Pharmacy Students’ Perceptions of the Objective Structured Clinical Examination in Jordan: A Cross-Sectional Study at Two Universities

Abstract

Background

The Objective Structured Clinical Examination (OSCE) is a widely used assessment tool in pharmacy education because of its structured and standardized approach.

Objective

This study aimed to evaluate pharmacy students’ perceptions of the OSCE experience in Jordan, and to assess the difference in perceptions based on GPA category.

Methods

A descriptive cross-sectional study was conducted among Bachelor of Pharmacy and Doctor of Pharmacy students at the University of Jordan and Jordan University of Science and Technology. A total of 236 students who had previously completed at least one OSCE were recruited using convenient sampling between March and May 2025. Data were collected using a validated questionnaire that assessed four domains: OSCE attributes, performance and implementation, scoring, objectivity and feedback, and educational outcomes. Responses were measured using a five-point Likert scale, and analyzed using descriptive and inferential statistical methods.

Results

Students reported generally neutral to slightly positive perceptions of the OSCE. More than half of the respondents (51.3%) perceived the examination as stressful, while perceptions regarding scoring objectivity and feedback quality varied. Approximately one-quarter of participants (28.3%) reported that the allocated time per station was inadequate. Most participants recognized the educational value of the OSCE in increasing awareness of potential dispensing and counseling errors. Bivariate analyses showed that students with higher GPAs reported significantly more positive perceptions regarding pre-examination preparation and station timing than those with lower GPAs (p-value < 0.05).

Conclusion

Students reported generally neutral to slightly positive perceptions of the OSCE. Most participants acknowledged the role of OSCE in increasing awareness of potential dispensing and counselling errors. However, concerns remained regarding examination-related stress and scoring objectivity. These findings highlight areas for future prospective, longitudinal, and multi-stakeholder research aimed at further evaluating and refining the OSCE process.

Introduction

Pharmacy education has evolved substantially, with an increasing emphasis on patient-centered practice and competency-based learning.^1–3 The adoption of problem-based learning has further highlighted the need for valid, reliable, and standardized tools to assess the clinical competencies of undergraduate pharmacy students worldwide.^1,2

To address this need and enhance the assessment of students’ clinical competencies, Harden et al⁴ introduced the Objective Structured Clinical Examination (OSCE). They defined the OSCE as “a timed examination in which medical students interact with a series of simulated patients at stations that may involve history taking, physical examination, counseling, or patient management”.⁴ The OSCE has since become a widely accepted method for assessing clinical competence across healthcare disciplines.²

The OSCE consists of a series of stations through which students rotate according to a predetermined schedule to demonstrate specific clinical skills, including patient counseling, communication, problem-solving, clinical reasoning, and pharmaceutical care. The design and format of an OSCE may vary in terms of the number of stations and the time allocated to each station.^2,5–7 A well-structured and systematically organized OSCE is considered one of the most reliable methods for assessing students’ clinical competencies within health professions curricula.^4,8,9

In recent years, the OSCE has demonstrated strong reliability and validity as an assessment tool capable of evaluating all three learning domains: cognitive, affective, and psychomotor.⁹ The OSCE approach has been adopted for pharmacy education because of its pivotal role in assessing students’ fundamental clinical skills and competencies.^4,9–12 Consequently, it has gained widespread popularity among pharmacy schools worldwide.^3,13 In response to this trend, the School of Pharmacy at the University of Jordan successfully developed, validated, and implemented an OSCE within its curricula beginning in the second semester of the 2014/2015 academic year.¹⁴

Despite its advantages, the OSCE is associated with several challenges.^5,11,12 The implementation of an OSCE requires extensive preparation, substantial material resources, considerable planning time, trained examiners, adequate support personnel, and simulated scenarios that may not fully reflect real clinical situations.^11,12 Moreover, challenges related to station standardization and the rigidity of checklists may limit the development, planning, and administration of the examination.^11,12

Nevertheless, the main challenges facing developing countries are securing adequately trained simulated patients and, to a lesser extent, establishing standardized station settings that require substantial resources. This highlights the need for periodic evaluation of the OSCE process to ensure its reliability, and facilitate continuous OSCE improvement.^11,12,15

Assessing students’ perspectives contributes significantly to a more comprehensive evaluation of the OSCE, as students are key stakeholders in the assessment process. A thorough evaluation of their perceptions is crucial for identifying areas requiring improvement.^12,16

In the current study, the University of Jordan (UJ) and Jordan University of Science and Technology (JUST) were selected because both universities offer Doctor of Pharmacy (PharmD) and Bachelor of Pharmacy (BSc of Pharmacy) programs. Moreover, the OSCE has a similar structure at both institutes. For the target sample, the OSCE was administered in two formats.

At the sixth-year level of the PharmD program, the OSCE requires students to rotate through a series of timed stations, with each station presenting a simulated clinical scenario or professional task. The design of these stations reflects real-world pharmacy practice such as patient counseling, prescription review, and clinical decision-making.

For the fourth- and fifth-year students enrolled in both programs, the OSCE consisted of three main stations: a patient station, where students were required to conduct a professional interview and review a prescription; a physician station, which involved reviewing patients’ medication records; and a medical test interpretation station, where students analyzed laboratory test results.

To maintain scoring consistency across these OSCE formats, each station utilizes predefined checklists and standardized rubrics to assess competencies such as communication clarity and information accuracy.

In Jordan, only two studies have investigated the OSCE in undergraduate pharmacy education. Almuqdadi et al¹⁴ assessed the OSCE within a single clinical rotation of the PharmD program, while Alhamad et al¹¹ examined its implementation across two institutions among students enrolled in the BSc of Pharmacy program only. However, both studies were limited in scope and did not examine students’ perceptions across different academic programs and institutions within a single study. The current study addresses this gap by including students from two public universities and covering both the PharmD and BSc of Pharmacy programs. Thus the aim of this study was to (1) assess the students’ perceptions of OSCE attributes, performances and implementation, scoring, objectivity and feedback, and educational outcomes among PharmD and BSc of Pharmacy students at UJ and JUST, and (2) explore differences in students’ perceptions of the OSCE according to grade point average (GPA) category.

Methods

Study Design and Participants

A descriptive cross-sectional study was conducted to evaluate BSc of Pharmacy and PharmD students’ perceptions of the OSCE in Jordan. The study included students from two universities: UJ and JUST. Eligible participants included fourth-, fifth-, and sixth-year students who had completed at least one OSCE as part of their curriculum. A total of 236 students participated in the study.

Data were collected using a self-administered questionnaire developed using Google® Forms. The questionnaire was designed to recruit a convenience sample of eligible participants during March 2025 and May 2025, corresponding to the period during which OSCEs were conducted at the two study sites.

The questionnaire link was shared through Microsoft® Teams and WhatsApp®. The total number of eligible students was 1101, distributed as follows: 161 sixth-year PharmD students at UJ, 206 fifth-year PharmD students at UJ, 167 fifth-year BSc of Pharmacy students at UJ, 330 fourth-year BSc of Pharmacy students at UJ, and 236 sixth-year PharmD students at JUST. Sample size estimation was based on the respondent-to-item ratio of 5:1.¹⁷

Data Collection Tool Development

The tool was administered in both English and Arabic within the same questionnaire to ensure clarity and comprehension. The questionnaire began with a brief description of the study and the eligibility criteria for participation, followed by an electronic informed consent form. Participants were then allowed to proceed to the questionnaire. The first section of the questionnaire included items on demographic and academic characteristics, such as age, gender, university, specialty, academic level, GPA, and previous diploma qualifications. The second section of the questionnaire was structured into four main domains based on the literature^9,12,18–23 and expert consultation to evaluate students’ perceptions of the OSCE: OSCE Attributes (13 items), OSCE Performance and Implementation (9 items), OSCE Scoring, Objectivity, and Feedback (10 items), and Educational Outcomes of the OSCE (4 items).

Questionnaire items (those related to attributes, performance, scoring, objectivity, feedback, and outcomes) were first forward-translated to Arabic by two of the authors. The translated version was then reviewed and evaluated by all authors, followed by back-translation into English by two bilingual individuals, one of whom was an expert from a health professions school. Any discrepancies identified during the translation process were discussed and resolved, and the forward- and back-translation procedures were repeated until no further differences were detected. Subsequently, the questionnaire items were adapted to account for social and religious sensitivities within the local community.

Responses were measured using a five-point Likert scale, ranging from 0 to 4, with higher scores indicating more positive perceptions.

Validity and Reliability

The questionnaire underwent content validation by experts in pharmacy education to ensure the clarity and relevance of the items.

Construct validity was assessed using pilot testing and statistical analysis. A pilot study involving 20 senior students from the School of Pharmacy was conducted to evaluate the final questionnaire. The results were used to refine the questionnaire and reorganize its sections. Responses from the pilot study were not included in the main study analysis. The Kaiser–Meyer–Olkin (KMO) measure confirmed sampling adequacy (KMO = 0.958 for all items), and Bartlett’s test of sphericity was statistically significant (p-value < 0.001) (Table 1).

Table 1.

Psychometric Properties and Reliability of the OSCE Perception Questionnaire, N=236

	All Items	OSCE Attributes Items	The OSCE Performance Items	The OSCE Scoring, Objectivity, and Feedback Items	Outcomes of the OSCE Items
Number of items	36	13	9	10	4
KMOa	0.958	0.923	0.933	0.910	0.808
Bartlett’s Test of Sphericity	9083.1	2389.6	2125.9	2041.5	937.2
p-value	<0.001	<0.001	<0.001	<0.001	<0.001
Cronbach’s Alpha	0.975	0.924	0.954	0.929	0.927

Note: ^aKaiser-Meyer-Olkin Measure of Sampling Adequacy.

Reliability testing using Cronbach’s alpha demonstrated excellent internal consistency across all domains: OSCE Attributes (α = 0.924), OSCE Performance and Implementation (α = 0.954), OSCE Scoring, Objectivity, and Feedback (α = 0.929), and Educational Outcomes of the OSCE (α = 0.927) (Table 1).

Data Analysis

Data were analyzed using SPSS version 23.0 (IBM Corp., Armonk, NY, USA). Kruskal–Wallis Test was used to assess differences in sample characteristics among GPA categories. Descriptive statistics, including frequencies, percentages, means, standard deviations, medians, and interquartile ranges, were used to summarize participants’ responses. The Mann–Whitney U-test was employed to examine differences in students’ perceptions according to GPA category, with statistical significance set at p-value < 0.05.

Results

Participant Characteristics

As listed in Table 2, a total of 236 students participated in the study. The mean age was 22.9 ± 1.4 years, and 73.3% of participants were female. The highest proportion of respondents consisted of PharmD students from the University of Jordan (44.9%). More than half of the participants (59.8%) reported a GPA of “very good” or higher. Differences between GPA categories were statistically significant according to specialty (p-value = 0.004), with PharmD students being more likely to report higher GPA levels than BSc of Pharmacy students.

Table 2.

Sociodemographic and Academic Characteristics of the Study Participants, N=236

Variable	N (%)
	All	GPA
		Very Good or More N=141 (59.7)	Good or Less N=95 (40.3)	p-valuea
Age, mean±SD	22.9±1.4	22.9±1.43	22.9±1.45	0.964b
Median (IQR)	23 (1)	23 (1)	23 (1)
Gender				0.684
Male	63 (26.7)	39 (61.9)	24 (38.1)
Female	173 (73.3)	102 (59)	71 (41)
Specialty & University				0.004
Pharmacy UJ	92 (39)	42 (45.7)	50 (54.3)
PharmD UJ	106 (44.9)	75 (70.8)	31 (29.2)
PharmD JUST	38 (16.1)	24 (63.2)	14 (36.8)
Academic Level				0.311
4th year	11 (4.6)	7 (36.4)	4 (63.6)
5th year	127 (53.8)	67 (52.8)	60 (47.2)
6th year	98 (41.5)	67 (68.4)	31 (31.6)
Diploma before university study				0.100
No	227 (96.2)	138 (60.8)	89 (39.2)
Yes	9 (3.8)	3 (33.3)	6 (66.7)
GPA		NA	NA	NA
Fair	16 (6.8)
Good	79 (33.5)
Very good	112 (47.5)
Excellent	28 (11.9)
Distinction	1 (0.4)

Notes: ^aKruskal Wallis Test (chi-square). ^bMann Whitney U. Bold font used for significant p-values.

Students’ Perceptions of OSCE Attributes

As shown in Table 3 and Figure 1, overall, students expressed neutral to slightly positive perceptions of the OSCE structure and organization. Stress was a concern, with 51.3% of respondents reporting that the OSCE was stressful. The lowest-rated items were “The OSCE was very stressful” (1.6±1.3), and “The OSCE was less stressful than other exams” (1.9±1.3). Similarly, the item “More time was needed to conduct the OSCE” received a mean score of 1.9±1.3. Almost two-thirds of the students agreed that “Full directions were given about the OSCE” (2.6±1.2), and “The OSCE is well structured and sequenced by the examiners” (2.7±1.2).

Table 3.

Students’ Perceptions of OSCE Attributes, N=236

Item	Alla	GPAa
		Very Good or More N=141 (59.7)	Good or Less N=95 (40.3)	p-valueb
1.1 Full directions were given about OSCE by the Examiners	2.6 ±1.2, 3 (2)	2.7 ±1.2, 3 (2)	2.5 ±1.2, 3 (1)	0.462
1.2 Awareness about the level of information needed for OSCE was appropriate	2.6 ±1.23, 3 (1)	2.7 ±1.2, 3 (2)	2.4 ±1.3, 3 (1)	0.113
1.3 The OSCE was well administered by the Examiners	2.6 ±1.2, 3 (2)	2.7 ±1.3, 3 (2)	2.6 ±1.2, 3 (1)	0.861
1.4 The OSCE is well structured and sequenced by the examiners	2.7 ±1.2, 3 (2)	2.7 ±1.3, 3 (2)	2.6 ±1.2, 3 (1)	0.636
1.5 The OSCE setting and content at each station were compatible with real situations	2.5 ±1.2, 3 (1)	2.2 ±1.2, 2 (2)	2.5 ±1.2, 3 (1)	0.490
1.6 The OSCE was fair	2.3 ±1.2, 2 (2)	2.3 ±1.3, 2 (2)	2.2 ±1.2, 2 (2)	0.756
1.7 The OSCE was very stressful*	1.6 ±1.3, 1 (1)	1.6 ±1.3, 1 (2)	1.6 ±1.3, 2 (2)	0.822
1.8 The OSCE was interesting	2.2 ±1.1, 2 (1)	2.4 ±1.1, 2 (1)	2.1 ±1.1, 2 (2)	0.174
1.9 The OSCE was less stressful than other exams	1.9 ±1.3, 2 (2)	2 ±1.3, 2 (2)	1.8 ±1.2, 2 (2)	0.319
1.10 More time was needed to conduct the OSCE*	1.9 ±1.3, 2 (2)	2 ±1.4, 2 (2)	1.9 ±1.3, 2 (2)	0.471
1.11 The OSCE covered broad areas of pharmacy training	2.4 ±1.2, 2 (1)	2.4 ±1.3, 3 (1)	2.3 ±1.2, 2 (1)	0.434
1.12 The OSCE allowed you to highlight the area of weaknesses you have as a student	2.4 ±1.1, 3 (1)	2.4 ±1.1, 3 (1)	2.4 ±1.1, 3 (1)	0.716
1.13 The OSCE allowed you to compensate for the area of weaknesses you have as a pharmacy student	2.2 ±1.2, 2 (2)	2.2 ±1.2, 2 (2)	2.1 ±1.1, 2 (2)	0.482

Notes: ^aData presented as mean±SD, Median (IQR). ^bMann Whitney U. *Negative sentence.

Figure 1.

Students’ perceptions of OSCE Attributes, N=236 (*negative sentence).

Students’ Perceptions of OSCE Performance

Students generally perceived OSCE performance aspects as relatively manageable, as demonstrated in Table 4 and Figure 2. Most students (65.2%) acknowledged that “Instructions were given clearly before the OSCE” (2.7 ± 1.2), whereas just over one-quarter of participants (28.3%) reported that the time allocated for each station was inadequate (2.3 ± 1.3).

Table 4.

Students’ Perceptions of OSCE Performance and Implementation, N=236

Item	Alla	GPAa
		Very Good or More N=141 (59.7)	Good or Less N=95 (40.3)	p-valueb
2.1 The students were aware of the nature of the OSCE before the exam	2.6 ±1.2, 3 (2)	2.8±1.1, 3 (2)	2.4±1.4, 3 (2)	0.006
2.2 Instructions were given clearly before the OSCE	2.7 ±1.2, 3 (2)	2.8±1.1, 3 (2)	2.5±1.3, 3 (2)	0.070
2.3 Instructions before the OSCE were beneficial for the exam performance	2.6 ±1.2, 3 (2)	2.7±1.1, 3 (2)	2.3±1.3, 2 (2)	0.015
2.4 The OSCE tasks reflected the skills taught during the training	2.5 ±1.3, 3 (1)	2.5±1.3, 3 (1)	2.4±1.3, 3 (1)	0.372
2.5 Time at each station of the OSCE was adequate	2.3 ±1.3, 2 (2)	2.5±1.3, 3 (3)	2.1±1.3, 2 (2)	0.019
2.6 Instructions during the OSCE were clear and unambiguous	2.6 ±1.2, 3 (1)	2.6±1.2, 3 (2)	2.5±1.3, 3 (1)	0.337
2.7 The required tasks during the OSCE were fair.	2.4 ±1.3, 3 (1)	2.5±1.3, 3 (2)	2.3±1.2, 2 (1)	0.250
2.8 The sequence of stations was logical and appropriate	2.5 ±1.2, 3 (1)	2.6±1.2, 3 (1)	2.3±1.2, 3 (1)	0.096
2.9 The OSCE provided you with opportunities to learn	2.6 ±1.2, 3 (1)	2.7±1.2, 3 (2)	2.5±1.2, 3 (1)	0.140

Notes: ^aData presented as mean±SD, Median (IQR). ^bMann Whitney U. Bold font used for significant p-values.

Figure 2.

Students’ perceptions of OSCE performance and implementation, N=236.

Significant differences according to GPA category were observed for three items. Students with a GPA of very good or higher reported higher scores for these items than students with GPA of good or less. These items related to students’ awareness of the nature of the OSCE before the examination (2.8±1.1 vs 2.4±1.4, p-value=0.006), perceptions of the benefits of pre-OSCE instructions for examination performance (2.7±1.1 vs 2.3±1.3, p-value=0.015), and perceptions regarding the adequacy of time allocated to each station (2.5±1.3 vs 2.1±1.3, p-value=0.019).

Students’ Perceptions of OSCE Scoring, Objectivity, and Feedback

As presented in Table 5 and Figure 3, students indicated generally neutral to slightly positive perceptions regarding OSCE scoring, objectivity, and feedback. More than two-thirds of the students agreed that “Communication skills are essential during the OSCE” (2.8±1.2), which was the highest-rated item, followed by “The OSCE was practical and useful experience” (2.6±1.2). A moderate rating was observed for the standardization of OSCE scores (2.4±1.2). The lowest-rated item was “The OSCE scores provide a true measure of essential clinical skills required for you as a pharmacy/PharmD student” (2.1±1.3). Lower ratings were generally observed for items related to feedback and scoring objectivity.

Table 5.

Students’ Perceptions of OSCE Scoring, Objectivity, and Feedback, N=236

Item	Alla	GPAa
		Very Good or More N=141 (59.7)	Good or Less N=95 (40.3)	p-valueb
3.1 The guidance about the OSCE scoring system was given	2.3 ±1.3, 3 (2)	2.4±1.3, 3 (2)	2.3±1.3, 3 (2)	0.826
3.2 The OSCE scores provide a true measure of essential clinical skills required for you as a pharmacy/Pharm D student	2.1 ±1.3, 2 (2)	2.1±1.3, 2 (2)	2 ±1.2, 2 (2)	0.697
3.3 The OSCE scores were standardized	2.4 ±1.2, 3 (1)	2.5±1.2, 3 (1)	2.4±1.2, 3 (1)	0.416
3.4 The OSCE was practical and useful experience	2.6 ±1.2, 3 (1)	2.7±1.2, 3 (2)	2.4 ±1.3, 3 (1)	0.244
3.5 Communication skills are essential during the OSCE	2.8 ±1.2, 3 (2)	2.9±1.1, 3 (2)	2.7±1.3, 3 (2)	0.306
3.6 OSCE scores were affected by personalities and social relations*	2.2 ±1.3, 2 (2)	2.1±1.3, 2 (2)	2.4±1.3, 2 (3)	0.150
3.7 Feedback given after OSCE by the examiners was clear and unambiguous	2.2 ±1.3, 2 (2)	2.3±1.3, 2 (2)	2±1.3, 2 (2)	0.336
3.8 Feedback given after OSCE was necessary for learning	2.2 ±1.2, 2 (2)	2.4±1.2, 3 (1)	2±1.2, 2 (2)	0.092
3.9 Feedback given after OSCE was objective and not subjective	2.2 ±1.2, 2 (2)	2.4±1.2, 3 (2)	2±1.2, 2 (2)	0.154
3.10 The overall quality of the feedback given to you after the OSCE was good	2.2 ±1.2, 2 (2)	2.3±1.3, 3 (2)	2±1.2, 2 (2)	0.140

Notes: ^aData presented as mean±SD, Median (IQR). ^bMann Whitney U. *Negative sentence.

Figure 3.

Students’ perceptions of OSCE scoring, objectivity, and feedback, N=236 (*negative sentence).

In addition, approximately 30% of students agreed that OSCE scores were affected by personalities and social relations (2.2±1.3).

Perceived Educational Outcomes of the OSCE

As presented in Table 6 and Figure 4, students reported generally positive perceptions regarding the educational outcomes of the OSCE. Nearly two-thirds of the students acknowledged that OSCE helped them identify potential errors in counseling processes (2.7±1.2) and that the OSCE encouraged reflection on professional practice (2.6±1.2). Approximately half of the students supported the inclusion of OSCEs as an assessment method in other pharmacy courses (2.3 ± 1.3).

Table 6.

Perceived Educational Outcomes and Impact of the OSCE, N=236

Item	Alla	GPAa
		Very Good or More N=141 (59.7)	Good or Less N=95 (40.3)	p-valueb
4.1 The OSCE made students aware of the types of mistakes that can be made in the course of the dispensing process	2.5 ±1.2, 3 (1)	2.6±1, 3 (1)	2.5±1.3, 3 (1)	0.708
4.2 The OSCE made students aware of the types of mistakes that can be made in the course of a counseling process	2.7 ±1.2, 3 (2)	2.7±1.1, 3 (2)	2.6±1.2, 3 (1)	0.611
4.3 The OSCE helped students recognize the importance of making informed and rational decisions in healthcare	2.6 ±1.2, 3 (2)	2.7±1.2, 3 (2)	2.6±1.2, 3 (1)	0.887
4.4 The OSCE should be included as an assessment method in other pharmacy classes	2.3 ±1.3, 3 (2)	2.4±1.3, 3 (2)	2.1±1.3, 2 (2)	0.072

Notes: ^aData presented as mean±SD, Median (IQR). ^bMann Whitney U.

Figure 4.

Perceived educational Outcomes and impact of the OSCE, N=236.

Discussion

This study evaluated pharmacy students’ subjective perceptions of the OSCE across two public universities in Jordan. The findings revealed overall neutral-to-slightly positive perceptions, accompanied by notable student concerns, particularly regarding fairness, objectivity, and stress associated with OSCE implementation.

While these subjective assessments do not constitute direct evidence of educational effectiveness, validity, reliability, or actual clinical skill acquisition, they provide meaningful insights into student acceptability and perceived challenges associated with the examination. Consequently, student feedback highlights potential areas for review and refinement of OSCE implementation practices, which may support student engagement and acceptance of the examination.

OSCE Attributes and Performance: Stress, Fairness, and Preparedness

A major finding of this study was the reported level of stress associated with the OSCE, with more than half of the students (51.3%) describing the examination as stressful, highlighting the perceived psychological demands of this assessment format. This finding is consistent with previous studies that have identified the OSCE as a significant source of anxiety among students and reported that students perceive the OSCE as stressful and not less stressful than conventional assessment methods.^9,12,24 Salih et al²⁵ identified stress as a significant impediment to optimal performance and learner satisfaction. In their study, stress was attributed to three main factors: the need to integrate clinical and theoretical knowledge and skills, the requirement to progress through OSCE stations according to a fixed schedule rather than having flexibility in managing time between tasks, and the continuous presence of examiners who observe and record students’ performance.²⁵

Students’ perceptions regarding the equity of an evaluation are widely recognized as an important factor in the overall acceptability of clinical examinations.²⁴ In the present study, less than half of the participating students agreed or strongly agreed that the OSCE was fair. This finding is consistent with existing literature reporting similar concerns regarding exam fairness. For example, a previous study found that fewer than half of the surveyed students perceived their OSCE as fairly designed.²⁴

Regarding student preparation, the findings indicated that most participants were aware of the examination format and reported receiving clear instructions before the OSCE. Specifically, most respondents agreed that the pre-examination guidance was clear and understandable. Although the present findings suggest generally positive perceptions regarding preparation, opportunities for further enhancement remain. For example, Basgut and Abdi¹³ recommended implementing structured pre-OSCE orientation sessions and providing students with written materials outlining examination blueprints and expectations to further support student readiness.

Concerning station duration, just over one-quarter of the participants believed that the time allocated to each station was inadequate. This finding differs somewhat from a previous study conducted in Jordan, which reported more widespread concerns regarding station timing and lower levels of student satisfaction with the time allowed for completion.¹⁴ This discrepancy may be attributed to differences in the study populations and assessment settings. Other potential factors associated with dissatisfaction regarding station duration include unfamiliarity with the assessment format and examination-related anxiety.¹⁴

To optimize the structure of such assessments, Fisseha and Desalegn¹² recommended regular evaluation of OSCE stations alongside appropriate adjustments to time limits. They further suggested avoiding uniform time allocations across all stations, as different clinical tasks may inherently require varying amounts of time.¹²

Scoring, Objectivity, and the Crucial Role of Feedback

Aspects of scoring, objectivity, and feedback emerged as important in students’ perceptions of the OSCE. Specifically, nearly one-third of the participants believed that OSCE scores were influenced by examiner personalities and social relationships, whereas a larger proportion of students disagreed with this view. While these subjective perceptions do not provide objective evidence of actual grading bias, they reflect concerns that have been discussed in the assessment literature. For instance, Fisseha and Desalegn¹² identified examiner training and checklist standardization as key considerations for maintaining assessment consistency. Furthermore, Almuqdadi et al¹⁴ highlighted inter-patient and inter-rater variability as potential factors that can influence students’ experiences. Although a higher number of stations is traditionally considered one approach to improving assessment consistency, Almuqdadi et al¹⁴ observed that a smaller number of stations coupled with a written examination can also provide a structured framework for evaluating student performance.

In terms of post-exam evaluations, fewer than half of the participants perceived the quality of the feedback as good, with a similar proportion considering it to be objective. Effective feedback is essential for helping students identify areas requiring improvement and for enhancing the overall quality of the examination.⁹ A study conducted in Malaysia compared two methods of OSCE feedback: immediate face-to-face feedback and individualized enhanced written feedback containing detailed scores. The findings indicated that students preferred written feedback because they perceived it as more beneficial and comfortable than face-to-face feedback. Students valued receiving detailed information about their performance at individual OSCE stations. The authors concluded that effective feedback is an integral component of the OSCE assessment process.²⁶

Educational Outcomes and Implications for Practice

Regarding perceived educational outcomes, a majority of the participants agreed that the OSCE increased their awareness of potential mistakes that may occur during the dispensing process, while nearly two-thirds agreed that it increased their awareness of mistakes that may occur during the counseling process. Furthermore, nearly two-thirds of the respondents agreed that the assessment helped them recognize the importance of making informed and rational decisions in healthcare. More than half of the participants also supported the inclusion of the OSCE as an assessment method in other pharmacy courses.

These perceptions are consistent with findings from a previous study conducted in Jordan, in which students expressed strong agreement that the OSCE was a useful assessment method and reported that it effectively evaluated their counseling skills.¹⁰ Similarly, another Jordanian study reported that more than half of the students believed that the OSCE increased their awareness of mistakes made during counseling and dispensing activities and recommended its inclusion as an assessment method in other pharmacy courses.¹¹ AlMuhaissen et al²⁷ concluded that pharmacy schools should modify their curricula to increase students’ exposure to community pharmacy, particularly the dispensing and compounding aspects of professional pharmacy practice.²⁷

Limitations of the Study

This study has several limitations that should be considered when interpreting its findings. First, although data were collected from two public universities, the sample demonstrated a marked institutional imbalance, with a substantially larger representation of students from UJ than from JUST (198 vs 38 students). However, the number of participants from JUST represented more than 15% of eligible student population at that institution.

Second, the descriptive, cross-sectional design captured students’ perceptions at a single point in time; therefore, changes in perceptions over time could not be evaluated, and causal inferences could not be made.

Third, data collection relied on a self-administered questionnaire, making the findings susceptible to recall, selection, and response biases.

Additionally, although the questionnaire underwent content validation, and reliability testing, the analysis did not account for potential clustering of responses across different OSCE administrations.

Finally, the findings were based entirely on students’ subjective perceptions and therefore do not constitute direct evidence of clinical competence, assessment validity, reliability, or actual skill acquisition. Furthermore, the study did not include the perspectives of examiners or faculty members, which are important for providing a more comprehensive, multi-stakeholder evaluation of the OSCE process.

Conclusion

This study provides insights into the perceptions of participating pharmacy students at two public universities in Jordan regarding their OSCE experience. The findings indicate that these participants held generally neutral to slightly positive perceptions of the examination, while also identifying concerns related to examination-related stress, scoring objectivity, and the quality and objectivity of post-examination feedback. Conversely, a majority of the participants recognized the educational utility of the OSCE in increasing awareness of potential dispensing and counseling errors.

The student-perceived challenges identified in this study warrant further systematic investigation. Future research should incorporate comprehensive and objective evaluations that include multiple stakeholder perspectives, particularly those of faculty members and examiners, to further assess and refine the OSCE process at these institutions.

Abbreviations

OSCE, the Objective Structured Clinical Examination; UJ, the University of Jordan; JUST, the Jordan University of Science and Technology; PharmD, Doctor of pharmacy; BSc, Bachelor; GPA, Grade Point Average; KMO, the Kaiser–Meyer–Olkin; SPSS, the Statistical Package for the Social Sciences; IRB, the Institutional Review Board.

Ethics Statement

Participation was voluntary and anonymous. Electronic informed consent was obtained before completing the survey. The study was approved by the Institutional Review Board (IRB) at the University of Jordan (through the Deanship of Scientific Research) (Decision No. 350/2025).

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that there are no conflicts of interest regarding the research, authorship, or publication of this article.