Over the past few years, objective structured clinical examinations (OSCEs) have shifted from being just another assessment format to something much more central in pharmacy education. That change reflects a deeper shift in what we expect from pharmacists, and more importantly, how we expect them to think in practice.
As clinical services have expanded and independent prescribing has broadened the scope of pharmacy practice, the gap between knowing something and being able to apply it has become harder to ignore. Assessing patients, interpreting symptoms, and making decisions in real time are skills that cannot be developed through revision alone. They require practice in conditions that resemble a real consultation.
OSCEs were originally introduced to address a longstanding issue in clinical education: the unreliability of observed practice. When students were assessed through a single long case or an unstructured examination, outcomes often depended on chance, the patient available, the examiner, or whether questions drifted beyond the curriculum. By breaking assessment into multiple short stations, each with a structured mark scheme and usually a different examiner, OSCEs created something more consistent. More stations allow wider sampling, and wider sampling produces a more reliable picture of performance.
What is more interesting now is not how OSCEs assess, but how they shape learning.
Different approach
Most traditional approaches in pharmacy still prioritise knowledge acquisition. Lectures, notes, and question banks are effective for building understanding, but they do not fully prepare students for the moment when that knowledge has to be applied under pressure.
OSCE-style learning takes a different approach. Students are placed in scenarios, asked to take a history, make decisions, and communicate clearly, often within strict time limits. The difference between knowing and doing becomes immediately obvious. A student who can describe the criteria for emergency contraception is not the same as one who can sit opposite a patient, ask the right questions sensitively, identify a safeguarding concern they were not expecting, and navigate both within the same consultation.
This is where experiential learning becomes relevant. Learning develops through cycles of experience, reflection, and adjustment. A student who role-plays a consultation, reflects on what they missed, and approaches the next scenario differently is engaging in a fundamentally different type of learning from someone who reads and moves on.
Feedback plays a central role in this process. Testing alone rarely leads to improvement; it is feedback that changes behaviour. When students can see not just what they got wrong, but why it matters, they begin to refine their reasoning rather than simply correct isolated mistakes. Over time, this supports self-regulated learning, where students identify their own gaps and take a more active role in improving them.
Range of scenarios
There is also a cognitive shift that happens with repeated exposure. Early in training, students often rely on pattern recognition, matching symptoms to conditions based on memorised associations. This can work in straightforward cases, but it carries risk when presentations are atypical. Clinicians tend to develop richer mental models that incorporate variation, context, and risk. They are less focused on finding a quick answer and more concerned with asking the right questions and ruling out what must not be missed.
OSCE-based learning, when used properly, supports this transition. Exposing students to a range of scenarios that do not always behave as expected encourages a more disciplined approach to reasoning. For example, a patient may request to buy a medication over the counter, but after taking the patient's full history, it would be most appropriate to triage the patient for urgent referral to the emergency department. Students learn to test assumptions and tolerate uncertainty rather than defaulting to familiar answers.
Tackling exam stress
The psychological aspect is just as important. OSCEs are inherently stressful, and that stress can either support or hinder learning. Moderate, task-focused pressure can sharpen performance; excessive anxiety, particularly when driven by fear of judgement, can impair it. Regular exposure to OSCE-style scenarios helps normalise that pressure. Confidence develops through familiarity, not last-minute preparation.
This is where one of the most common issues becomes clear: cramming.
Many students leave practical preparation until close to the exam, focusing instead on memorising content. The difficulty is that clinical performance does not respond well to that approach. Communication, structure, and decision-making require repetition. OSCE-based learning challenges this pattern by encouraging earlier and more consistent engagement with clinical practice. It shifts the focus from “what do I need to know?” to “how do I handle this situation?” That shift has significant implications for both exams and future practice.
For pharmacy, this matters. In practice, the goal is not simply to identify the most likely condition, but to recognise risk, manage uncertainty, and make safe decisions in the context of incomplete information. That requires a mindset built through repeated exposure, reflection, and adjustment.
Clinical responsibility
In that sense, the rise of OSCE-based learning represents more than a change in assessment. It reflects a profession adapting to increased clinical responsibility.
Looking ahead, this approach is likely to become more prominent, particularly as technology develops. Digital platforms and AI create opportunities for more adaptive learning, where scenarios can be tailored, feedback can be immediate, and practice can occur at scale.
Used well, OSCE-based learning does more than prepare students for exams. It prepares them for clinical practice, where decisions are rarely neat, time is limited, and the consequences matter.
That is where its value becomes clear.
(Leya Luhar is the founder of OSCE Toolbox)
