Implementing an Objective Structured Teaching Exercise (OSTE) in an OBGYN Residency Program

Abstract

Abstract Introduction Residency program directors are being asked to train residents to be better teachers and to evaluate their teaching skills, yet to do so, they need programs that are fair, reproducible, and effective. We designed and implemented a resident-as-teacher training program using a simulated, videotaped teaching encounter—an objective structured teaching exercise (OSTE)—with a resident teaching a trained medical student. The goal of the exercise was for residents to practice teaching skills and self-assessment and to receive immediate faculty evaluation of their teaching. Methods Residents are introduced to the program during first-year orientation. The program is meant to be instructional, as well as evaluative, and participation is mandatory. Residents are taught the principles of asking open-ended questions, use of body language, timing of questioning, and assessment of the learner's background. During orientation, they are also introduced to the resident-as-teacher evaluation tool, and they conduct a practice resident-as-teacher exercise with a trained medical student. Although the residents view their performances on video, the orientation exercise has no evaluative component, as it is designed as an introduction to the program. Each resident then annually participates in the resident-as-teacher OSTE in each of the 4 years of residency, with formal faculty evaluation and self-evaluation, and the results become part of the resident's portfolio. Cases are based on core topics from the learning objectives for medical students written by the Association of Professors of Gynecology and Obstetrics, and the same topic is used for all residents in each academic year. Residents are instructed to teach the student as they typically would in the clinical setting. The encounter lasts 7 minutes and is videotaped. One OB-GYN faculty member observes each encounter from an observation booth with a one-way mirror and evaluates each resident using the evaluation tool. The resident is also asked to self-evaluate, using the same evaluation tool. This evaluation tool has been validated. Results The OSTE has been used for the last 5 years in the OB-GYN residency program at Beth Israel Deaconess Medical Center, Harvard Medical School. There are five residents per year in the residency program, and 30 residents have participated in the program. An assessment of the effectiveness of the program showed that resident participants felt the program in general was “very helpful” (4.1 ± 0.7 on a 5-point scale). Residents rated receiving immediate feedback on their teaching strategies and recognizing the importance of teaching by having the program equally as the most helpful components of the program. They found the process of developing the habit of formal self-reflection after self-viewing of the video of their teaching, especially when combined with immediate faculty feedback, very valuable. Discussion The success of the exercise is dependent on multiple factors, including faculty time for conducting the exercise, room space and equipment for videotaping, scheduling of protected time for participating resident and medical students, effective evaluation by a faculty member, and effective self-assessment by the resident.

Keywords

• OSTE
• Teacher