MedEdPORTAL (Sep 2014)
An OSCE to Assess Trainee Management of Complex Older Adults and to Teach Documentation, Coding, and Billing
Abstract
Abstract Introduction Our geriatric fellowship assessment was initially developed in 2010 as a full-day objective structured clinical evaluation (OSCE) to provide formative feedback for geriatric fellows throughout the Michigan State University College of Human Medicine Fellowship Network. Our OSCE has since been expanded by using a blueprint to capture various aspects of clinical care that fellows are likely to encounter: geriatric syndromes, end-of-life care, geriatric practice sites, and varying patient complexity (robust, frail, dying). Methods This resource provides nine comprehensive geriatric assessment OSCEs. Material relevant to all the OSCES includes the blueprint for fellowship assessment, Geriatric Fellowship Curriculum Milestones by the American Geriatrics Society referenced in the blueprint, billing help sheet, and standardized patient (SP) training checklist. Each of the nine OSCES has its own doorway information (for learners), case synopsis (for faculty), SP instructions and script, SP evaluation checklist, faculty evaluation checklist, example documentation, documentation audit (with billing codes), and necessary supplemental documents. Each case requires 30 minutes with the SP (and family or support staff), followed by 15 minutes to complete documentation and billing. Each fellow is observed by a single faculty member. Faculty have access to their checklists throughout the case and can make comments for formative feedback as the case evolves. Results Since 2010, we have evaluated 10 geriatric fellows, eight of whom have participated in two OSCE events, allowing for assessment of clinical improvement. Fellow performance was rated well by all SPs for both midyear and end-of-year performance. Faculty evaluations suggested that fellows improved their performance of cognitive assessments and ability to counsel impaired drivers and appropriately referred for formal driving evaluations. Review of fellows' documentation suggested that trainees frequently omitted the chief complaint, which is a necessary component of all billing encounters. Discussion Our geriatric OSCE cases represent real-life situations that geriatricians encounter in practice. While the cases we present are comprehensive, they are by no means exhaustive. We feel that our OSCE could be improved by development of additional cases. Furthermore, we are in the process of validating our SP and faculty evaluations by performing interrater reliability analyses, which will strengthen these tools. Funding remains a future challenge, as direct costs for this assessment are approximately $3,000 at a dedicated simulation center. To date, we have received grant funding, with the remaining costs shared between the various fellowship network sites that participate in the events.
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