After the success of last year’s inaugural Objective Structured Clinical Examinations (OSCE), the Department of Anesthesia approached the Internal Medicine Residency Program about the possibility of the Anesthesia interns participating in the clinical skills testing. Adding the Anesthesia interns increased the total number of individuals tested during last week’s OSCE from 33 to 47.
Though the number of interns increased, the objective of the OSCE did not change. Internal Medicine Education Development Director Jane Rowat and Dr. Manish Suneja, Internal Medicine Residency Program Director, designed the OSCE with the goal of obtaining a baseline understanding of what skills each new arrival to Iowa possessed. The data obtained aid both the learner and program administrations in building a development plan tailored specifically to each learner’s needs. No sense in spending extra time honing a young doctor’s ability to document a clinical encounter if he or she has that down but still needs to work on handling phone calls from nursing.
The structure of the day remained largely the same as last year. A morning and an afternoon session each ran half of the trainees through a series of clinical skills for faculty observers. However, with the addition of the Anesthesia class, more faculty observers were needed this year. Eighteen simulated patients (SPs)—actors who memorize symptoms and a backstory, in addition to being prepared for improvisation when necessary—from the Carver College of Medicine’s Integrated Clinical Assessment Program (ICAP) also took part in the OSCE. Four clinical suite proctors as well as the ICAP director were available to answer intern and faculty questions, as well as to support the computer technology.
Eight skills were again chosen from the thirteen Entrustable Professional Activities (EPA) listed by the Association of American Medical Colleges (AAMC).
The Internal Medicine and Anesthesia interns demonstrated their facility in these EPAs as they rotated through five different 20-minute scenarios:
- Gather a history and perform a physical examination.
- Provide an oral presentation of a clinical encounter.
- Give or receive a patient handover to transition care responsibility.
- Recognize a patient requiring urgent or emergent care and initiate evaluation and management.
- Obtain informed consent for tests or procedures.
- Interpret EKG and radiographs.
In addition to increasing the number of participants, another change to the OSCE this year was moving from paper to electronic evaluation forms, which were completed by the faculty observers at each station. Automation of the formative feedback from faculty and SPs allowed the residency programs to review individual and cohort performance, as well as to make the information available to the interns in a more timely manner.
Before beginning the OSCE, all interns filled out a self-confidence survey for a number of tasks they will be required to perform as care providers. At the conclusion of each testing session, interns completed a self-evaluation of their performance as well as an evaluation of the OSCE experience. This last series of responses will guide Ms. Rowat and Dr. Suneja as they document their findings for a future publication and begin preparations for next year’s OSCE.
The OSCE was funded in part by an institutional grant from UI’s Graduate Medical Education. Special thanks to those faculty members who gave up half or all of their day to make this important assessment a success.
Department of Anesthesia
Department of Family Medicine
Department of Internal Medicine