A Critical Eye on OSCE Use: A Framework for Evaluating Impact, Efficiency, and Sustainability

Objective Structured Clinical Examinations (OSCEs) are integral skills-assessment tools used across pharmacy curricula for students to demonstrate unique competencies. Given the changing landscape of the profession and the challenges facing academic pharmacy, the critical question for programs is not whether to implement OSCEs, but rather how to thoughtfully integrate them within curricular assessment frameworks to maximize educational impact and optimize resource utilization. OSCEs provide value by assessing skills-based competencies and Entrustable Professional Activities, providing structured, realistic patient simulations not always feasible in clinical settings. They enable faculty to deliver timely formative and summative feedback, encourage student self-reflection, and identify students who may struggle clinically despite didactic success, allowing for intervention. Implementing OSCEs presents substantial challenges and considerations. Faculty workload is a significant concern, demanding time and resources for case development, standardized patient and evaluator training, oversight, and subsequent grading and feedback. Students often experience significant test anxiety due to the time pressure and performance-based nature of the assessment, which can hinder engagement and feedback processing. Programmatically, a balancing act is required between enhanced curricular assessment and administrative burden. These complexities necessitate a critical lens for programs to consider: 1) Why are we using OSCEs in the first place? 2) Whose perspectives should inform their design and implementation? 3) How do OSCEs complement existing assessment strategies? The purpose of this commentary is to provide a decision framework, the IDEAL-R, to ensure meaningful integration, judicious use of resources, and, ultimately, to enhance the educational impact and sustainability of OSCEs within the pharmacy curriculum.