MedEdPORTAL (Jan 2012)
Scenarios and Standardized Professionals From the Objective Structured System-Interaction Examinations (OSSIEs) of an Internal Medicine Residency Program
Abstract
Abstract The purpose of this study is to make available information regarding standardized professionals, as used by the Southern Illinois University School of Medicine Internal Medicine Residency Program during the Objective Structured Systems-Interaction Examination (OSSIE). The 15 scenarios and their affiliated materials may be used by others working at institutions using standardized performance- and systems-based examinations. The definition of a competent physician is evolving from ‘the doctor who possesses the right attributes” to ‘the doctor who does the right thing.” The public is concerned about the delivery of competent care, which can be assessed by concrete measures such as quality, safety, and cost. Competent care is provided through collaboration with the other members of the health care team and is proven by good outcomes.1 In light of this new definition of competence, the Accreditation Council for Graduate Medical Education (ACGME) has identified systems-based practice as one of the six core competencies needed by residents to practice effectively in today's health care milieu. To be competent in systems-based practice, ‘residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.”2 The ACGME has proposed the use of simulations, Objective Structured Clinical Examinations (OSCEs), and standardized patients (SPs) for assessing resident performance and for providing formative evaluations. These approaches place residents in circumstances that simulate real-life situations. OSCEs standardize the evaluation by controlling the variance that is inherent in real-life situations.3, 4 In contrast to the OSCE, where most standardized-patient encounters are set in the simulated clinic office, the Objective Structured System-Interaction Examination (OSSIE) cases use a variety of simulated settings. OSSIE cases are situated in simulated hospital rooms, physician offices, nurses' stations, conference rooms, and resident lounges. These settings require using desks and other furniture instead of exam tables. In addition, charts, x-rays, and other props have to be prepared for accurate simulation. Some charts need to replicate hospital records and thus need simulated history and physicals, progress notes, lab reports, radiology reports, etc. Much time is devoted to ensure that these documents look as authentic as possible. Previous publications have described the creation of the OSSIE as a performance-based examination and its feasibility as a measure of systems-based practice.5, 6
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