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Development and Evaluation of a Hand Surgery Orthopaedic Longitudinal OSCE
Joshua Abzug, MD; Robert Sterling, MD
University of Maryland Medical Center, Baltimore, MD

Introduction: Objective Structured Clinical Examinations (OSCE) have become routine for educating and testing medical students and medical and surgical residents. OSCEs can be used for improving interpersonal skills, communication skills, and professionalism and the ACGME recommends OSCE as the preferred assessment of these competencies. We developed and administered an OSCE utilizing a hand surgery case, with the same standardized families throughout all sessions, to assess residents interpersonal and communication skills.
Materials & Methods: We developed an OSCE program for our residents in our Clinical Education and Evaluation Laboratory (CEEL). The OSCE session consisted of 3 parts: patient evaluation, informed consent, and breaking bad news. Each resident saw the same standardized patient (SP) family for each of the 3 encounters of a program for longitudinal evaluation by the same SPs. Evaluation checklists were filled out by SPs for each encounter to rate performance using a standard scale (4=role model, 3=competent, 2=some competence but needs improvement, 1=not competent). At the end of the 3rd encounter, face-to-face feedback was provided to the resident. Finally, each resident provided an evaluation of the program at the end of the day.
Results: The majority of residents felt that the SP encounters mirrored a patient encounter (75% ganglion cyst), but a high percentage did not rate the OSCE as a "useful learning experience" (35% ganglion). The SPs rated the majority of residents as role model or competent (history:81%, informed consent:82%, breaking of bad news:79%); the corresponding resident performance self-assessment as role model or competent was much more favorable (97%, 92%, and 87% respectively). 95% of the residents did not ask patients/family members to repeat back what they heard to demonstrate understanding while obtaining informed consent. When asked to evaluate the program, a minority of residents found the feedback at the end of the program helpful. Ninety-four percent of our residents agree with the statement, "Practice makes perfect, therefore as a physician I should have opportunities to practice procedures and receive feedback on my performance as much as possible to maximize my skill when I operate on real patients." When this same question was posed substituting "communication skills" for "procedures", only 30% agreed.
Conclusions: In comparing SP evaluations and resident self-evaluations, the residents frequently overestimate their competence in effectively communicating with their patients. The majority of residents believe that OSCEs are not important to their training and will not help make them better physicians.


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