MedEdPORTAL (Mar 2015)
Aligning Institutional OSCEs with Clinical Learning Environment Review Focus Areas and Competencies
Abstract
Abstract Introduction The Accreditation Council of Graduate Medical Education's Next Accreditation System's focus on outcomes presents unique challenges and opportunities to institutions and residency programs. Programs must review how well current measures address the new requirements and develop ways to capture missing elements through direct observation tools such as the objective structured clinical examination (OSCE). As a means to ensure standardized assessment of a communication and interpersonal skills curricula a series of OSCE cases were developed for residents at all levels of training. Methods For 2 years, the five nonspecialty-specific OSCEs were conducted at a simulation center to formatively assess residents' interpersonal and communication skills (IPC): delivering bad news, error disclosure, informed consent, surgical health care disparity, and medical health care disparity. Each patient encounter lasted 8 minutes, after which standardized patients (SPs) were given 3 minutes to score a given resident's IPC using the adapted form of the Kalamazoo Essential Elements Communication Checklist (KEECC-A), while the resident completed a self-evaluation. After that, SPs had 5 minutes to provide verbal feedback to the residents, who then attended a short group debriefing session. Fourteen SPs received structured training for this OSCE in both role portrayal and rating resident performance utilizing the KEECC-A. A handout aligning KEECC-A with CLER focus areas and competencies was provided to faculty in the second year. Results In the 2012-2013 year, 104 residents participated in the OSCE, and in the 2013-2014 year 112 residents participated. When comparing KEECC-A average scores between the 2 years, the 2013-2014 participating residents showed an improvement for the Bad News (t(196) = 3.13, p < .001) and Informed Consent (t(196) = 2.06, p < .05) cases. Feedback from the 2012-2013 year indicated that faculty did not deem the selected cases as ubiquitously relevant across programs, which was reflected in low faculty engagement. Resident feedback also showed a decrease in perceived utility of the OSCE as PGY level increased. After implementation of the handout aligning the KEECC-A with CLER focus areas and competencies, surveys from residents and program directors indicated more favorable attitudes toward the OSCE. Discussion The inclusion and recognition of department faculty champions was critical. In addition to reviewing data with residents, they also recommended how trends could be addressed at the program and institutional level. In addition, the debriefing materials for each case was essential; faculty remarked that little preparation and orientation was needed and helped them discuss the cases with residents.
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