Waltz Margaret, Davis Arlene, Cadigan R Jean, Jaswaney Rohit, Smith Melissa, Joyner Benny
Research Associate, Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine.
Associate Professor, Department of Social Medicine, University of North Carolina at Chapel Hill School of Medicine.
MedEdPORTAL. 2020 Jan 31;16:10873. doi: 10.15766/mep_2374-8265.10873.
The ethical skills fundamental to medical practice encompass a large portion of the Accreditation Council for Graduate Medical Education (ACGME) professionalism milestones. Yet many ethical practices are difficult to reduce to milestone frameworks given the variety of traditions of moral reasoning that clinician-trainees and their colleagues might properly employ.
We developed an observed standardized clinical examination (OSCE) simulation with standardized patients to assess the ethical skills captured in professionalism milestones in pediatrics. The OSCE included four vignettes based on actual cases that presented problems without a correct answer. Residents discussed ethically challenging issues with standardized patients and were evaluated on specific ethical tenets contained in the professionalism milestones. Our assessment guide for preceptors offered content for debriefing and assessment. We piloted this OSCE with seven preceptors and 17 pediatric residents in two different medical settings.
Residents all agreed that the four cases were realistic. All but two residents agreed that OSCEs like this one are an appropriate or objective way of assessing the ACGME professionalism milestones. All preceptors reported that they strongly agreed the assessment improved their ability to assess the professionalism milestones.
This OSCE offers a structured method to assess professionalism milestones and a forum to discuss ethical problem solving. It can also be used solely as a training exercise in ethical decision making and having difficult conversations.
医学实践的基本伦理技能涵盖了研究生医学教育认证委员会（ACGME）专业素养里程碑的很大一部分。然而，鉴于临床实习医生及其同事可能合理采用的各种道德推理传统，许多伦理实践难以简化为里程碑框架。
我们开发了一种与标准化病人合作的观察性标准化临床考试（OSCE）模拟，以评估儿科专业素养里程碑中所包含的伦理技能。该OSCE包括四个基于实际案例的 vignette，这些案例提出的问题没有正确答案。住院医师与标准化病人讨论了具有伦理挑战性的问题，并根据专业素养里程碑中包含的特定伦理原则进行评估。我们为带教老师提供的评估指南为汇报和评估提供了内容。我们在两种不同的医疗环境中，对7名带教老师和17名儿科住院医师进行了该OSCE的试点。
住院医师都认为这四个案例是现实的。除两名住院医师外，所有住院医师都认为像这样的OSCE是评估ACGME专业素养里程碑的一种合适或客观的方式。所有带教老师都报告说，他们强烈同意这种评估提高了他们评估专业素养里程碑的能力。
这种OSCE提供了一种评估专业素养里程碑的结构化方法和一个讨论伦理问题解决的论坛。它也可以仅用作伦理决策和进行艰难对话的培训练习。
