AI-mediated, simulation-based OSCE preparation program in nursing education: clinical skill performance, anxiety, reflective thinking and learner perceptions: a mixed-methods study

Abstract

Given the high-stakes nature of OSCEs and the anxiety they often provoke, this study examined the effects of an artificial intelligence (AI)-mediated OSCE preparation program on nursing students’ exam anxiety, reflective thinking, clinical performance and experiences. Methods This mixed-methods study was conducted with 37 second-year nursing students. Quantitative data included self-efficacy, test anxiety, reflective thinking, OSCE perception scales and OSCE performance scores, while the qualitative phase involved three focus groups with 22 students, using a thematic analysis approach. Results Self-efficacy increased significantly over time (p = .010; ηp² = 0.121), particularly in the cognitive dimension, while exam anxiety decreased (p = .001; ηp² = 0.254) and critical reflection improved (p = .031; ηp² = 0.092). Although total reflective thinking did not change significantly (p = .145), OSCE perceptions decreased (p = .001; d = 0.608), OSCE performance improved (p