Performance Under Pressure: Development and Validation of the OSCE Anxiety Scale for Healthcare Education

Objective Structured Clinical Examinations (OSCEs) are widely used to assess clinical competencies in healthcare education, but they often induce significant anxiety that may impair student performance. Despite the prevalence of OSCE-related anxiety, no psychometrically validated instrument exists to specifically measure this construct across healthcare disciplines. This study aimed to develop and validate the OSCE Anxiety Scale (OAS), a psychometrically sound instrument for measuring anxiety related to OSCEs in healthcare education. This psychometric validation study included 608 pharmacy students. The OAS was developed by modifying Spielberger's Test Anxiety Inventory for OSCE contexts through expert panel review, content validation, and pilot testing. Factor structure was assessed using exploratory and confirmatory factor analyses. Reliability was evaluated through internal consistency measures (Cronbach's alpha and McDonald's omega). Validity was examined through content, convergent, discriminant, and known-groups approaches. Confirmatory factor analysis supported a two-factor structure comprising Emotionality and Worry dimensions (χ²/df = 1.17, CFI = .983, TLI = .980, RMSEA = .021, SRMR = .033). The OAS demonstrated excellent internal consistency for the Emotionality subscale (α = .915, ω = .916), Worry subscale (α = .856, ω = .857), and total scale (α = .932, ω = .933). Convergent validity was supported by Average Variance Extracted values exceeding .50 for both factors. Discriminant validity was confirmed through heterotrait-monotrait ratio analysis (HTMT = .642). Known-groups validity was demonstrated by significant differences in anxiety levels across OSCE experience groups (F(2, 605) = 18.74, p < .001), with anxiety decreasing as experience increased. The OSCE Anxiety Scale is a reliable and valid instrument for measuring anxiety in clinical skills assessment contexts. Its robust psychometric properties support its use in healthcare education, research and practice. The scale enables identification of students experiencing excessive OSCE anxiety and facilitates evaluation of educational interventions designed to reduce assessment anxiety and improve clinical performance.