Objective To explore the application effect of online and offline hybrid teaching based on clinical competence combined with objective structured clinical examination (OSCE) in the clinical undergraduate anesthesia teaching. Methods Sixty undergraduate students who completed their anesthesiology internship at the First Affiliated Hospital of Anhui University of Chinese Medicine between January and July 2024 were selected for this study. Based on their internship commencement dates, they were divided into two groups: a control group (January to April 2024) and an observation group (April to July 2024), with 30 participants in each group. The control group received traditional offline teaching, while the observation group adopted an online-offline hybrid teaching method oriented towards clinical skills. Both groups used OSCE as the assessment mode. Compare the scores of basic knowledge, handling of anesthesia crisis events, skill assessment, teaching satisfaction, and comprehensive ability scores before and after the teaching process between the two groups. Results The scores of the basic knowledge assessment, anesthesia crisis event handling assessment, and skills assessment of the students in the observation group were significantly higher than those of the control group. Additionally, the satisfaction levels regarding the training content, mode, and effect of the observation group were also notably higher (All P＜0.05). After the training, the abilities of the students in both groups significantly improved compared to before the training (All P＜0.05), and the observation group outperformed the control group (P＜0.05). Conclusion The online and offline hybrid teaching approach based on clinical skills, combined with OSCE assessment, applied to the undergraduate clinical teaching of anesthesiology, can significantly enhance students"" theoretical, operational and comprehensive clinical abilities, and improve teaching satisfaction.