Objective Structured Clinical Examinations

Innovation in education can take a lot of different forms, but even the way in which an educator learns what needs to be taught can be revolutionary. Last week, Education Development Director Jane Rowat and Dr. Manish Suneja, Internal Medicine Residency Program Director, guided the evaluation of the new class of interns joining the department in a day-long series of assessments called Objective Structured Clinical Examinations (OSCE).

Because different medical schools place varying levels of emphasis on skill development and assess them differently, a potential gap could exist between program expectations and intern proficiency when arriving at Iowa. Once performed, the OSCE results aids the individual learner in guiding their own personalized development plan and offers the residency program opportunities for curricular development.

In morning and afternoon sessions, each half of the intern class demonstrated skills in the presence of faculty and senior resident evaluators. These eight skills were chosen from the thirteen skills the Association of American Medical Colleges (AAMC) referred to as Entrustable Professional Activities (EPA). Each EPA is a unit of work an intern should be able to perform unsupervised on Day One of residency.

Dr. Suneja and Ms. Rowat selected these skills for evaluation:

• Gather a history and perform a physical examination.
• Document a clinical encounter in the patient record.
• Provide an oral presentation of a clinical encounter.
• Give or receive a patient handover to transition care responsibility.
• Handle call from nursing.
• Obtain informed consent for tests or procedures.
• Interpret EKG and radiographs.

In order to quickly and efficiently assess these skills and in order to ensure that their practice reflects real-life as much as possible, the interns were given ten to twenty minutes per task. More than a dozen faculty members, all four Chief Residents, four room proctors, and more than two dozen professional simulated patients filled three state-of-the-art observation clinical suites. Each room is equipped with video cameras for observation to minimize distraction for the intern and recording to allow for later review.

Congratulations to Dr. Suneja and Ms. Rowat on the implementation of this project, the seeds of which began as a grant application to the GME under the title “EPA Checkpoint at R1 Orientation.” And special thanks to all those educators who helped ensure this day’s success:

Faculty:

•         Gwen Beck
•         Brian Gehlbach
•         Katie Harris
•         Bill Iverson
•         Krista Johnson
•         Carly Kuehn
•         Laurie Lyckholm
•         Brad Manning
•         Brian McConomy
•         Marcy Rosenbaum
•         Jane Rowat
•         Justin Smock
•         Manish Suneja
•         Katie White

Chief Residents

•         Sheena CarlLee
•         Amanda Grippen Goddard
•         Aaron Vose
•         Josiah Zubairu

Senior Resident

• Keenan Laraway