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Using Communication OSCEs to Assess Resident Competency and Guide Program Curriculum
Mary P. Abernathy, MD, MS, Mark J. Di Corcia, PhD, OTR
Objective: Annual combined OSCE/OSAT exams are given to each resident class assessing PGY-specific milestones. This setting allows faculty the ability to assess residents in a controlled, consistent and confidential setting using standardized patients for the OSCE portions. Two communication OSCE exams were given to PGY-1 and PGY-3 residents regarding delivering bad news (informing a patient she had experienced a missed AB at 9 weeks on a routine first trimester ultrasound) and obtaining a domestic violence history on a patient that presented with vague complaints to the ER. Both of these OSCEs showed low scoring as judged by the average resident scores. Communication and domestic violence workshops were instituted into the curriculum and the scores pre and post intervention were assessed to determine the effectiveness of the interventions.
Methods: Residents were assessed using a 10 point Critical Task Appraisal and Evaluation tool developed from the Kalamazoo Consensus statement on effective physician-patient interactions during the annual OSCE exams. Faculty viewed the standardized patient-physician interaction from a separate control room. The same faculty member and standardized patient completed all the exams for each class consistently in one setting. Residents were given written feedback after the entire OSCE/OSAT exam day was completed. All residents attended the workshops which were added to the curriculum each year. Cumulative results were compared using a 2 sample t-test analysis.
Results: PGY-1 residents averaged 7.67 prior to the Physician-Patient Communication workshop in 2010 and averaged 9.3 (p<0.05) in 2011 and 9.2 (p<0.05) in 2012 following the communications workshop dealing with delivering bad news and improving physician-patient communications skills. PGY-3 residents averaged 6.86 prior to a domestic violence workshop in 2011 and averaged 7.1 (p=0.79) in 2012.
Conclusions: Annual OSCE exams allow consistent and controlled assessment of resident’s progression to competency in Interpersonal and Communication skills. These areas are difficult to assess each resident independently under the same controlled condition in the clinical setting. The cumulative scoring during the OSCEs allows the residency program the ability to assess and make adjustments in the curriculum. Both of these OSCEs indicated weaknesses in our curriculum which was improved to varying degrees using dedicated didactic time.
CREOG & APGO Annual Meeting, 2013, Resident, Residency Director, Interpersonal & Communication Skills, GME, Simulation, Quality & Safety, Standardized Patient, Advocacy, General Ob-Gyn,