Preclinical objective structured clinical examination for Family Nurse Practitioner students: Impact on clinical confidence and perceptions of curricular integration

ABSTRACT: Family Nurse Practitioner (FNP) programs often lack structured preclinical competency verification, which delays identification of learning needs and creates patient safety risks. Although registered nurses demonstrate sophisticated clinical judgment within team-based practice, FNP practice demands autonomous diagnostic reasoning, generating differential diagnoses and formulating management plans. This shift requires intentional educational support through formative assessment. At one Western United States public university FNP program, students entered practicum without standardized preclinical evaluation. Faculty observed wide variation in preparedness, from overconfidence to hesitation. This single-cohort, mixed methods pilot educational program evaluation implemented a formative preclinical Objective Structured Clinical Examination for 12 FNP students to evaluate confidence in primary care assessment and diagnostic reasoning while exploring curriculum integration feasibility. Students rated confidence using the Simulation Effectiveness Tool-Modified; faculty used the Lasater Clinical Judgment Rubric. Structured debriefings and surveys captured qualitative data. Two 30-minute standardized patient encounters, an adult and pediatric wellness visits incorporating anemia recognition, followed International Nursing Association for Clinical Simulation and Learning standards. Prebriefing, encounters, documentation, and debriefing integrated Kolb's experiential learning and Tanner's clinical judgment frameworks. Students reported moderate confidence in primary care assessment (M = 2.32) and diagnostic reasoning (M = 2.26), with lower confidence in clinical decision making (M = 1.70). Faculty ratings paralleled student self-assessments: highest in noticing (M = 2.7), lowest in reflecting (M = 2.0). Students (M = 3.90) and faculty (M = 4.89) rated the Objective Structured Clinical Examination as educationally valuable and appropriate; however, faculty expressed sustainability concerns (M = 2.44). The preclinical Objective Structured Clinical Examination provided structured opportunity for diagnostic reasoning practice and identification of learning needs before practicum entry, demonstrating feasibility within competency-based FNP education.