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Graduate nursing schools around the world rely on nurse practitioner (NP) objective structured clinical examinations (OSCEs) to assess the clinical proficiency of NP students. An OSCE consists of a variety of highly versatile stations (generally 15–20) designed to evaluate a diverse assortment of skills the NP students should have mastered over the course of their education. To administer NP-OSCEs, nursing schools are generally required to hire actors, who are then trained to simulate real patients. The value of this implementation is that simulations are extremely realistic and also highly configurable by instructors. However, the unfortunate downside of this strategy is that many patient groups cannot be simulated, most notably, pediatric patients. Further, the recent coronavirus disease 2019 (COVID-19) pandemic made it difficult, if not impossible, to safely hold in-person NPOSCEs with paid actors and therefore motivated research in practical alternatives.
As part of preparation for the NP-OSCEs, nursing schools are often required to use a variety of highly detailed simulation manikins. These manikins are used to teach NP students an array of procedures, assess their mastery of certain techniques, and of course, prepare them for the OSCEs. Additionally, in recent years, because the pandemic limited in-person interaction for OSCEs, simulation manikins have been employed as a safe alternative to trained actors. Despite their undeniable value, several problems occur with these manikins. First, they are expensive, often costing more than $75,000 (Haerling & Miller, 2024), and the cost is especially relevant for smaller institutions, which generally have less money available to spend on expensive equipment. As a result, colleges and universities often have a limited quantity and variety of manikins, resulting in limited NP student interaction with them. In parallel, and from a pedagogical perspective, assessment of NP student performance on an OSCE is time consuming and difficult for instructors because they must monitor and grade each NP student as they perform the various procedures for the assessment.
Although adult OSCEs often involve the use of paid adult actors as patients, pediatric OSCEs do not have this luxury, effectively restricting the options to either using a pediatric manikin or forgoing this particular version of the examination completely. Pediatric OSCEs typically have two phases: verbal and physical examination. The NP student begins by greeting the...