From St. Joseph Mercy Oakland (B.J.D.), Pontiac; Wayne State University SOM (S.B., D.P., D.L.); St. John Hospital (R.H.); Wayne State University Detroit Medical Center (N.T.), Detroit; St. Mary Mercy (J.K.), Livonia; Providence Hospital (S.A.), Southfield; and St. Joseph Mercy Ann Arbor (P.M.), Ypsilanti, MI.
Simul Healthc. 2020 Apr;15(2):69-74. doi: 10.1097/SIH.0000000000000404.
For the past 30 years, there has been a growing emphasis on communication and self-evaluation skills training in graduate medical education. This is reflected in the Next Accreditation System. The Objective Structured Clinical Examination (OSCE) is widely used in graduate medical education for assessing dimensions of interpersonal communication and counseling skills. The OSCEs may be developed to target challenging clinical scenarios difficult to capture in clinical practice and can be used as a medium for resident self-evaluation.
The aims of the study were to evaluate residents' interpersonal, communication, and counseling skills using Kalamazoo Essential Elements Communication Checklist in 4 clinically challenging scenarios and to compare standardized patient (SP) evaluations to residents' self-evaluation by category of medical school.
South East Michigan Center for Medical Education is a consortium of teaching hospitals. Member residents participate in 4 OSCEs as part of their postgraduate 1 curriculum. The OSCEs were developed to evaluate clinically relevant but difficult to capture scenarios including: (a) error disclosure/counseling an angry patient; (b) delivering bad news/end of life; (c) domestic violence; and (d) counseling a patient with colon cancer requesting alternative treatments. At the conclusion of each OSCE, SPs evaluated and residents self-evaluated their performance. Once evaluations were completed, SPs provided residents with feedback.
Six member institutions and 344 residents participated during the 2014, 2015, and 2016 academic years. There were more international medical graduates (59%) than graduates of Liaison Committee for Medical Education-accredited medical schools. There were more males (62.2%) than females. Standardized patients rated residents higher than residents rated themselves in 2014 (<0.001), but not in 2015 or 2016. When combining all years and all residents, there was no correlation of SP and resident scores. Standardized patients rated female residents higher than female residents rated themselves (P < 0.0001). Male residents scored themselves similarly to the SPs, but male residents rated themselves higher than female residents rated themselves (P < 0.001). Standardized patient scores for male and female residents were not significantly different.
Targeted OSCEs provide an objective format to evaluate residents in challenging clinical scenarios. Resident self-evaluations did not correlate with SPs. In addition, female residents rated themselves lower than male residents and lower than SPs. There is need to develop interventions and curricula to improve resident's self-evaluation skills and in particular address lower self-evaluation by female trainees.
在过去的 30 年中，研究生医学教育越来越强调沟通和自我评估技能的培训。这反映在下一个认证系统中。客观结构化临床考试（OSCE）广泛用于研究生医学教育，以评估人际沟通和咨询技巧的各个维度。OSCE 可以针对在临床实践中难以捕捉的具有挑战性的临床情况进行开发，并且可以作为居民自我评估的媒介。
本研究的目的是使用 Kalamazoo 基本沟通要素检查表在 4 个具有临床挑战性的场景中评估居民的人际沟通、沟通和咨询技能，并按医学院的类别比较标准化患者（SP）评估与居民自我评估。
东南密歇根医学教育中心是一个由教学医院组成的联合体。会员居民作为其研究生 1 课程的一部分参加 4 次 OSCE。OSCE 的开发目的是评估具有临床相关性但难以捕捉的场景，包括：（a）披露错误/为愤怒的患者提供咨询；（b）传达坏消息/生命末期；（c）家庭暴力；和（d）为要求替代治疗的结肠癌患者提供咨询。在每个 OSCE 结束时，SP 评估并居民自我评估他们的表现。一旦评估完成，SP 就会向居民提供反馈。
在 2014、2015 和 2016 学年期间，有 6 个成员机构和 344 名居民参加。国际医学毕业生（59%）多于联委会认证医学学校的毕业生。男性（62.2%）多于女性。标准化患者对居民的评分高于居民自我评分 2014 年（<0.001），但 2015 年和 2016 年并非如此。当结合所有年份和所有居民时，SP 和居民的评分没有相关性。标准化患者对女居民的评分高于女居民对自己的评分（P<0.0001）。男居民对自己的评分与 SP 相似，但男居民对自己的评分高于女居民对自己的评分（P<0.001）。男居民和女居民的标准化患者评分没有显著差异。
针对性的 OSCE 为在具有挑战性的临床场景中评估居民提供了客观的格式。居民的自我评估与 SP 不相关。此外，女居民对自己的评价低于男居民和 SP。需要制定干预措施和课程，以提高居民的自我评估技能，特别是解决女学员自我评价较低的问题。
