The Objective Structured Clinical Evaluation (OSCE) may be a nerve-wracking title to the incoming intern, conjuring stressful memories of their just-completed medical school exams. But the goal of the OSCEs as it has been designed and run for nearly a decade by the residency program in Internal Medicine at Iowa is to produce the opposite of stress, supporting the interns in their transition from undergraduate medical education (UME) to graduate medical education (GME).
As Program Director Manish Suneja, MD, makes clear during each intern OSCE orientation, the goal of each station which evaluates one more “entrustable clinical skills” is to provide formative feedback about the interns’ skill level. The OSCE is designed to help interns gain confidence before stepping onto the wards that they are well-trained physicians ready to practice medicine as well as to provide them with information they can use to improve their clinical skills during this transition.
The feedback from the interns every year is consistent. Education Development Director Jane Rowat, MS, said, “They very much appreciate the immediate, formative feedback as well as they like having the opportunity to practice clinical skills in a safe environment.”
This concept has continued to build momentum, spreading throughout University of Iowa Health Care. In 2023, a second day of OSCEs was added to accommodate more residency programs’ interns. Again, this year approximately 90 interns from 14 residency programs at Iowa were evaluated. More than 60 station observers provided real-time feedback, and nearly 40 members of the college’s Clinical Skills Program served in functional roles, such as room proctors and simulated patients.
The complicated series of stations and large number of faculty observers delivering a near-decade’s worth of data to Rowat and Suneja has made telling this story to other academic medical centers all the more compelling. Earlier this year, the duo served as first and senior author on a paper published by the Journal of the Association of American Medical Colleges (AAMC). Their article demonstrates as they have in previous publications the rigor and reliability of what had already been supported by scores of interns and faculty anecdotally every year.
The OSCE provides individualized baseline clinical skill data as interns begin their residency. In the coming weeks OSCE performance data as well as the core clinical skills task confidence surveys completed by each intern before and after the OSCE will be reviewed during a meeting between the intern and their residency team’s Associate Program Director. Based on this discussion and self-reflection the intern will develop an individualized learning plan over the subsequent two or three months. In addition, the Internal Medicine Chief Residents will also support the interns in their transition by providing workplace-based clinical skills observations.
In a joint statement to participants, Rowat and Suneja thanked everyone for their contributions (“cannot happen without the help from so many”), including the college’s GME office. “GME partnering with the institution has provided an opportunity to support this important experience for interns during the transition from UME to GME.”
Internal Medicine Station Observers
Rachel Anderson (IM Chief Resident)
Lisa Antes
Taylor Cox
Justin Holmes
Krista Johnson
Carly Kuehn
Luke Morrey (IM Chief Resident)
Matt Soltys
Justin Smock
Jenny Strouse
Roger Struble
Joe Szot (back-up)
Lauren Zabel (IM Chief Resident)
Yana Zemkova
Internal Medicine/Psychiatry Station Observer
Melissa Ludgate
Internal Medicine Station Leaders
Carly Kuehn
Lee Sanders
Matt Soltys
Jenny Strouse
Administration
Manish Suneja, OSCE co-director
Jane Rowat, OSCE co-director
Abbey Gilpin, online management