MedEdPORTAL (Jun 2013)
Assessing First-Responder and BLS Skills: The Case of Mona Shadid
Abstract
Abstract Introduction This objective structured clinical examination (OSCE) involves a 5-minute patient encounter that aims to assess a trainees' basic resuscitation skills in responding to a patient with an un-witnessed collapse in an outpatient clinic setting. The target audience includes preclinical medical students, nursing students, junior resident physicians, and other trainees who have gone through first-responder and basic life support training. Methods The case involved a patient presenting to an outpatient clinic complaining of vague chest pain who collapsed while waiting to see the physician. The encounter began with the student entering the office and a “friend” (a standardized patient) informing him/her of the situation. The patient, “Mona,” was a mannequin on the ground. The student was expected to perform several critical actions, including assessing Mona's responsiveness, checking for a pulse, initiating and continuing chest compressions and mouth-to-mouth ventilation, calling for Emergency Medical Services (EMS) and an automated external defibrillator (AED), and communicating with EMS personnel. Timed cues are incorporated to provide a more structured flow to the case. Results The OSCE at our institution was run at the Clinical Skills Center in the spring of 2012 (n = 43) and 2013 (n = 38), with all first-year students participating. It was successful in assessing student performance of the critical actions, and highlighting areas that required emphasis and review. We found that students had the most difficulty remembering to check for a pulse prior to starting chest compressions (only 51.2% did this), open the airway using a jaw thrust (2.2%) rather than a head-tilt/chin-lift maneuver (74.4%), calling for an AED (37.2%), and the ratio of chest compressions to ventilations. Only 34.9% performed the correct number of chest compressions, while only 27.9% gave at least two breaths per cycle. Discussion The OSCE was meant to be formative for the students and to provide feedback on the course's efficacy for the course directors. The OSCE grade did not contribute to the students' overall medical school grades, although our OSCE checklist can easily be used as a grading tool as well.
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