Modeling the antecedents of clinical examination performance

Background: Objective structured clinical examinations can be used to understand students’ care skill performance and to evaluate courses. Thus, identifying antecedents to improved skill performance in these examinations is crucial for improving students’ future care ability. Objectives: This study examined the antecedents of clinical skill performance in nursing students and determined whether perceived task load and anxiety mediate the relationships between task characteristics and skill performance. Methods: A quantitative approach was conducted. The questionnaire for this study was comprised of five measures: Simulation Learning Effectiveness Scale, Task Characteristic Subscale, Task Cognitive Loading Scale, State-Trait Anxiety Inventory, and a clinical practice examination. Finding: Structural equation modeling revealed that students’ simulation learning effectiveness was positively associated with three task characteristics (task autonomy; task variety, identity, and significance; and task feedback) during clinical examinations. Further, the effect of learning effectiveness on task feedback was greater than on task autonomy, variety, identity, and significance. In addition, task load mediated the relationship between task variety, identity, and significance and clinical examination performance, whereas anxiety mediated the relationships between all three task characteristics and clinical examination performance. Conclusion: Promoting nursing students’ simulation learning effectiveness is crucial for improving feedback in regard to the task. Further, those who perceived the task as having more variety, identity, and significance were more likely to perceive the task as having a higher cognitive load and to experience anxiety, which, in turn, led to poorer performance. Interventions should, therefore, managers’ aim to reduce students’ perceived load and anxiety before they participate in clinical skill examinations.