Continuous improvement is not just an expectation for trainees in the Internal Medicine Residency Program, it is also the standard for the program’s faculty and curriculum. A visible example can be seen in what was known for nearly nine years as the Objective Structured Clinical Evaluation (OSCE), but is now called Clinical Skills Coaching for Intern Readiness (CSC), a half-day skills assessment that provides both the intern and the program a baseline understanding of each trainee’s abilities related to clinical skills.

Over the years, the CSC’s designers and co-directors, Education Development Director Jane Rowat, MS, and Residency Program Director Manish Suneja, MD, have listened to feedback and constantly adapted their sessions. One frequent comment from participants was that the name “OSCE” raised concerns. As medical students the interns regularly participated in OSCEs, which are structurally similar to the residency’s CSC. In each program, the learner moves through a series of stations demonstrating their competency at clinical tasks including oral presentations and informed consent. The difference between the OSCE and the CSC, however, is in how the results of their performance are handled.

“The CSC is not graded,” Suneja said. “But when interns heard ‘OSCE,’ and they instantly flashed back to their experiences in med school. Unlike previous experiences, the CSC is a formative exercise rather than an evaluation for a grade.” The results are used by program leadership to guide future instruction and to also give the learner a chance for self-assessment at the conclusion of the CSC and then again later to track their progress.

Rowat noted that changing the name to focus on coaching allows the emphasis of the CSC to be on clinical skill improvement in a safe environment. This adjustment is just one of many changes that Rowat and Suneja have implemented both from their own direct observations.

Other changes made over time have included the use of advancing technology to shorten the delivery time of the results to both the interns and residency program directors. Another significant change was necessitated in June 2020. For the safety of all of participants, the Internal Medicine and Family Medicine residency programs pivoted from an in-person OSCE to a hybrid model of in-person demonstration combined with video conferencing to allow for off-site observation of the encounters.

In less than a decade the CSC has expanded to include dozens more interns from other departments in the sessions, requiring the addition of a second full day. Rowat and Suneja and the rest of the program team have published multiple times about the program and the usefulness of the data. Another manuscript will be forthcoming in the Journal of Graduate Medical Education. The team has also conducted a “UME to GME” workshop at an internal medicine program directors’ national meeting (APDIM) in 2022.

Now that the CSC has separated itself from the OSCE, the possibilities for greater expansion are likely to grow. Moreover, learner and faculty comfort with and interest in real-time feedback on specific skills have helped drive other innovations like the homegrown mobile application qUIkcoach, which is now in its fourth year of use since piloting.

For this year’s recap video we also interviewed members of the Carver College of Medicine’s Simulated Patient Program, without whom the CSC would not be possible.

Credits

Internal Medicine Station Observers

• Desmond Barber
• Adam Blaine (Chief Resident)
• Andy Bryant
• Krista Johnson
• Reed Johnson
• Morton Machir
• Tyler Maggio (Chief Resident)
• Luke Morrey
• Marcus Osman (Chief Resident)
• Justin Smock
• Matt Soltys
• Jenny Strouse
• Roger Struble
• Joe Szot
• Mackenzie Walhof (Chief Resident)
• Yana Zemkova

Internal Medicine/Psychiatry Station Observer

• Melissa Ludgate

Internal Medicine Station Leaders

• Lisa Antes
• Carly Kuehn
• Lee Sanders
• Matt Soltys
• Jenny Strouse

Administration

• Manish Suneja, CSC co-director
• Jane Rowat, CSC co-director
• Abbey Gilpin, online video conferencing management
• Lori Strommer, electronic evaluations