Geriatric Cardiology OSCE: The Hidden Curriculum, Identifying End Stage Heart Disease & Clarifying Care Goals

Abstract

Abstract Introduction Fellowship Programs must soon comply with the ACGME's Next Accreditation System (NAS) Milestone performance tracking and reporting requirement and consider Entrustable Professional Activities (EPAs) to measure fellow performance. At the Medical College of Wisconsin (MCW), geriatricians and cardiologists worked together to create and implement a geriatric cardiology education OSCE for cardiology fellows to asses fellow competence in relevant EPAs. This resource is an objective structured clinical exam (OSCE) on geriatric cardiology education for cardiology fellows. Methods This resource contains all the materials necessary for the geriatric cardiology OSCE regarding end-stage heart disease and end-of-life goal setting. The resource also contains an additional agenda, timeline, and second evaluation form if it's to be combined with our other geriatric cardiology OSCE. Our evaluation tools included a session evaluation and learner self-assessment of skills pre- and postsession. As educators, our goal was to see if the learners were able to recognize that the cardiac disease was at an end-stage process, and then follow with an exploration of cognitive, functional, and social situations in the context of the patient's goals and wishes to discuss a hospice/palliative care approach. Results Results of the post-OSCE session evaluations showed fellows rating ‘Instructional strategies advanced my learning about geriatrics” as very good (33%) and excellent (66%) and “Overall effectiveness of session” as very good (44%) and excellent (56%). Session strengths included “Patient cases are relevant to daily patient care, very realistic,” and “Excellent discussion of end of life issues.” Pre- and post-EPA ratings revealed a shift to competence. The EPA item, “I can independently identify when a patient's illness trajectory is appropriate for palliative care/hospice” showed a pre-to-post competence change from 56% to 100%. Discussion Our curricular session demonstrates that OSCE is an effective, well-received instructional method to teach cardiology fellows geriatrics related to Accreditation Council for Graduate Medical Education competencies.

Keywords

• OSCE
• Geriatrics
• Standardized Patient
• Goals of Care
• Patient Care Planning
• Cardiology