MedEdPORTAL (Jan 2012)
Sam Rodilla, Knee Pain
Abstract
Abstract Introduction This is resource is an OSCE case created for use with standardized patients (SPs), for teaching and/or evaluation purposes. The case is intended for medical students, years 1–4 (depending on a medical school's type of curriculum), as well as residents and faculty development. Methods Mr./Ms. Sam Rodilla is evaluated in outpatient clinic for new-onset right knee pain. Three days ago, s/he noted the onset of pain on the back of the left wrist, which grew worse with wrist extension. This resolved spontaneously after only 1 day. Yesterday morning, the patient began to feel pain in the right knee, worsening with bending the knee. Yesterday, the knee felt “swollen,” now, it is difficult for the patient to walk due to the pain. The recommended length of the session is 15 minutes for the learner in the patient room, 10 minutes for the patient note, and 30 minutes for debriefing with the faculty-observer (for teaching purposes only). Results The case has been successfully implemented with students at the Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. Interrater reliability was assessed on a continuous basis at the originating program, and for 20 consecutive cases, it was above 80%. Additionally, a case study was completed to review interrater reliability between SPs and faculty observers in a multiple-station high-stakes OSCE examination. Results indicated faculty and SPs matched in scoring. Discussion This OSCE case enriches the available library of cases for teaching and examination in internal medicine, family medicine, rheumatology, and infectious diseases. It requires students to demonstrate observational skills and the ability to translate theoretical concepts to the bedside. The complexity of the case keeps students engaged and focused, and requires them to build a comprehensive differential diagnosis. The case allows teaching faculty to modify the evaluation checklists to suit a particular institution's learning objectives; in this way, even if a student has already read the case on the web, the detail and extent of evaluation remain unknown.
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