The Ohio State University College of Nursing, Columbus, Ohio.
The Ohio State University, Columbus, Ohio.
J Am Assoc Nurse Pract. 2020 Apr 16;33(5):359-365. doi: 10.1097/JXX.0000000000000409.
The provision of care through telehealth is emerging as a strategy to meet the challenges of a changing health care system; however, educational experiences associated with telehealth are limited in nursing curricula. In 2018, the National Organization of Nurse Practitioner Faculties (NONPF) recommended incorporating telehealth modalities in nurse practitioner education, including clinical skills assessment. Objective structured clinical examinations (OSCEs) have been used as formative and summative evaluations of health science students since the 1970s to assess application of didactic learning in clinical practice. Although few studies have investigated integrating OSCEs, virtual simulation, or telehealth in distance education, those that exist demonstrate significant improvement in clinical decision making. This article describes the development and implementation of an OSCE at a large Midwestern university delivered via web conferencing to evaluate online family nurse practitioner (FNP) students' abilities to deliver care using telecommunication technology. An e-visit notification listing the types of symptoms available for treatment by telehealth served as a content list. Students completed a 15-minute e-visit assessing and managing the care of a standardized patient presenting with a recent onset of dysuria. The video conference included the FNP student, standardized patient, and faculty evaluating in real time using a rubric incorporating NONPF competencies for telehealth. Structured group debrief, an integral part of the learning process in clinical simulations, followed the e-visit OSCE using free conference calling. Faculty and student feedback and evaluations of this summative OSCE implemented for three cohort groups (103 students) positively reflect the importance of preparing students for practice in a transformed health care system.
远程医疗作为应对医疗体系变革挑战的一种策略正在兴起；然而，护理课程中远程医疗相关的教育经验有限。2018 年，美国护士从业者学院协会（NONPF）建议在护士从业者教育中纳入远程医疗模式，包括临床技能评估。客观结构化临床考试（OSCE）自 20 世纪 70 年代以来已被用于评估卫生科学学生的理论学习在临床实践中的应用，作为形成性和总结性评价。尽管很少有研究将 OSCE、虚拟模拟或远程医疗整合到远程教育中，但现有的研究表明，这在临床决策方面有显著的提升。本文描述了在中西部一所大型大学中，通过网络会议开展 OSCE 评估远程在线家庭执业护士（FNP）学生使用远程通讯技术提供护理的能力的过程。以可通过远程医疗治疗的症状类型列表作为电子就诊通知。学生需在 15 分钟内完成电子就诊，评估和管理一位以近期尿痛起病的标准化患者的护理。视频会议包括 FNP 学生、标准化患者和实时评估的教师，采用 NONPF 远程医疗能力的评分表。在电子就诊 OSCE 之后，会使用免费电话会议进行结构化小组讨论，这是临床模拟学习过程的一个重要组成部分。基于三批（103 名学生）学生的反馈，对该总结性 OSCE 的教师和学生评价反映出，为学生在转型医疗体系中实践做好准备的重要性。
