OSCE adapts to COVID-19 necessities

Last year, the third year for the Intern Objective Structured Clinical Evaluations (OSCE) was the most successful yet. Organizers Manish Suneja, MD, and Jane Rowat, MS, had received the stamp of peer review and had expanded to include interns from two other residency programs (Anesthesia and Family Medicine) within University of Iowa Health Care for evaluation.

But just when it seemed all the wrinkles had been smoothed out, the coronavirus hit and when the COVID-19 pandemic made it clear that it would stick around well into the new academic year, Suneja, Rowat, and other leaders within the Education Team began to strategize how essential educational activities including the OSCE could still be delivered safely. The data regarding the skill level for selected clinical tasks gleaned from the OSCE for each new intern proved too useful to abandon the OSCE experience entirely. Moreover, organizers knew that by the time June 30 arrived, these recent medical school graduates would not have had a patient interaction in close to four months. Allowing the interns to practice core clinical skills in a simulated environment and receive feedback before they began residency would be just as important as the baseline evaluations themselves.

After careful planning and discussion with many stakeholders including Ellen Franklin, Director of Clinical Skills Assessment in the Carver College of Medicine, a hybrid plan that adhered to COVID-19 guidelines was developed. To ensure the safety of the interns, simulated patients, and faculty observers, this year’s OSCE relied heavily on the use of Zoom, the video teleconferencing platform, similar to what UI Health Care is using for its telehealth visits. The core clinical kills assessed remained the same from previous years:

  • 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.
  • Handle an urgent / emergent call from nursing.
  • Obtain informed consent for tests or procedures.
  • Interpret EKG and radiographs.

Forty-one interns participated in the 2020 OSCE, each in a Zoom breakout room. Two of the five 20-minute scenarios involved direct simulated patient-intern encounters while other encounters were carried out using Zoom. Faculty observers watched offsite and provided immediate feedback via Zoom and scored each intern on selected criteria for the stations. Prior to the OSCE, 24 faculty observers and 27 simulated patients were trained on the functionality of Zoom.

OSCE Schematic

“All things considered, it went pretty well. Anytime you introduce a new element, especially one that relies heavily on technology, you are bound to hit a few bumps,” Suneja said. Always a difficult series of activities with so many moving parts to coordinate, certain skill evaluations this year relied on interns and faculty observers to sync up in designated “breakout rooms” via webcams instead of the traditional in-room video cameras. Organizers emphasized how adaptable the interns themselves were though and how pleased they were to flex their clinical muscles again. The use of PPE, face masks and shields, also proved no great hurdle for the interns or the simulated patients. As much as anything else, the sooner they familiarized themselves with their safety equipment, the better their actual clinical experiences would be.

Feedback from the interns themselves included the following statements:

“Amazing job!  Very structured, varied-very detailed and prompt feedback.”

“Very helpful and well organized. Really appreciate being able to try out skills I haven’t used in months before direct patient care.”

“I am so impressed with this experience. Day had minimal interruptions. Staff provided great feedback and promptly.”

Faculty evaluations were also obtained and included comments such as the following:

“This year’s OSCE was of utmost important to allow the interns to return to ‘clinical thinking’ after being off due to COVID.”

“Extremely well organized for the first ever ZOOM OSCE.”

Thank you to:

Department of Internal Medicine
Mohammad Ansari (current fellow, former Chief Resident)
Nicholas Arnold (Chief Resident)
Gwen Beck
Andrew Bryant
Brian Gehlbach
Amanda Heuszel (Chief Resident)
Krista Johnson
Vicki Kijewski
Laurel Lyckholm

Jane Rowat
Lee Sanders
Roger Struble (Chief Resident)
Manish Suneja
Justin Smock
Matthew Soltys (Chief Resident)
Jennifer Strouse (current fellow, former Chief Resident)
Andrea Weber
Katherine White

Department of Family Medicine
Karla Hemesath
Nymisha Rao (Chief Resident)
Brigit Ray
Marcy Rosenbaum
Wendy Shen
Justis Stolz (Chief Resident)
Kate Thoma
Jason Wilbur

Very special thanks to Ellen Franklin and the many Simulated Patients she recruits for their flexibility and their essential contribution to our efforts!

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