CarlLee Sheena, Rowat Jane, Suneja Manish
J Grad Med Educ. 2019 Apr;11(2):214-220. doi: 10.4300/JGME-D-18-00601.2.
A residency program's intern cohort is comprised of individuals from different medical schools that place varying levels of emphasis on Core Entrustable Professional Activities for Entering Residency (CEPAERs). Program directors have expressed concerns about the preparedness of medical school graduates. Though guiding principles for implementation of the CEPAERs have been published, studies using this framework to assess interns' baseline skills during orientation are limited.
A CEPAER-based objective structured clinical examination (OSCE) was implemented with the aims to (1) assess each intern's baseline clinical skills and provide formative feedback; (2) determine an intern's readiness for resident responsibilities; (3) inform individualized education plans; and (4) address identified gaps through curricular change.
During orientation, all 33 interns from internal medicine (categorical, preliminary, and medicine-psychiatry) participated in the OSCE. Six 20-minute stations evaluated 8 EPAs. Faculty completed a global assessment, and standardized patients completed a communications checklist and global assessment. All interns completed a self-assessment of baseline skills and a post-OSCE survey.
Stations assessing handoffs, informed consent, and subjective, objective, assessment, and plan (SOAP) note were the lowest-performing stations. Interns performed lower in skills for which they did not report previous training. Formal instruction was incorporated into didactic sessions for the lowest-performing stations. The majority of interns indicated that the assessment was useful, and immediate feedback was beneficial.
This OSCE during orientation offers just-in-time baseline information regarding interns' critical skills and may lead to individualized feedback as well as continuous curricular improvement.
住院医师培训项目的实习医生群体由来自不同医学院校的人员组成，这些院校对进入住院医师培训阶段的核心可托付专业活动（CEPAERs）的重视程度各不相同。项目主任对医学院毕业生的准备情况表示担忧。尽管已经发布了实施CEPAERs的指导原则，但使用该框架在入职培训期间评估实习医生基线技能的研究却很有限。
实施一项基于CEPAERs的客观结构化临床考试（OSCE），旨在（1）评估每位实习医生的基线临床技能并提供形成性反馈；（2）确定实习医生承担住院医师职责的准备情况；（3）为个性化教育计划提供信息；（4）通过课程改革弥补已发现的差距。
在入职培训期间，内科（普通、初级和内科 - 精神科）的所有33名实习医生都参加了OSCE。六个20分钟的考站评估了8项可托付专业活动（EPA）。教员完成整体评估，标准化病人完成沟通清单和整体评估。所有实习医生都完成了基线技能的自我评估和OSCE后的调查。
评估交接班、知情同意以及主观、客观、评估和计划（SOAP）记录的考站表现最差。实习医生在他们未报告曾接受过培训的技能方面表现较差。针对表现最差的考站，在理论课程中纳入了正式指导。大多数实习医生表示该评估很有用，即时反馈很有益。
此次入职培训期间的OSCE提供了有关实习医生关键技能的及时基线信息，并可能带来个性化反馈以及课程的持续改进。
