THE NUTS AND BOLTS OF CREATING AN OBJECTIVE STRUCTURED CLINICAL

EXAMINATION (OSCE) FOR MEDICAL STUDENTS AND RESIDENTS

SOPHIA CHEN, DO, MPH

COURSE DIRECTOR, PHYSICIAN’S CORE ASSISTANT DIRECTOR, PEDIATRIC EDUCATION

CHRISTIN M. TRABA, MD, MPH

ASSOCIATE PROGRAM DIRECTOR, PEDIATRICS SITE DIRECTOR, PEDIATRIC CERKSHIP

SUSAN G. MAUTONE, MD, FAAP

VICE-CHAIR FOR EDUCATION CLERKSHIP AND PROGRAM DIRECTOR

DEPARTMENT OF PEDIATRICS, UMDNJ – NEW JERSEY MEDICAL SCHOOL, NEWARK, NJ

APPD/COMSEP Combined Annual Spring Meeting

April 12, 2013

Disclosure Information

In the past 12 months, we have no relevant

financial relationships with the manufacturer(s)

of any commercial product(s) and/or

provider(s) of commercial services.

This presentation will not include discussion of

pharmaceuticals or devices that have not been

approved by the FDA.

Objectives

At the conclusion of this session, participants will be able to:

Discuss steps in creating an OSCE to assess the clinical competence of students and residents.

Develop a standardized patient encounter, including a patient script and scoring checklist.

Identify the common pitfalls in implementing an OSCE and strategies to overcome them.

Overview

Introduction: 10 minutes

Brief overview of OSCEs in the preclinical and clinical years

Small groups: 30 minutes

Case development

Large group: 30 minutes

Group presentations

Discussion of obstacles encountered

Wrap-up: 20 minutes

Video of a pediatric OSCE

Lessons learned

Q&A

LESSONS LEARNED

Case Development

Choosing Diagnoses

Clinical conditions that standardized patient can simulate

Developing Objectives

Focused HPI and Physical Examination

Linking milestones/competencies to objectives

Linking to Direct Observation requirement for ACGME and

LCME

Duration of encounter

How long?

How much time between each encounter?

Case Development (cont.)

Grading Checklist

Assigning points

Revision of Cases

Faculty and

standardized patient

feedback

Resident/Student

performance

Recruitment of Faculty/SPs

Faculty

Chair/Departmental Support

Faculty Training

Standardized Patients (SPs)/Parents

Appropriate Age (min 6 years of age)

Script

SP Training

Immediate feedback post encounter

Dropouts

Reimbursement

Tech Support

AV/Proctoring Support

Videotaping

Benefits

Consent Form

Turnaround Time

OSCE Remediation

Testing Site

Grading

Time required to grade each encounter

Curving?

Outcomes

Resident/Student Feedback

OSCE vs. TOSCE

Score Sheet

Grade for each encounter

References

Harden RM, Stevenson M, Downie WW, Wilson GM. Assessment of clinical competence using objective structured examination. Br Med J. 1975 Feb 22;1(5955):447-51. PMID: 1115966

Smith LJ, Price DA, Houston IB. Objective structured clinical examination compared with other forms of student assessment. Arch Dis Child.1984 Dec;59(12):1173-6. PMID: 6524948

Joorabchi B. Objective structured clinical examination in a pediatric residency program. Am J Dis Child. 1991 Jul;145(7):757-62. PMID: 2058606

Carraccio C, Englander R. The objective structured clinical examination: a step in the direction of competency-based evaluation. Arch Pediatr Adolesc Med. 2000 Jul;154(7):736-41. Review. PMID: 10891028

Pierre RB, Wierenga A, Barton M, Branday JM, Christie CD. Student evaluation of an OSCE in paediatrics at the University of the West Indies, Jamaica. BMC Med Educ. 2004 Oct 16;4:22. PMID:15488152

Hafler JP, Connors KM, Volkan K, Bernstein HH. Developing and evaluating a residents' curriculum. Med Teach. 2005 May;27(3):276-82. PMID:16011952

Jefferies A, Simmons B, Tabak D, McIlroy JH, Lee KS, Roukema H, Skidmore M. Using an objective structured clinical examination (OSCE) to assess multiple physician competencies in postgraduate training. Med Teach. 2007 Mar;29(2-3):183-91. PMID: 17701631

Casey PM, Goepfert AR, Espey EL, Hammoud MM, Kaczmarczyk JM, Katz NT, Neutens JJ, Nuthalapaty FS, Peskin E; Association of Professors of Gynecology and Obstetrics Undergraduate Medical Education Committee. To the point: reviews in medical education--the Objective Structured Clinical Examination. Am J Obstet Gynecol. 2009 Jan;200(1):25-34. doi: 10.1016/j.ajog.2008.09.878. Review. PMID: 19121656

Dong T, Saguil A, Artino AR Jr, Gilliland WR, Waechter DM, Lopreaito J, Flanagan A, Durning SJ. Relationship between OSCE scores and other typical medical school performance indicators: a 5-year cohort study. Mil Med. 2012 Sep;177(9 Suppl):44-6. PMID: 23029860

Baig LA, Violato C. Temporal stability of objective structured clinical exams: a longitudinal study employing item response theory. BMC Med Educ. 2012 Dec 7;12:121. doi: 10.1186/1472-6920-12-121. PMID: 23216816

QUESTIONS?