.8). A pilot test with 30 final-year students demonstrated good internal consistency (Cronbach's α= 0.84). The questionnaire was administered before and after the intervention in both study groups to evaluate learning outcomes.

Sponsors and collaborators

Lead sponsor

Torbat Heydariyeh University of Medical Sciences

Other

Registry information

Important dates

Study start: 2024
Primary completion: 2024
Study completion: 2024
First posted: Jun 18, 2026
Registry last updated: Jun 18, 2026

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