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.