Objective Structured Clinical Examinations (OSCEs) for High-Stakes Assessment of Certified Registered Nurse Anesthesiologists (CRNAs).

• Written examinations are the primary method of competency assessment for CRNAs. • OSCEs assess higher tiers of Miller's Pyramid of competency. • OSCEs can supplement written examinations for high-stakes assessments of learners. Certified registered nurse anesthesiologists (CRNAs) undergoing high stakes assessment must demonstrate competency. Written competency is the current method of high-stakes assessment, and this paper uses Miller's Pyramid of competency to explore use of the objective structured clinical examination (OSCE) for high-stakes assessment. The modified Delphi method was used with 10 experts to design and execute an anaphylaxis OSCE simulation scenario of 3 proficiency levels. OSCE performance assessment tools included a checklist and global rating scale (O-GRS). A system usability survey was used to assess OSCE utility. The overall system usability survey score was below our goal of 75. Assessment tool results did not demonstrate high correlation among panelists, although mean scores for each performance showed statistically significant differences in scores (p <.001). Our paper showed the process of OSCE design, execution, and utility. Although results did not allow us to strongly recommend use of OSCEs for high-stakes assessment of CRNAs, we are encouraged that our results will provide direction for future papers related to this topic. [ABSTRACT FROM AUTHOR]