Objective Structured Clinical Examination Case: Mary Smith

Abstract

Abstract Introduction The purpose of the Mary Smith encounter is to challenge students to manage a common geriatric presentation as part of an eight-station objective structured clinical examination (OSCE) for third-year medical students completing a geriatric clerkship. Students conduct a focused history to assess the patient's diabetes and counsel as needed. The educational objectives of the encounter are to assess students' abilities to address noncompliance with a diabetes self-care regimen, effectively counsel a patient on a diabetes self-care regimen, and make appropriate referrals for diabetes management. Methods The standardized patient (SP) portrays Mary Smith, a 70-year-old woman presenting to the outpatient office after her daughter has urged her to see a doctor for her diabetes. The examinee's task is to obtain a focused history and counsel the patient regarding her situation. The SP encounter is limited to 15 minutes in the actual exam room. Following the encounter, the examinee has 10 minutes to document the encounter in a SOAP-style patient note. The submission includes six case-specific documents, an instructor's guide, and an introduction to the case. Results This case was used in both the 2010 and 2011 OSCEs for 300 third-year students. No major pitfalls were reported. The case's Angoff cut score (derived from a panel of experts coming together to decide what score constitutes minimal competence) was set at 52. The overall mean (SD) for the case was 66 (11), with 92% of students scoring above the Angoff cut score. Discussion Both the faculty and the SP actors commented about the importance of this case in training and consistently reinforcing best practices for treating the geriatric diabetic patient. When carrying out the case, make sure that the SP has been trained well and has memorized the role and that practice runs are conducted multiple times prior to the beginning of the usage of the case. The case has many subtle nuisances that are very important to the delivery of the learning objectives.

Keywords

• Counseling
• Non-Compliance