similarities between case study and action research

Action Research vs. Case Study

What's the difference.

Action research and case study are both research methodologies used in social sciences to investigate and understand complex phenomena. However, they differ in their approach and purpose. Action research is a collaborative and participatory approach that involves researchers and practitioners working together to identify and solve practical problems in real-world settings. It aims to bring about positive change and improvement in the context being studied. On the other hand, case study is an in-depth and detailed examination of a particular individual, group, or situation. It focuses on understanding the unique characteristics and dynamics of the case being studied and often involves extensive data collection and analysis. While action research emphasizes practical application and problem-solving, case study emphasizes detailed exploration and understanding of a specific case.

Further Detail

Introduction.

Action research and case study are two widely used research methodologies in various fields. While both approaches aim to gain insights and understanding, they differ in their focus, design, and implementation. This article will explore the attributes of action research and case study, highlighting their similarities and differences.

Action Research

Action research is a participatory approach that involves collaboration between researchers and practitioners to address real-world problems. It emphasizes the active involvement of stakeholders in the research process, aiming to bring about practical change and improvement. Action research typically follows a cyclical process, consisting of planning, action, observation, and reflection.

One of the key attributes of action research is its focus on generating knowledge that is directly applicable to the context in which it is conducted. It aims to bridge the gap between theory and practice by actively involving practitioners in the research process. This participatory nature allows for a deeper understanding of the complexities and nuances of the problem being investigated.

Action research often involves multiple iterations, with each cycle building upon the insights gained from the previous one. This iterative approach allows for continuous learning and adaptation, enabling researchers to refine their interventions and strategies based on the feedback received. It also promotes a sense of ownership and empowerment among the participants, as they actively contribute to the research process.

Furthermore, action research is characterized by its emphasis on collaboration and co-learning. It encourages the exchange of ideas and knowledge between researchers and practitioners, fostering a sense of shared responsibility and collective action. This collaborative approach not only enhances the quality of the research but also increases the likelihood of successful implementation of the findings.

In summary, action research is a participatory and iterative approach that aims to generate practical knowledge through collaboration between researchers and practitioners. It focuses on addressing real-world problems and promoting positive change within specific contexts.

Case study, on the other hand, is an in-depth investigation of a particular phenomenon, event, or individual. It involves the detailed examination of a specific case or cases to gain a comprehensive understanding of the subject under study. Case studies can be conducted using various research methods, such as interviews, observations, and document analysis.

One of the key attributes of case study research is its ability to provide rich and detailed insights into complex phenomena. By focusing on a specific case, researchers can delve deep into the intricacies and unique aspects of the subject, uncovering valuable information that may not be easily captured through other research methods.

Case studies are often used to explore and understand real-life situations in their natural settings. They allow researchers to examine the context and dynamics surrounding the case, providing a holistic view of the phenomenon under investigation. This contextual understanding is crucial for gaining a comprehensive and nuanced understanding of the subject.

Furthermore, case studies are particularly useful when the boundaries between the phenomenon and its context are not clearly defined. They allow for the exploration of complex and multifaceted issues, enabling researchers to capture the interplay of various factors and variables. This holistic approach enhances the validity and reliability of the findings.

Moreover, case studies can be exploratory, descriptive, or explanatory in nature, depending on the research questions and objectives. They can be used to generate hypotheses, provide detailed descriptions, or test theoretical frameworks. This versatility makes case study research applicable in various fields, including psychology, sociology, business, and education.

In summary, case study research is an in-depth investigation of a specific phenomenon, providing rich and detailed insights into complex situations. It focuses on understanding the context and dynamics surrounding the case, allowing for a comprehensive exploration of multifaceted issues.

Similarities

While action research and case study differ in their focus and design, they also share some common attributes. Both approaches aim to gain insights and understanding, albeit through different means. They both involve the collection and analysis of data to inform decision-making and improve practice.

Furthermore, both action research and case study can be conducted in naturalistic settings, allowing for the examination of real-life situations. They both emphasize the importance of context and seek to understand the complexities and nuances of the phenomena under investigation.

Moreover, both methodologies can involve multiple data collection methods, such as interviews, observations, and document analysis. They both require careful planning and design to ensure the validity and reliability of the findings.

Additionally, both action research and case study can contribute to theory development. While action research focuses on generating practical knowledge, it can also inform and contribute to theoretical frameworks. Similarly, case studies can provide empirical evidence that can be used to refine and expand existing theories.

In summary, action research and case study share common attributes, including their aim to gain insights and understanding, their focus on real-life situations, their emphasis on context, their use of multiple data collection methods, and their potential contribution to theory development.

Action research and case study are two distinct research methodologies that offer unique approaches to gaining insights and understanding. Action research emphasizes collaboration, participation, and practical change, while case study focuses on in-depth investigation and contextual understanding. Despite their differences, both approaches contribute to knowledge generation and have the potential to inform theory and practice. Researchers should carefully consider the nature of their research questions and objectives to determine which approach is most suitable for their study.

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Home » Education » Difference Between Action Research and Case Study

Difference Between Action Research and Case Study

Main difference – action research vs case study.

Research is the careful study of a given field or problem in order to discover new facts or principles. Action research and case study are two types of research, which are mainly used in the field of social sciences and humanities. The main difference between action research and case study is their purpose; an action research study aims to solve an immediate problem whereas a case study aims to provide an in-depth analysis of a situation or case over a long period of time.

1. What is Action Research?      – Definition, Features, Purpose, Process

2. What is Case Study?      – Definition, Features, Purpose, Process

What is Action Research

Action research is a type of a research study that is initiated to solve an immediate problem. It may involve a variety of analytical, investigative and evaluative research methods designed to diagnose and solve problems. It has been defined as “a disciplined process of inquiry conducted by and for those taking the action. The primary reason for engaging in action research is to assist the “actor” in improving and/or refining his or her actions” (Sagor, 2000). This type of research is typically used in the field of education. Action research studies are generally conductors by educators, who also act as participants.

Here, an individual researcher or a group of researchers identify a problem, examine its causes and try to arrive at a solution to the problem. The action research process is as follows.

Action Research Process

• Identify a problem to research
• Clarify theories
• Identify research questions
• Collect data on the problem
• Organise, analyse, and interpret the data
• Create a plan to address the problem
• Implement the above-mentioned plan
• Evaluate the results of the actions taken

The above process will keep repeating. Action research is also known as cycle of inquiry or cycle of action since it follows a specific process that is repeated over time.

What is a Case Study

A case study is basically an in-depth examination of a particular event, situation or an individual. It is a type of research that is designed to explore and understand complex issues; however, it involves detailed contextual analysis of only a limited number of events or situations. It has been defined as “an empirical inquiry that investigates a contemporary phenomenon within its real-life context; when the boundaries between phenomenon and context are not clearly evident; and in which multiple sources of evidence are used.” (Yin, 1984)

Case studies are used in a variety of fields, but fields like sociology and education seem to use them the most. They can be used to probe into community-based problems such as illiteracy, unemployment, poverty, and drug addiction. 

Case studies involve both quantitative and qualitative data and allow the researchers to see beyond statistical results and understand human conditions. Furthermore, case studies can be classified into three categories, known as exploratory, descriptive and explanatory case studies.

However, case studies are also criticised since the study of a limited number of events or cases cannot easily establish generality or reliability of the findings. The process of a case study is generally as follows:

Case Study Process

• Identifying and defining the research questions
• Selecting the cases and deciding techniques for data collection and analysis
• Collecting data in the field
• Evaluating and analysing the data
• Preparing the report

Action Research : Action research is a type of a research study that is initiated to solve an immediate problem.

Case Study : Case study is an in-depth analysis of a particular event or case over a long period of time.                         

Action Research : Action research involves solving a problem.

Case Study : Case studies involve observing and analysing a situation.

Action Research : Action research studies are mainly used in the field of education.

Case Study : Case studies are used in many fields; they can be specially used with community problems such as unemployment, poverty, etc.

Action Research : Action research always involve providing a solution to a problem.

Case Study : Case studies do not provide a solution to a problem.

Participants

Action Research : Researchers can also act as participants of the research.

Case Study : Researchers generally don’t take part in the research study.

Zainal, Zaidah.  Case study as a research method . N.p.: n.p., 7 June 2007. PDF.

 Soy, Susan K. (1997).  The case study as a research method . Unpublished paper, University of Texas at Austin.

Sagor, Richard.  Guiding school improvement with action research . Ascd, 2000.

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Running head: Comparative Similarities and Differences

Comparative Similarities and Differences between Action Research, Participative Research, and Participatory Action Research

Critical inquiry group 2: john bell, gail cheney, cindy hoots, elaine kohrman, jesse schubert, lisa stidham, scott traynor, critical inquiry - summer '04 – boga antioch university seattle.

            Research paradigms or perspectives have developed their own cultures of inquiry that describe different research processes used to observe, describe, and understand phenomena. Action, participative, and participatory action research are relatively new types of social research methods which coincide with the move from the Newtonian world to an era when quantum theory has deeply challenged the Cartesian-based philosophy in science. The rise of a post mechanistic view within the scientific disciplines, one where the observer affects and is affected by the observed, has signified the transition from the industrial age to the age of cybernetic theory and systems thinking. These three types of research are a part of a continuum of action-oriented research processes that combine inquiry with creating direct social change and is not limited to just explanation of information or data (Boga, 2004). Each reflects a different level of commitment and influence of those being studied on and in the research process. Each also has a different purpose. The following briefly describes each research process and explores the similarities and difference between them based on the goals of the research model, the frameworks of the research including any assumptions that are made at the base level, and the level of commitment, involvement and influence of participants.

Action Research

            Action research (AR) is a paradigm of inquiry where the researcher’s primary purpose is to improve the capacity and subsequent practices of the researcher rather than to produce theoretical knowledge (Elliott, 1991). Improving practice means that the quality of the outcome of the process and products together are enhanced. A defining characteristic of AR is that the researcher initiates change based on a feeling that something needs to change to create a better human situation. The researcher provides direction toward realization and transformation of values through the process. Ends are not defined as specific goals or objectives before hand.

            The researcher may act as an individual or with a team of colleagues as the facilitator of clients. The researcher improves skills and co-learns with the clients during the process. The researcher leads the process of identifying the problem, drawing facts and opinions from the clients, and leads the group to identify gaps in understanding. There is a unified conception, but there is not a rigid division of specialized tasks or roles. The researcher and the group identify actions to take and jointly analyze results, reflect on these actions and results, and propose new courses of action. The researcher and the clients act together to create or actualize satisfying results for change. The researcher leads the group through identifying the course of actions for diffusion, but does not necessarily engage in these actions. (Boga, 2004).

            This continuing process of reflection on the part of the researcher and clients develops the researcher’s capacity to discern the right course of action and to make ethical judgments in future situations involving complex, human relationships. This resulting practical wisdom is grounded in the researcher’s experience in real cases. A wholistic appreciation of the situation to inform the narrative of the case at hand is greater than any analytical or theoretical contributions.

            Several disparate processes are unified such as the development of the individual researcher, the design of the process, and the action-reflection cycle for both the researcher as an individual and with the clients. Although this method is primarily researcher led, collaborative reflection is imperative to encompass the experience and perceptions of the clients to make modifications to other change efforts based on shared feedback from collaborative members of the group (Elliott, 1991).

Participative Research

            Participative research (PR) is a method where the primary goal is to create an environment and process where context-bound knowledge emerges to develop ‘local theory’ that is understandable and actionable. PR is initiated by the organization of interest. The researcher and participants collaborate actively in a loosely defined group process to study and change their social reality. (Whyte, 1989)

            All members of the organization can participate. Participants must have the will and resources to participate and take on active roles and directly influence defining the problem, choose the methods used to gather the data, analyze the data, prepare the findings, and create action. (Boga, 2004) (Elden, 1981, 258). The wholistic process is group led and self-organized, and adapts to changes as needed. Results are jointly prepared, and reported to those affected. The group decides when the group is finished.

            Participants treat each other as colleagues. Through the give and take of a dialogic process, the researcher and participants learn together. The researcher’s role as one of many ‘co-learners’ in not as an expert, but as a ‘co-producer of learning.’ The researcher is dependent on where and how the data comes, has less control over the research design process itself, and has to be flexible to the perspectives and definitions of the participants. The researcher is not merely a bystander but needs to contribute toward the creation and discovery of a process that can stand on its own. A participative researcher needs to develop a context-sensitive framework, be flexible to changes in the framework based on the local knowledge from participants in their own terms, and solve problems. The result of this type of collaboration is very context-oriented to create new shared understandings. (Reason & Rowan, 1981).

            As Sohng (1995) comments, participatory research is a collaborative and empowering process because it (a) brings isolated people together around common needs and problems; (b) validates their experiences as the foundation for understanding and critical reflection; (c) presents the knowledge and experiences of the researchers as additional resources upon which to critically reflect; and (d) contextualises what might have previously felt like personal, individual problems or weaknesses. The primary strength of an action-oriented or participatory approach to research is therefore not about description but about trying things out. It is a research approach that sees its function as one of giving us different ways of relating to natural and social environments. Researchers need to be aware of how members of a group perceive and speak about their lives. This means they must endeavour to find out everything that can be found out about the community being researched. Ideally, the researcher already lives in the community, partakes in its affairs and has an ongoing relationship with the community.

Participatory Action Research

            Participatory action research (PAR) combines both the goals of improved capacity and practice of researchers, as in AR, and of achieving practical objectives and changing social reality, as in PR, through group participation. Those affected by a problem participate in planning, carrying out, analyzing and applying the results of the research. The growth and development of the participants are also an important part of the desired outcome. This method is initiated by the organization of interest and engages researchers that share control of the social process design with participants in the organization.

            The research approach is jointly designed through discussions between professional researchers and active participation by some members of the organization. PAR acknowledges that people affected by a problem are in the best position to understand and suggest solutions. Local and experiential knowledge are valued. Participants carry out the data collection and analyze the results. The researcher cannot have tight control or an agenda in terms of research topic or design, but do need to be in a situation where the problem is relevant and important to participants, and uses credible methods.

            Specifically when situations are complex with no clear line of inquiry to follow, PAR can contribute to advancing theory and knowledge along with achieving practical results. As a participant-centered approach, PAR is grounded in first-hand knowledge and participation by the participants affected. This enables researchers to gain relevant knowledge during the process which encourages creative surprises. This leads to new understandings by integrating ideas across disciplines that are typically isolated from each other to solve problems. These advances can contribute to major organizational changes along with advancing theoretical understandings across multiple disciplines.

Similarities between Methods

            The primary similarities in the three methods are active participation, open-ended objectives, and high levels of commitment from the researcher and the participants to the research problem and active learning.

            The first similarity between these three methods of research is that individuals/employees and not only researchers/leadership from an organization collaboratively design and actively participate in the research process. In AR, although the researchers are studying themselves in the context of a working with an organization, it can also be a collaborative effort when the whole group or organization is being supported by an action research process. PR requires the input and involvement of employees, including leadership, in designing the process with researchers as a group through implementing the results. PAR involves those most affected by a problem and engages them in planning, carrying out, and applying the results of the research.

            The second similarity in that each of these methods is that the end objectives are not directly specified in the beginning and the process results in solving real problems in organizations. AR is geared toward creating a more capable individual so that person is equipped to deal with the complexity of today’s work issues. PR allows employees to influence and create solutions to a business problem. PAR creates new knowledge through the process of solving real business or organizational problems while also improving the capacity of individuals in the organization.

            Third, these research models are similar in the high level of commitment and involvement required from the organization, the employees, and the researcher about the importance of the problem and to the learning that results. The organization is central to the success of the research because participants are empowered to change their reality in all three methods. The researcher guides the process to varying degrees in each method, but in all cases contributes to framing a process that is wholistic, flexible, and enhances shared learning. Isolated people, groups, disciplines and disparate processes are unified through dialogue. The result is context-oriented new understandings about individuals and the organization as a whole.

Differences between Methods

            The differences between the three types of research lie in the methods used to reach the goal of problem solving but are also primarily in the specific goal of each type of research. As Elden points out:

The cutting edge difference is the immediate goal of the research. Where the goal is to develop change capacity so that workers can solve their own problems and keep solving them (self-maintained learning.) the general knowledge research design seems to be of limited utility. (1981, 259)

            Action research focuses on the idea that improving the process improves the organization. Elliot explains:

The fundamental aim of action research is to improve practice rather than to produce knowledge. The production and utilization of knowledge is subordinate to, and conditioned by, this fundamental aim. (Elliott, 1991)

AR requires the most personal commitment and involvement of these three research methods. In effect, this method requires ongoing practice and growth and is therefore a long-term commitment.

Participative research utilizes the tacit knowledge and experience of employees and leadership in the process, requires group level commitment as well as researcher commitment for the term of the project while the team addresses and solves a relevant problem. In participative research, the long-term skills of the participants to “solve their own problems and keep solving them” (Elden, 1981, 259) is an outcome that extends beyond the research project itself. The focus in participative research is on the inclusion of the participants and their organizations within the process and the practical outcome, rather removing the process from its context. The researcher is not a facilitator of the process as in action research, but a ‘co-producer of learning.’ As Elden makes clear:

Research is participatory when those directly affected by it influence each of these four [problem definition, methods choice, data analysis & use of findings] decisions and help carry them out. (1981, 258)

            In contrast, PAR requires both researchers in their own group, organizational members in their own group and both groups collaboratively to commit to the research process for both a scientific goal of furthering the research method and a tangible problem solving goal such as whether or not to close a manufacturing plant. PAR has implications for the participants as participant within their larger environment. The participants and researchers are processing significant theoretical issues together.

We can rekindle the intellectual excitement in our field if we are willing to leave the mainstream to involve ourselves with practitioners and struggle with them to solve important practical problems – which also have important theoretical implications (Whyte, 1989)

PAR relies on reflective practice of the researchers in action and unlike action research does not wait to apply new understandings to the next situation, but incorporates them into the ongoing process. This reflective practice transforms views of structural problems and their values about the systems under study in the process and leads to more creative ‘surprises’ and solutions. The result of participatory action research is the opportunity for researchers and participants to link enhanced capacity and wisdom from action research with the ‘local theory’ from group participants in participative research to be agents of major social changes at the organizational level.

            In comparing basic, applied and participative research, Elden makes the point that his examination is not to exclude any specific paradigm, but to highlight the relative utility of each for specific purposes. Elden states,

No one of these types, of course, is intrinsically right or wrong. The question is useful for what? Regardless of what one is aiming at, researcher role must be consistent with the research goal. (1981, 261)

            T he three types of research discussed are a part of a continuum of naturalistic, post-positivist, systemic research methodology. All three have frameworks for the research method used but allow for modification as new observations and conclusions are made. Knowledge regarding a particular problem is best determined by groups of people affected. By arriving at a consensus and using qualitative methods of research rather than drawing conclusions purely through observation, measurement and quantitative analysis as is done in rationalistic research greater creativity and problem solving can emerge. Appendix I – Types of Research

Denzin, N. K., & Lincoln, Y. S. (1998). The landscape of qualitative research : theories and issues . Thousand Oaks, CA: Sage Publications.

Elliott, J. (1991). Action research for educational change . Milton Keynes England ; Philadelphia: Open University Press.

Elden, M., Reason, P., & Rowan, J. (1981). Human inquiry : a sourcebook of new paradigm research . Chichester Eng. ; New York: J. Wiley.

Sohng, Sung Sil Lee. (1995). Participatory Action Research and Community Organizing. Seattle, WA.

Tashakkori, A., & Teddlie, C. (2003). Handbook of mixed methods in social & behavioral research . Thousand Oaks, CA: SAGE Publications.

Wadsworth, Y. (1998). What is Participatory Action Research? < http://www.scu.edu.au/schools/gcm/ar/ari/p-ywadsworth98.html>.

Whyte, W. F. (1989). Advancing Scientific Knowledge Through Participatory Action Research. Sociological Forum, 4 (3) 367-85.

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• What Is Action Research? | Definition & Examples

What Is Action Research? | Definition & Examples

Published on January 27, 2023 by Tegan George . Revised on January 12, 2024.

Table of contents

Types of action research, action research models, examples of action research, action research vs. traditional research, advantages and disadvantages of action research, other interesting articles, frequently asked questions about action research.

There are 2 common types of action research: participatory action research and practical action research.

• Participatory action research emphasizes that participants should be members of the community being studied, empowering those directly affected by outcomes of said research. In this method, participants are effectively co-researchers, with their lived experiences considered formative to the research process.
• Practical action research focuses more on how research is conducted and is designed to address and solve specific issues.

Both types of action research are more focused on increasing the capacity and ability of future practitioners than contributing to a theoretical body of knowledge.

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Action research is often reflected in 3 action research models: operational (sometimes called technical), collaboration, and critical reflection.

• Operational (or technical) action research is usually visualized like a spiral following a series of steps, such as “planning → acting → observing → reflecting.”
• Collaboration action research is more community-based, focused on building a network of similar individuals (e.g., college professors in a given geographic area) and compiling learnings from iterated feedback cycles.
• Critical reflection action research serves to contextualize systemic processes that are already ongoing (e.g., working retroactively to analyze existing school systems by questioning why certain practices were put into place and developed the way they did).

Action research is often used in fields like education because of its iterative and flexible style.

After the information was collected, the students were asked where they thought ramps or other accessibility measures would be best utilized, and the suggestions were sent to school administrators. Example: Practical action research Science teachers at your city’s high school have been witnessing a year-over-year decline in standardized test scores in chemistry. In seeking the source of this issue, they studied how concepts are taught in depth, focusing on the methods, tools, and approaches used by each teacher.

Action research differs sharply from other types of research in that it seeks to produce actionable processes over the course of the research rather than contributing to existing knowledge or drawing conclusions from datasets. In this way, action research is formative , not summative , and is conducted in an ongoing, iterative way.

As such, action research is different in purpose, context, and significance and is a good fit for those seeking to implement systemic change.

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Action research comes with advantages and disadvantages.

• Action research is highly adaptable , allowing researchers to mold their analysis to their individual needs and implement practical individual-level changes.
• Action research provides an immediate and actionable path forward for solving entrenched issues, rather than suggesting complicated, longer-term solutions rooted in complex data.
• Done correctly, action research can be very empowering , informing social change and allowing participants to effect that change in ways meaningful to their communities.

Disadvantages

• Due to their flexibility, action research studies are plagued by very limited generalizability  and are very difficult to replicate . They are often not considered theoretically rigorous due to the power the researcher holds in drawing conclusions.
• Action research can be complicated to structure in an ethical manner . Participants may feel pressured to participate or to participate in a certain way.
• Action research is at high risk for research biases such as selection bias , social desirability bias , or other types of cognitive biases .

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Normal distribution
• Degrees of freedom
• Null hypothesis
• Discourse analysis
• Control groups
• Mixed methods research
• Non-probability sampling
• Quantitative research
• Inclusion and exclusion criteria

Research bias

• Rosenthal effect
• Implicit bias
• Cognitive bias
• Selection bias
• Negativity bias
• Status quo bias

Action research is conducted in order to solve a particular issue immediately, while case studies are often conducted over a longer period of time and focus more on observing and analyzing a particular ongoing phenomenon.

Action research is focused on solving a problem or informing individual and community-based knowledge in a way that impacts teaching, learning, and other related processes. It is less focused on contributing theoretical input, instead producing actionable input.

Action research is particularly popular with educators as a form of systematic inquiry because it prioritizes reflection and bridges the gap between theory and practice. Educators are able to simultaneously investigate an issue as they solve it, and the method is very iterative and flexible.

A cycle of inquiry is another name for action research . It is usually visualized in a spiral shape following a series of steps, such as “planning → acting → observing → reflecting.”

Sources in this article

We strongly encourage students to use sources in their work. You can cite our article (APA Style) or take a deep dive into the articles below.

George, T. (2024, January 12). What Is Action Research? | Definition & Examples. Scribbr. Retrieved September 3, 2024, from https://www.scribbr.com/methodology/action-research/

Cohen, L., Manion, L., & Morrison, K. (2017). Research methods in education (8th edition). Routledge.

Naughton, G. M. (2001).  Action research (1st edition). Routledge.

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Action research or case study?

When planning for a practice-based enquiry or small-scale study you will most often be confronted with the choice between an action research or case study approach. Strictly speaking, there are many approaches to enquiries, but for practical reasons the action research or case study approaches are amongst the most popular for teacher-researchers.

Your decision for one or the other approach must be well justified and to this end you must consult research methodology literature. However, in the following there will be a simplified exploration of the two approaches to get you started.

What is action research? Action research should be considered as a way of life in the classroom. As a reflective practitioner you will observe what happens in your class and then identify an issue or problem that you need to address. After consulting relevant literature you will then formulate a new approach or intervention, which you carry out in your classroom. Once you have worked with this intervention you will reflect and reconsider its effectiveness and impact and the cycle can start again. For a practice-based enquiry you may go through several cycles or through one cycle only. The advantage of the action research is that it naturally develops from your teaching practice and that it addresses real issues within your classroom. Typical critique of action researches would be that they are not rigorous or systematic enough.

What is case study? A case study is more difficult to understand because it can be a method as well as a methodology. Here we only look at case studies for their methodological function. If you want to learn more about a specific issue or you want to explore a particular problem or occurrence, then the case study is for you. The description of what makes a “case” differs in various research methodology publications, but generally speaking a “case” can refer to a group of people, a specific person or issue, a collective of ideas. The advantage of a case study is that you get to know the status quo in all its facets and so you gain a deep insight into your field of study. Common critique of the case study approach is that it is so specialised and specific to the context of the research that generalisability is lost. Sometimes it is also said that the mere description of a status quo is not practical for teachers because there are no changes. My argument would be that detailed knowlegde of what happens in your classroom or school can lead to recommendations for future practice. It is just that you do not enter a cyclical approach of evaluating and revisiting your suggested changes.

Action research or case study? Both approaches have their benefits and limitations within the realm of practice-based enquiries. The choice therefore depends on what it is that you want to find out. Are you planning to introduce a new teaching strategy or changes or interventions with some or all of your pupils? Or are you trying to explore a specific topic? The former would be a justification for action research, whereas the latter hints at a case study. You must be guided by your research focus, your research question or hypothesis and by the research methodology publications you consult.

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Action Research vs Case Study : Know the Key Difference Between Two Qualitative Research Methods

A research method is nothing but a technique of inquiry which proceeds from the underlying philosophical assumptions to research design and data collection. Specific research methods imply various assumptions, skills, research practices and the choice of research approach influences the manner in which the data is collected. 

Among various research methods, the most popular and widely used design is qualitative research. This design consists of many philosophical perspectives and various research methods, of which includes  action research and case study research.

Action Research

Action research is a type of qualitative research, which is adopted by the researcher in order to solve the immediate problem arisen during the particular course of time. It is a way which bridges the gap between educational theory and professional practice by improvising their current practices. This type of research helps the researcher to improvise its current practices and is applied for researching into issues.

The main purpose of action research is to learn through action leading to personal or professional development. It enables researchers not only to suggest appropriate lines of action but also to investigate the actual effects of such actions. Further, this type of research is situation based, is useful in problem-solving and deals with individuals or groups with a common purpose of improving practice.

Action research is conducted in classrooms and organisations, where the practitioner will observe what happens and then identify an issue or problem that they need to address. Further according to the issues, ways to solve the problems are identified and applied by the practitioner in their practices. This approach is applied using qualitative designs to explain what is happening and to understand the effects of some educational intervention. 

Further, this research helps in addressing practical problems and in generating knowledge to produce change.

Methods used in collecting data in action research are:

• Observing individuals or groups
• Using audio and videotape recording
• Using structured or semi-structured interviews
• Taking field notes
• Conducting surveys or questionnaires

Case study research is more of a qualitative method of research where there is an in-depth study of an individual or a group of individuals. It explores a contemporary prodigy within its real-life context and provides an organised way of observing the events, collecting data, analysing information, and reporting the results.

Further, the case study method focuses on the description or exploration of a particular phenomenon, rather than identifying the cause and effect. This method includes both quantitative and qualitative data and allow the researchers to see beyond statistical results and understand human conditions like illiteracy, poverty, etc. 

Case studies is categorised in 3 ways: exploratory, explanatory and descriptive.

Exploratory case studies explore any event in the data which serves as a point of interest to the researcher. For example, a researcher conducting an exploratory case study on an individual’s learning process may ask questions, such as, “Does a student use any strategies when he learns a text?” This type of question results in further examination of the phenomenon. 

On the other hand, the explanatory case study examines the data carefully and explains the phenomenon occurred in the data.

Descriptive case studies describe the natural phenomena which occur within the data. For example, what are the strategies used by the learner?, etc. 

Case studies are useful as they help the researcher to analyse the data at a small level but there is a  tendency for the researcher to be biased at the time of interpreting the data. 

Methods used in collecting the data in the case study method are:

• Interviews, transcript analyses or protocol 
• An exploration of artifacts.
• A review of documents and archived record
• Direct participant observations
• Field studies

Difference between action research and case study

At times people confuse the action research method with that of case study as both are a little bit similar to each other. But in real-time, they are quite different.

• Action research focuses on solving the immediate problem whereas, case studies focus on a particular phenomenon for a longer period of time.
• Action research method emphasis on solving the problem whereas case study method emphasis on observing, analysing and interpreting a particular phenomenon or scenario.
• Researcher at times can also be the part of the action research whereas in case study researcher don’t take part in the research.

Now that you know the difference between the two approaches, choose the method accordingly and accomplish your research.

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Difference between Case Study and Action research

1. Action Research : Action Research is a type of qualitative research. As the name suggests it is more action oriented in order to solve an immediate problem. Action research helps the researcher to improvise its current practices and is applied for researching into issues. It aims to learn through action leading to personal or professional development means focuses on improving and/or refining actions. This type research generally used in field of education to bridge the gap between educational theory and professional practice by improvising their current practices. This helps in observing the problem and identifying the cause and then addressing the issue so mainly it is more focused on immediate addressing to practical problems and in generating knowledge to produce change.

2. Case Study : Case study research refers to an in-depth examination of a particular event or individual or a group of individuals. It is more of a qualitative method of research where it understand complex issues by deeply observing and analyzing the event or situation by collecting and reporting the data related to the event or situation. Case study research is more towards description rather than immediate cause and effect finding. Case study is categorized into three ways i.e., exploratory, explanatory and descriptive based on research method. These studies involve both quantitative and qualitative data. This type of research can be used to address community-based problems like illiteracy, unemployment, poverty, and drug addiction.

Difference between Case study and Action Research :

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Please note you do not have access to teaching notes, distinguishing action research from participative case studies.

Journal of Systems and Information Technology

ISSN : 1328-7265

Article publication date: 1 March 1997

Action researchers contend that a complex social process can be studied best by introducing changes into that process and observing the effects of these changes. The approach used by organizational consultants must also introduce change, but in this case, the theoretical development and the rigorous empirical foundation are prerequisite elements of the activity. Participative case studies are a common scientific report proceeding from consulting projects. This paper discusses the contrasts between the action research method, consulting, and participative case studies. Ethical problems arise when action research is knowingly or unknowingly conflated with consultation practices, since this combination makes the usual set of action research dilemmas even more problematic. An improved understanding of the action research‐consulting contrasts aids in distinguishing the contributions of participative case studies to the information systems literature.

• Action research
• Research‐consulting
• Prerequisite elements

Baskerville, R.L. (1997), "Distinguishing action research from participative case studies", Journal of Systems and Information Technology , Vol. 1 No. 1, pp. 24-43. https://doi.org/10.1108/13287269780000733

Copyright © 1997, MCB UP Limited

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• Open access
• Published: 28 August 2024

The design, implementation, and evaluation of a blended (in-person and virtual) Clinical Competency Examination for final-year nursing students

• Rita Mojtahedzadeh 1 ,
• Tahereh Toulabi 2 , 3 &
• Aeen Mohammadi 1  

BMC Medical Education volume  24 , Article number:  936 ( 2024 ) Cite this article

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Introduction

Studies have reported different results of evaluation methods of clinical competency tests. Therefore, this study aimed to design, implement, and evaluate a blended (in-person and virtual) Competency Examination for final-year Nursing Students.

This interventional study was conducted in two semesters of 2020–2021 using an educational action research method in the nursing and midwifery faculty. Thirteen faculty members and 84 final-year nursing students were included in the study using a census method. Eight programs and related activities were designed and conducted during the examination process. Students completed the Spielberger Anxiety Inventory before the examination, and both faculty members and students completed the Acceptance and Satisfaction questionnaire.

The results of the analysis of focused group discussions and reflections indicated that the virtual CCE was not capable of adequately assessing clinical skills. Therefore, it was decided that the CCE for final-year nursing students would be conducted using a blended method. The activities required for performing the examination were designed and implemented based on action plans. Anxiety and satisfaction were also evaluated as outcomes of the study. There was no statistically significant difference in overt, covert, and overall anxiety scores between the in-person and virtual sections of the examination ( p  > 0.05). The mean (SD) acceptance and satisfaction scores for students in virtual, in-person, and blended sections were 25.49 (4.73), 27.60 (4.70), and 25.57 (4.97), respectively, out of 30 points, in which there was a significant increase in the in-person section compared to the other sections. ( p  = 0.008). The mean acceptance and satisfaction scores for faculty members were 30.31 (4.47) in the virtual, 29.86 (3.94) in the in-person, and 30.00 (4.16) out of 33 in the blended, and there was no significant difference between the three sections ( p  = 0.864).

Evaluating nursing students’ clinical competency using a blended method was implemented and solved the problem of students’ graduation. Therefore, it is suggested that the blended method be used instead of traditional in-person or entirely virtual exams in epidemics or based on conditions, facilities, and human resources. Also, the use of patient simulation, virtual reality, and the development of necessary virtual and in-person training infrastructure for students is recommended for future research. Furthermore, considering that the acceptance of traditional in-person exams among students is higher, it is necessary to develop virtual teaching strategies.

Peer Review reports

The primary mission of the nursing profession is to educate competent, capable, and qualified nurses with the necessary knowledge and skills to provide quality nursing care to preserve and improve the community’s health [ 1 ]. Clinical education is one of the most essential and fundamental components of nursing education, in which students gain clinical experience by interacting with actual patients and addressing real problems. Therefore, assessing clinical skills is very challenging. The main goal of educational evaluation is to improve, ensure, and enhance the quality of the academic program. In this regard, evaluating learners’ performance is one of the critical and sensitive aspects of the teaching and learning process. It is considered one of the fundamental elements of the educational program [ 2 ]. The study area is educational evaluation.

Various methods are used to evaluate nursing students. The Objective Structured Clinical Examination (OSCE) is a valid and reliable method for assessing clinical competence [ 1 , 2 ]. In the last twenty years, the use of OSCE has increased significantly in evaluating medical and paramedical students to overcome the limitations of traditional practical evaluation systems [ 3 , 4 ]. The advantages of this method include providing rapid feedback, uniformity for all examinees, and providing conditions close to reality. However, the time-consuming nature and the need for a lot of personnel and equipment are some disadvantages of OSCE [ 5 , 6 ]. Additionally, some studies have shown that this method is anxiety-provoking for some students and, due to time constraints, being observed by the evaluator and other factors can cause dissatisfaction among students [ 7 , 8 ].

However, some studies have also reported that this method is not only not associated with high levels of stress among students [ 9 ] but also has higher satisfaction than traditional evaluation methods [ 4 ]. In addition, during the COVID-19 pandemic, problems such as overcrowding and student quarantine during the exam have arisen. Therefore, reducing time and costs, eliminating or reducing the tiring quarantine time, optimizing the exam, utilizing all facilities for simulating the clinical environment, using innovative methods for conducting the exam, reducing stress, increasing satisfaction, and ultimately preventing the transmission of COVID-19 are significant problems that need to be further investigated.

Studies show that using virtual space as an alternative solution is strongly felt [ 10 , 11 , 12 ]. In the fall of 2009, following the outbreak of H1N1, educational classes in the United States were held virtually [ 13 ]. Also, in 2005, during Hurricane Katrina, 27 universities in the Gulf of Texas used emergency virtual education and evaluation [ 14 ].

One of the challenges faced by healthcare providers in Iran, like most countries in the world, especially during the COVID-19 outbreak, was the shortage of nursing staff [ 15 , 16 ]. Also, in evaluating and conducting CCE for final-year students and subsequent job seekers in the Clinical Skills Center, problems such as student overcrowding and the need for quarantine during the implementation of OSCE existed. This problem has been reported not only for us but also in other countries [ 17 ]. The intelligent use of technology can solve many of these problems. Therefore, almost all educational institutions have quickly started changing their policies’ paradigms to introduce online teaching and evaluation methods [ 18 , 19 ].

During the COVID-19 pandemic, for the first time, this exam was held virtually in our school. However, feedback from professors and students and the experiences of researchers have shown that the virtual exam can only partially evaluate clinical and practical skills in some stations, such as basic skills, resuscitation, and pediatrics [ 20 ].

Additionally, using OSCE in skills assessment facilitates the evaluation of psychological-motor knowledge and attitudes and helps identify strengths and weaknesses [ 21 ]. Clinical competency is a combination of theoretical knowledge and clinical skills. Therefore, using an effective blended method focusing on the quality and safety of healthcare that measures students’ clinical skills and theoretical expertise more accurately in both in-person and virtual environments is essential. The participation of students, professors, managers, education and training staff, and the Clinical Skills Center was necessary to achieve this important and inevitable goal. Therefore, the Clinical Competency Examination (CCE) for nursing students in our nursing and midwifery school was held in the form of an educational action research process to design, implement, and evaluate a blended method. Implementing this process during the COVID-19 pandemic, when it was impossible to hold an utterly in-person exam, helped improve the quality of the exam and address its limitations and weaknesses while providing the necessary evaluation for students.

The innovation of this research lies in evaluating the clinical competency of final-year nursing students using a blended method that focuses on clinical and practical aspects. In the searches conducted, only a few studies have been done on virtual exams and simulations, and a similar study using a blended method was not found.

The research investigates the scientific and clinical abilities of nursing students through the clinical competency exam. This exam, traditionally administered in person, is a crucial milestone for final-year nursing students, marking their readiness for graduation. However, the unforeseen circumstances of the COVID-19 pandemic and the resulting restrictions rendered in-person exams impractical in 2020. This necessitated a swift and significant transition to an online format, a decision that has profound implications for the future of nursing education. While the adoption of online assessment was a necessary step to ensure student graduation and address the nursing workforce shortage during the pandemic, it was not without its challenges. The accurate assessment of clinical skills, such as dressing and CPR, proved to be a significant hurdle. This underscored the urgent need for a change in the exam format, prompting a deeper exploration of innovative solutions.

To address these problems, the research was conducted collaboratively with stakeholders, considering the context and necessity for change in exam administration. Employing an Action Research (AR) approach, a blend of online and in-person exam modalities was adopted. Necessary changes were implemented through a cyclic process involving problem identification, program design, implementation, reflection, and continuous evaluation.

The research began by posing the following questions:

What are the problems of conducting the CCE for final-year nursing students during COVID-19?

How can these problems be addressed?

What are the solutions and suggestions from the involved stakeholders?

How can the CCE be designed, implemented, and evaluated?

What is the impact of exam type on student anxiety and satisfaction?

These questions guided the research in exploring the complexities of administering the CCE amidst the COVID-19 pandemic and in devising practical solutions to ensure the validity and reliability of the assessment while meeting stakeholders’ needs.

Materials and methods

Research setting, expert panel members, job analysis, and role delineation.

This action research was conducted at the Nursing and Midwifery School of Lorestan University of Medical Sciences, with a history of approximately 40 years. The school accommodates 500 undergraduate and graduate nursing students across six specialized fields, with 84 students enrolled in their final year of undergraduate studies. Additionally, the school employs 26 full-time faculty members in nursing education departments.

An expert panel was assembled, consisting of faculty members specializing in various areas, including medical-surgical nursing, psychiatric nursing, community health nursing, pediatric nursing, and intensive care nursing. The panel also included educational department managers and the examination department supervisor. Through focused group discussions, the panel identified and examined issues regarding the exam format, and members proposed various solutions. Subsequently, after analyzing the proposed solutions and drawing upon the panel members’ experiences, specific roles for each member were delineated.

Sampling and participant selection

Given the nature of the research, purposive sampling was employed, ensuring that all individuals involved in the design, implementation, and evaluation of the exam participated in this study.

The participants in this study included final-year nursing students, faculty members, clinical skills center experts, the dean of the school, the educational deputy, group managers, and the exam department head. However, in the outcome evaluation phase, 13 faculty members participated in-person and virtually (26 times), and 84 final-year nursing students enrolled in the study using a census method in two semesters of 2020–2021 completed the questionnaires, including 37 females and 47 males. In addition, three male and ten female faculty members participated in this study; of this number, 2 were instructors, and 11 were assistant professors.

Data collection tools

In order to enhance the validity and credibility of the study and thoroughly examine the results, this study utilized a triangulation method consisting of demographic information, focus group discussions, the Spielberger Anxiety Scale questionnaire, and an Acceptance and Satisfaction Questionnaire.

Demographic information

A questionnaire was used to gather demographic information from both students and faculty members. For students, this included age, gender, and place of residence, while for faculty members, it included age, gender, field of study, and employment status.

Focus group discussion

Multiple focused group discussions were conducted with the participation of professors, administrators, experts, and students. These discussions were held through various platforms such as WhatsApp Skype, and in-person meetings while adhering to health protocols. The researcher guided the talks toward the research objectives and raised fundamental questions, such as describing the strengths and weaknesses of the previous exam, determining how to conduct the CCE considering the COVID-19 situation, deciding on virtual and in-person stations, specifying the evaluation checklists for stations, and explaining the weighting and scoring of each station.

Spielberger anxiety scale questionnaire

This study used the Spielberger Anxiety Questionnaire to measure students’ overt and covert anxiety levels. This questionnaire is an internationally standardized tool known as the STAI questionnaire that measures both overt (state) and covert (trait) anxiety [ 22 ]. The state anxiety scale (Form Y-1 of STAI) comprises twenty statements that assess the individual’s feelings at the moment of responding. The trait anxiety scale (Form Y-2 of STAI) also includes twenty statements that measure individuals’ general and typical feelings. The scores of each of the two scales ranged from 20 to 80 in the current study. The reliability coefficient of the test for the apparent and hidden anxiety scales, based on Cronbach’s alpha, was confirmed to be 0.9084 and 0.9025, respectively [ 23 , 24 ]. Furthermore, in the present study, Cronbach’s alpha value for the total anxiety questionnaire, overt anxiety, and covert anxiety scales were 0.935, 0.921, and 0.760, respectively.

Acceptance and satisfaction questionnaire

The Acceptability and Satisfaction Questionnaire for Clinical Competency Test was developed by Farajpour et al. (2012). The student questionnaire consists of ten questions, and the professor questionnaire consists of eleven questions, using a four-point Likert scale. Experts have confirmed the validity of these questionnaires, and their Cronbach’s alpha coefficients have been determined to be 0.85 and 0.87 for the professor and student questionnaires, respectively [ 6 ]. In the current study, ten medical education experts also confirmed the validity of the questionnaires. Regarding internal reliability, Cronbach’s alpha coefficients for the student satisfaction questionnaire for both virtual and in-person sections were 0.76 and 0.87, respectively. The professor satisfaction questionnaires were 0.84 and 0.87, respectively. An online platform was used to collect data for the virtual exam.

Data analysis and rigor of study

Qualitative data analysis was conducted using the method proposed by Graneheim and Lundman. Additionally, the criteria established by Lincoln and Guba (1985) were employed to confirm the rigor and validity of the data, including credibility, transferability, dependability, and confirmability [ 26 ].

In this research, data synthesis was performed by combining the collected data with various tools and methods. The findings of this study were reviewed and confirmed by participants, supervisors, mentors, and experts in qualitative research, reflecting their opinions on the alignment of findings with their experiences and perspectives on clinical competence examinations. Therefore, the member check method was used to validate credibility.

Moreover, efforts were made in this study to provide a comprehensive description of the research steps, create a suitable context for implementation, assess the views of others, and ensure the transferability of the results.

Furthermore, researchers’ interest in identifying and describing problems, reflecting, designing, implementing, and evaluating clinical competence examinations, along with the engagement of stakeholders in these examinations, was ensured by the researchers’ long-term engagement of over 25 years with the environment and stakeholders, seeking their opinions and considering their ideas and views. These factors contributed to ensuring confirmability.

In this research, by reflecting the results to the participants and making revisions by the researchers, problem clarification and solution presentation, design, implementation, and evaluation of operational programs with stakeholder participation and continuous presence were attempted to prevent biases, assumptions, and research hypotheses, and to confirm dependability.

Data analysis was performed using SPSS version 21, and descriptive statistical tests (absolute and relative frequency, mean, and standard deviation) and inferential tests (paired t-test, independent t-test, and analysis of variance) were used. The significance level was set at 0.05. Parametric tests were used based on the normality of the data according to the Kolmogorov-Smirnov statistical test.

Given that conducting the CCE for final-year nursing students required the active participation of managers, faculty members, staff, and students, and to answer the research question “How can the CCE for final-year nursing students be conducted?” and achieve the research objective of “designing, implementing, and evaluating the clinical competency exam,” the action research method was employed.

The present study was conducted based on the Dickens & Watkins model. There are four primary stages (Fig.  1 ) in the cyclical action research process: reflect, plan, act, observe, and then reflect to continue through the cycle [ 27 ].

The cyclical process of action research [ 27 ]

Stage 1: Reflection

Identification of the problem.

According to the educational regulations, final semester nursing students must complete the clinical competency exam. However, due to the COVID-19 pandemic and the critical situation in most provinces, inter-city travel restrictions, and insufficient dormitory space, conducting the CCE in-person was not feasible.

This exam was conducted virtually at our institution. However, based on the reflections from experts, researchers have found that virtual exams can only partially assess clinical and practical skills in certain stations, such as basic skills, resuscitation, and pediatrics. Furthermore, utilizing Objective Structured Clinical Examination (OSCE) in skills assessment facilitates the evaluation of psychomotor skills, knowledge, and attitudes, aiding in identifying strengths and weaknesses.

P3, “Due to the COVID-19 pandemic and the critical situation in most provinces, inter-city travel restrictions, and insufficient dormitory space, conducting the CCE in-person is not feasible.”

Stage 2: Planning

Based on the reflections gathered from the participants, the exam was designed using a blended approach (combining in-person and virtual components) as per the schedule outlined in Fig.  2 . All planned activities for the blended CCE for final-year nursing students were executed over two semesters.

P5, “Taking the exam virtually might seem easier for us and the students, but in my opinion, it’s not realistic. For instance, performing wound dressing or airway management is very practical, and it’s not possible to assess students with a virtual scenario. We need to see them in person.”

P6"I believe it’s better to conduct those activities that are highly practical in person, but for those involving communication skills like report writing, professional ethics, etc., we can opt for virtual assessment.”

Design and implementation of the blended CCE

Stage 3: Act

Cce implementation steps.

The CCE was conducted based on the flowchart in Fig.  3 and the following steps:

Steps for conducting the CCE for final-year nursing students using a blended method

Step 1: Designing the framework for conducting the blended Clinical Competency Examination

The panelists were guided to design the blended exam in focused group sessions and virtual panels based on the ADDIE (Analysis, Design, Development, Implementation, Evaluation) model [ 28 ]. Initially, needs assessment and opinion polling were conducted, followed by the operational planning of the exam, including the design of the blueprint table (Table  1 ), determination of station types (in-person or virtual), designing question stems in the form of scenarios, creating checklists and station procedure guides by expert panel groups based on participant analysis, and the development of exam implementation guidelines with participant input [ 27 ]. The design, execution, and evaluation were as follows:

In-person and virtual meetings with professors were held to determine the exam schedule, deadlines for submitting checklists, decision-making regarding the virtual or in-person nature of stations based on the type of skill (practical, communication), and presenting problems and solutions. Based on the decisions, primary skill stations, as well as cardiac and pediatric resuscitation stations, were held in person. In contrast, virtual stations for health, nursing ethics, nursing reports, nursing diagnosis, physical examinations, and psychiatric nursing were held.

News about the exam was communicated to students through the college website and text messages. Then, an online orientation session was held on Skype with students regarding the need assessment of pre-exam educational workshops, virtual and in-person exam standards, how to use exam software, how to conduct virtual exams, explaining the necessary infrastructure for participating in the exam by students, completing anxiety and satisfaction questionnaires, rules and regulations, how to deal with rejected individuals, and exam testing and Q&A. Additionally, a pre-exam in-person orientation session was held.

To inform students about the entire educational process, the resources and educational content recommended by the professors, including PDF files, photos and videos, instructions, and links, were shared through a virtual group on the social media messenger, and scientific information was also, questions were asked and answered through this platform.

Correspondence and necessary coordination were made with the university clinical skills center to conduct in-person workshops and exams.

Following the Test-centered approach, the Angoff Modified method [ 29 , 30 ] was used to determine the scoring criteria for each station by panelists tasked with assigning scores.

Additionally, in establishing standards for this blended CCE for fourth-year nursing students, for whom graduation was a prerequisite, the panelists, as experienced clinical educators familiar with the performance and future roles of these students and the assessment method of the blended exam, were involved [ 29 , 30 ](Table 1 ).

Step 2: Preparing the necessary infrastructure for conducting the exam

Software infrastructure.

The pre- and post-virtual exam questions, scenarios, and questionnaires were uploaded using online software.

The exam was conducted on a trial basis in multiple sessions with the participation of several faculty members, and any issues were addressed. Students were authenticated to enter the exam environment via email and personal information verification. The questions for each station were designed and entered into the software by the respective station instructors and the examination coordinator, who facilitated the exam. The questions were formatted as clinical scenarios, images, descriptive questions, and multiple-choice questions, emphasizing the clinical and practical aspects. This software had various features for administering different types of exams and various question formats, including multiple-choice, descriptive, scenario-based, image-based, video-based, matching, Excel output, and graphical and descriptive statistical analyses. It also had automatic questionnaire completion, notification emails, score addition to questionnaires, prevention of multiple answer submissions, and the ability to upload files up to 4 gigabytes. Student authentication was based on national identification numbers and student IDs, serving as user IDs and passwords. Students could enter the exam environment using their email and multi-level personal information verification. If the information did not match, individuals could not access the exam environment.

Checklists and questionnaires

A student list was prepared, and checklists for the in-person exam and anxiety and satisfaction questionnaires were reproduced.

Empowerment workshops for professors and education staff

Educational needs of faculty members and academic staff include conducting clinical competency exams using the OSCE method; simulating and evaluating OSCE exams; designing standardized questions, checklists, and scenarios; innovative approaches in clinical evaluations; designing physical spaces and setting up stations; and assessing ethics and professional commitment in clinical competency exams.

Student empowerment programs

According to the students’ needs assessment results, in-person workshops on cardiopulmonary resuscitation and airway management and online workshops were held on health, pediatrics, cardiopulmonary resuscitation, ethics, nursing diagnosis, and report writing through Skype messenger. In addition, vaccination notes, psychiatric nursing, and educational files on clinical examinations and basic skills were recorded by instructors and made available to students via virtual groups.

Step 3: CCE implementation

The CCE was held in two parts, in-person and virtual.

In-person exam

The OSCE method was used for this section of the exam. The basic skills station exam included dressing and injections, and the CPR and pediatrics stations were conducted in person. The students were divided into two groups of 21 each semester, and the exam was held in two shifts. While adhering to quarantine protocols, the students performed the procedures for seven minutes at each station, and instructors evaluated them using a checklist. An additional minute was allotted for transitioning to the next station.

Virtual exam

The professional ethics, nursing diagnosis, nursing report, health, psychiatric nursing, and physical examination stations were conducted virtually after the in-person exam. This exam was made available to students via a primary and a secondary link in a virtual space at the scheduled time. Students were first verified, and after the specified time elapsed, the ability to respond to inactive questions and submitted answers was sent. During the exam, full support was provided by the examination center.

The examination coordinator conducted the entire virtual exam process. The exam results were announced 48 h after the exam. A passing grade was considered to be a score higher than 60% in all stations. Students who failed in various stations were given the opportunity for remediation based on faculty feedback, either through additional study or participation in educational workshops. Subsequent exams were held one week apart from the initial exam. It was stipulated that students who failed in more than half of the stations would be evaluated in the following semester. If they failed in more than three sessions at a station, a decision would be made by the faculty’s educational council. However, no students met these situations.

Step 4: Evaluation

The evaluation of the exam was conducted by examiners using a checklist, and the results were announced as pass or fail.

Stage 4: Observation / evaluation

In this study, both process and outcome evaluations were conducted:

Process evaluation

All programs and activities implemented during the test design and administration process were evaluated in the process evaluation. This evaluation was based on operational program control and reflections received from participants through group discussion sessions and virtual groups.

Sample reflections received from faculty members, managers, experts, and students through group discussions and social messaging platforms after the changes:

P7: “The implementation of the blended virtual exam, in the conditions of the COVID-19 crisis where the possibility of holding in-person exams was not fully available, in my opinion, was able to improve the quality of exam administration and address the limitations and weaknesses of the exam entirely virtually.”

P5: “In my opinion, this blended method was able to better evaluate students in terms of clinical readiness for entering clinical practice.”

Outcomes evaluation

The study outcomes were student anxiety, student acceptance and satisfaction, and faculty acceptance and satisfaction. Before the start of the in-person and virtual exams, the Spielberger Anxiety Questionnaire was provided to students. Additionally, immediately after the exam, students and instructors completed the acceptance and satisfaction questionnaire for the relevant section. After the exam, students and instructors completed the acceptance and satisfaction questionnaire again for the entire exam process, including feasibility, satisfaction with its implementation, and educational impact.

Design framework and implementation for the blended Clinical Competency Examination

The exam was planned using a blended method (part in-person, part virtual) according to the Fig.  2 schedule, and all planned programs for the blended CCE for final-year nursing students were implemented in two semesters.

Evaluation results

In this study, 84 final-year nursing students participated, including 37 females (44.05%) and 47 males (55.95%). Among them, 28 (33.3%) were dormitory residents, and 56 (66.7%) were non-dormitory residents.

In this study, both process and outcome evaluations were conducted.

All programs and activities implemented during the test design and administration process were evaluated in the process evaluation (Table  2 ). This evaluation was based on operational program control and reflections received from participants through group discussion sessions and virtual groups on social media.

Anxiety and satisfaction were examined and evaluated as study outcomes, and the results are presented below.

The paired t-test results in Table  3 showed no statistically significant difference in overt anxiety ( p  = 0.56), covert anxiety ( p  = 0.13), and total anxiety scores ( p  = 0.167) between the in-person and virtual sections before the blended Clinical Competency Examination.

However, the mean (SD) of overt anxiety in persons in males and females was 49.27 (11.16) and 43.63 (13.60), respectively, and this difference was statistically significant ( p  = 0.03). Also, the mean (SD) of overt virtual anxiety in males and females was 45.70 (11.88) and 51.00 (9.51), respectively, and this difference was statistically significant ( p  = 0.03). However, there was no significant difference between males and females regarding covert anxiety in the person ( p  = 0.94) and virtual ( p  = 0.60) sections. In addition, the highest percentage of overt anxiety was apparent in the virtual section among women (15.40%) and the in-person section among men (21.28%) and was prevalent at a moderate to high level.

According to Table  4 , One-way analysis of variance showed a significant difference between the virtual, in-person, and blended sections in terms of acceptance and satisfaction scores.

The results of the One-way analysis of variance showed that the mean (SD) acceptance and satisfaction scores of nursing students of the CCE in virtual, in-person, and blended sections were 25.49 (4.73), 27.60 (4.70), and 25.57 (4.97) out of 30, respectively. There was a significant difference between the three sections ( p  = 0.008).

In addition, 3 (7.23%) male and 10 (76.3%) female faculty members participated in this study; of this number, 2 (15.38%) were instructors, and 11 (84.62%) were assistant professors. Moreover, they were between 29 and 50 years old, with a mean (SD) of 41.37 (6.27). Furthermore, they had 4 to 20 years of work experience with a mean and standard deviation of 13.22(4.43).

The results of the analysis of variance showed that the mean (SD) acceptance and satisfaction scores of faculty members of the CCE in virtual, in-person, and blended sections were 30.31 (4.47), 29.86 (3.94), and 30.00 (4.16) out of 33, respectively. There was no significant difference between the three sections ( p  = 0.864).

This action research study showed that the blended CCE for nursing students is feasible and, depending on the conditions and objectives, evaluation stations can be designed and implemented virtually or in person.

The blended exam, combining in-person and virtual elements, managed to address some of the weaknesses of entirely virtual exams conducted in previous terms due to the COVID-19 pandemic. Given the pandemic conditions, the possibility of performing all in-person stations was not feasible due to the risk of students and evaluators contracting the virus, as well as the need for prolonged quarantine. Additionally, to meet the staffing needs of hospitals, nursing students needed to graduate. By implementing the blended exam idea and conducting in-person evaluations at clinical stations, the assessment of nursing students’ clinical competence was brought closer to reality compared to the entirely virtual method.

Furthermore, the need for human resources, station setup costs, and time spent was less than the entirely in-person method. Therefore, in pandemics or conditions where sufficient financial resources and human resources are not available, the blended approach can be utilized.

Additionally, the evaluation results showed that students’ total and overt anxiety in both virtual and in-person sections of the blended CCE did not differ significantly. However, the overt anxiety of female students in the virtual section and male students in the in-person section was considerably higher. Nevertheless, students’ covert anxiety related to personal characteristics did not differ in virtual and in-person exam sections. However, students’ acceptance and satisfaction in the in-person section were higher than in the virtual and blended sections, with a significant difference. The acceptance and satisfaction of faculty members from the CCE in in-person, virtual, and blended sections were the same and relatively high.

A blended CCE nursing competency exam was not found in the literature review. However, recent studies, especially during the COVID-19 pandemic, have designed and implemented this exam using virtual OSCE. Previously, the CCE was held in-person or through traditional OSCE methods.

During the COVID-19 pandemic, nursing schools worldwide faced difficulties administering clinical competency exams for students. The virtual simulation was used to evaluate clinical competency and develop nursing students’ clinical skills in the United States, including standard videos, home videos, and clinical scenarios. Additionally, an online virtual simulation program was designed to assess the clinical competency of senior nursing students in Hong Kong as a potential alternative to traditional clinical training [ 31 ].

A traditional in-person OSCE was also redesigned and developed through a virtual conferencing platform for nursing students at the University of Texas Medical Branch in Galveston. Survey findings showed that most professors and students considered virtual OSCE a highly effective tool for evaluating communication skills, obtaining a medical history, making differential diagnoses, and managing patients. However, professors noted that evaluating examination techniques in a virtual environment is challenging [ 32 ].

However, Biranvand reported that less than half of the nursing students believed the in-person OSCE was stressful [ 33 ]. At the same time, the results of another study showed that 96.2% of nursing students perceived the exam as anxiety-provoking [ 1 ]. Students believe that the stress of this exam is primarily related to exam time, complexity, and the execution of techniques, as well as confusion about exam methods [ 7 ]. In contrast to previous research results, in a study conducted in Egypt, 75% of students reported that the OSCE method has less stress than other examination methods [ 9 ]. However, there has yet to be a consensus across studies on the causes and extent of anxiety-provoking in the OSCE exam. In a study, the researchers found that in addition to the factors mentioned above, the evaluator’s presence could also be a cause of stress [ 34 ]. Another survey study showed that students perceived the OSCE method as more stressful than the traditional method, mainly due to the large number of stations, exam items, and time constraints [ 7 ]. Another study in Egypt, which designed two stages of the OSCE exam for 75 nursing students, found that 65.6% of students reported that the second stage exam was stressful due to the problem-solving station. In contrast, only 38.9% of participants considered the first-stage exam stressful [ 35 ]. Given that various studies have reported anxiety as one of the disadvantages of the OSCE exam, in this study, one of the outcomes evaluated was the anxiety of final-year nursing students. There was no significant difference in total anxiety and overt anxiety between students in the in-person and virtual sections of the blended Clinical Competency Examination. The overt anxiety was higher in male students in the in-person part and female students in the virtual section, which may be due to their personality traits, but further research is needed to confirm this. Moreover, since students’ total and overt anxiety in the in-person and virtual sections of the exam are the same in resource and workforce shortages or pandemics, the blended CCE is suggested as a suitable alternative to the traditional OSCE test. However, for generalization of the results, it is recommended that future studies consider three intervention groups, where all OSCE stations are conducted virtually in the first group, in-person in the second group, and a blend of in-person and virtual in the third group. Furthermore, the results of the study by Rafati et al. showed that the use of the OSCE clinical competency exam using the OSCE method is acceptable, valid, and reliable for assessing nursing skills, as 50% of the students were delighted, and 34.6% were relatively satisfied with the OSCE clinical competency exam. Additionally, 57.7% of the students believed the exam revealed learning weaknesses [ 1 ]. Another survey study showed that despite higher anxiety about the OSCE exam, students thought that this exam provides equal opportunities for everyone, is less complicated than the traditional method, and encourages the active participation of students [ 7 ]. In another study on maternal and infant care, 95% of the students believed the traditional exam only evaluates memory or practical skills. In contrast, the OSCE exam assesses knowledge, understanding, cognitive and analytical skills, communication, and emotional skills. They believed that explicit evaluation goals, appropriate implementation guidelines, appropriate scheduling, wearing uniforms, equipping the workroom, evaluating many skills, and providing fast feedback are among the advantages of this exam [ 36 ]. Moreover, in a survey study, most students were satisfied with the clinical environment offered by the OSCE CCE using the OSCE method, which is close to reality and involves a hypothetical patient in necessary situations that increase work safety. On the other hand, factors such as the scheduling of stations and time constraints have led to dissatisfaction among students [ 37 ].

Furthermore, another study showed that virtual simulations effectively improve students’ skills in tracheostomy suctioning, triage concepts, evaluation, life-saving interventions, clinical reasoning skills, clinical judgment skills, intravenous catheterization skills, role-based nursing care, individual readiness, critical thinking, reducing anxiety levels, and increasing confidence in the laboratory, clinical nursing education, interactive communication, and health evaluation skills. In addition to knowledge and skills, new findings indicate that virtual simulations can increase confidence, change attitudes and behaviors, and be an innovative, flexible, and hopeful approach for new nurses and nursing students [ 38 ].

Various studies have evaluated the satisfaction of students and faculty members with the OSCE Clinical Competency Examination. In this study, one of the evaluated outcomes was the acceptability and satisfaction of students and faculty members with implementing the CCE in blended, virtual, and in-person sections, which was relatively high and consistent with other studies. One crucial factor that influenced the satisfaction of this study was the provision of virtual justification sessions for students and coordination sessions with faculty members. Social messaging groups were formed through virtual and in-person communication, instructions were explained, expectations and tasks were clarified, and questions were answered. Students and faculty members could access the required information with minimal presence in medical education centers and time and cost constraints. Moreover, with the blended evaluation, the researcher’s communication with participants was more accessible. The written guidelines and uploaded educational content of the workshops enabled students to save the desired topics and review them later if needed. Students had easy access to scientific and up-to-date information, and the application of social messengers and Skype allowed for sending photos and videos, conducting workshops, and questions and answering questions. However, the clinical workshops and examinations were held in-person to ensure accuracy. The virtual part of the examination was conducted through online software, and questions focused on each station’s clinical and practical aspects. Students answered various questions, including multiple-choice, descriptive, scenario, picture, and puzzle questions, within a specified time. The blended examination evaluated clinical competency and did not delay these individuals’ entry into the job market. Moreover, during the severe human resource shortage faced by the healthcare system, the examination allowed several nurses to enter the country’s healthcare system. The blended examination can substitute in-person examination in pandemic and non-pandemic situations, saving facilities, equipment, and human resources. The results of this study can also serve as a model to guide other nursing departments that require appropriate planning and arrangements for Conducting Clinical Competency Examinations in blended formats. This examination can also be developed to evaluate students’ clinical performance.

One of the practical limitations of the study was the possibility that participants might need to complete the questionnaires accurately or be concerned about losing marks. Therefore, in a virtual session before the in-person exam, the objectives and importance of the study were explained. Participants were assured that it would not affect their evaluation and that they should not worry about losing marks. Additionally, active participation from all nursing students, faculty members, and staff was necessary for implementing this plan, achieved through prior coordination, virtual meetings, virtual group formation, and continuous reflection of results, creating the motivation for continued collaboration and participation.

Among other limitations of this study included the use of the Spielberger Anxiety Questionnaire to measure students’ anxiety. It is suggested that future studies use a dedicated anxiety questionnaire designed explicitly for pre-exam anxiety measurement. Another limitation of the current research was its implementation in nursing and midwifery faculty. Therefore, it is recommended that similar studies be conducted in nursing and midwifery faculties of other universities, as well as in related fields, and over multiple consecutive semesters. Additionally, for more precise effectiveness assessment, intervention studies in three separate virtual, in-person, and hybrid groups using electronic checklists are proposed. Furthermore, it is recommended that students be evaluated in terms of other dimensions and variables such as awareness, clinical skill acquisition, self-confidence, and self-efficacy.

Conducting in-person Clinical Competency Examination (CCE) during critical situations, such as the COVID-19 pandemic, is challenging. Instead of virtual exams, blended evaluation is a feasible approach to overcome the shortages of virtual ones and closely mimic in-person scenarios. Using a blended method in pandemics or resource shortages, it is possible to design, implement, and evaluate stations that evaluate basic and advanced clinical skills in in-person section, as well as stations that focus on communication, reporting, nursing diagnosis, professional ethics, mental health, and community health based on scenarios in a virtual section, and replace traditional OSCE exams. Furthermore, the use of patient simulators, virtual reality, virtual practice, and the development of virtual and in-person training infrastructure to improve the quality of clinical education and evaluation and obtain the necessary clinical competencies for students is recommended. Also, since few studies have been conducted using the blended method, it is suggested that future research be conducted in three intervention groups, over longer semesters, based on clinical evaluation models and influential on other outcomes such as awareness and clinical skill acquisition self-efficacy, confidence, obtained grades, and estimation of material and human resources costs. This approach reduced the need for physical space for in-person exams, ensuring participant quarantine and health safety with higher quality. Additionally, a more accurate assessment of nursing students’ practical abilities was achieved compared to a solely virtual exam.

Data availability

The datasets generated and analyzed during the current study are available on request from the corresponding author.

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Acknowledgements

We want to thank the Research and Technology deputy of Smart University of Medical Sciences, Tehran, Iran, the faculty members, staff, and officials of the School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran, and all individuals who participated in this study.

All steps of the study, including study design and data collection, analysis, interpretation, and manuscript drafting, were supported by the Deputy of Research of Smart University of Medical Sciences.

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RM. Participating in study design, accrual of study participants, review of the manuscript, and critical revisions for important intellectual content. TT : The investigator; participated in study design, data collection, accrual of study participants, and writing and reviewing the manuscript. AM: Participating in study design, data analysis, accrual of study participants, and reviewing the manuscript. All authors read and approved the final version of the manuscript.

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This action research was conducted following the participatory method. All methods were performed according to the relevant guidelines and regulations in the Declaration of Helsinki (ethics approval and consent to participate). The study’s aims and procedures were explained to all participants, and necessary assurance was given to them for the anonymity and confidentiality of their information. The results were continuously provided as feedback to the participants. Informed consent (explaining the goals and methods of the study) was obtained from participants. The Smart University of Medical Sciences Ethics Committee approved the study protocol (IR.VUMS.REC.1400.011).

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Mojtahedzadeh, R., Toulabi, T. & Mohammadi, A. The design, implementation, and evaluation of a blended (in-person and virtual) Clinical Competency Examination for final-year nursing students. BMC Med Educ 24 , 936 (2024). https://doi.org/10.1186/s12909-024-05935-9

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• Clinical Competency Examination (CCE)
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