OSCE broadens its scope

Internal Medicine Residency Educational Director Jane Rowat, Clinical Assistant Professor Dr. Sheena CarlLee, and Residency Program Director Dr. Manish Suneja have received funding for an expansion of an education-related project from the Graduate Medical Education Innovation Fund Committee. Over the past two years, the residency program has organized Objective Structured Clinical Examinations (OSCE) to assess the proficiency of incoming interns at performing certain clinical tasks, or Entrustable Professional Activities (EPA). These eight EPAs include skills such as interpreting common diagnostic and screening tests, gathering a patient history and performing a physical examination, and recognizing a patient requiring urgent or emergent care, and are among the thirteen designated by the Association of American Medical Colleges (AAMC). In an intensive half-day session, the OSCE allows education leadership to establish a baseline understanding of an incoming class’s ability and how best to tailor instruction. Last summer’s OSCE added incoming interns from the Department of Anesthesia to the assessed group.

With two years’ worth of data on record and a better understanding of what limitations exist in the OSCE, the research team will now apply these same principles to observation throughout the year. Dubbed “mini-structured clinical observations” (MSCO), the application-based assessments will assess learners in six EPAs: handoffs, obtaining informed consent, writing progress notes, holding “difficult conversations,” navigating on-call urgent/emergent care situations, and managing a diabetes-related visit. The GME funds will enable in part the development and deployment of MSCO observation forms and electronic tools that will aid evaluators in real-time assessment. “OSCE stations deconstruct the doctor-patient encounter,” Ms. Rowat said. “The types of cases that can be simulated constrain the types of patient problems that can be used for assessment.” The MSCO expansion will allow for workplace-based assessment by general internal medicine teams both within the University of Iowa Hospitals & Clinics as well as at the Iowa City VA Medical Center.