Navigating Through Expectations of Graduate Students on a High Stakes Objective Structured Clinical Exam (OSCE) Simulation

ABSTRACT As nurse practitioner (NP) education continues to expand in online and hybrid formats, faculty are challenged to ensure consistent evaluation of clinical competence. Simulation, and specifically the objective structured clinical exam (OSCE), provides a structured and standardized method to assess clinical skills, reasoning, and decision‐making in a controlled environment.Implementation of a high‐stakes OSCE revealed that students commonly experience anxiety and uncertainty, particularly when first exposed to this method of evaluation. However, structured pre‐briefing, purposeful design aligned with simulation standards, and comprehensive debriefing support student learning and performance. The addition of a virtual OSCE as a preparatory experience further decreased anxiety and improved student confidence prior to live simulation.Despite initial stress, students consistently report that OSCE experiences enhance clinical reasoning, communication, and readiness for practice. This chapter emphasizes the importance of intentional design and scaffolded simulation experiences to support competency development and provides practical considerations for integrating high‐stakes simulation into graduate NP education.