Office of Educational Quality Improvement, Harvard Medical School, Boston, Massachusetts, USA.
Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
Telemed J E Health. 2022 Feb;28(2):248-257. doi: 10.1089/tmj.2021.0094. Epub 2021 May 17.
In March 2020, students' in-person clinical assessments paused due to COVID-19. The authors adapted the June Objective Standardized Clinical Examination (OSCE) to a telehealth OSCE to preserve live faculty observation of students' skills and immediate feedback dialogue between students, standardized patients, and faculty members. The authors assessed students' reactions and comparative performance. OSCE and telehealth educators used draft Association of American Medical Colleges (AAMC) telehealth competencies to create educational materials and adapt OSCE cases. Students anonymously answered queries about the challenges of the telehealth encounters, confidence in basic telehealth competencies, and educational value of the experience. Cohort-level performance data were compared between the January in-person and June telehealth OSCEs. One hundred sixty students participated in 29 Zoom two-case telehealth OSCEs, equaling 58 h of assessment time. Survey response rate: 59%. Students indicated moderate challenge in adapting physical examinations to the telehealth format and indicated it to be cognitively challenging. Confidence in telehealth competencies was rated "moderate" to "very," but was most pronounced for the technical aspects of telehealth, rather than safety engagement with a patient. Although authors found no significant difference in cohort-level performance in total scores and history-taking between the OSCEs, physical examination and communication scores differed between the two assessments. It was feasible to adapt a standardized OSCE to a telehealth format when in-person clinical skills assessment was impossible. Students rated this necessary innovation positively, and it adequately assessed foundational clinical skills performance. Given future competency needs in telehealth, we suggest several education and training priorities.
2020 年 3 月，由于 COVID-19 的影响，学生的现场临床评估暂停。作者将 6 月的客观标准化临床考试（OSCE）改编为远程医疗 OSCE，以保留现场教师对学生技能的观察和学生、标准化患者和教师之间的即时反馈对话。作者评估了学生的反应和比较表现。OSCE 和远程医疗教育者使用草稿美国医学协会（AAMC）远程医疗能力来创建教育材料和改编 OSCE 案例。学生匿名回答了关于远程医疗接触的挑战、对基本远程医疗能力的信心以及该体验的教育价值的问题。在 1 月的现场和 6 月的远程医疗 OSCE 之间比较了队列级别的表现数据。160 名学生参加了 29 次 Zoom 双案例远程医疗 OSCE，相当于 58 小时的评估时间。调查回复率：59%。学生表示在将体检适应远程医疗格式方面存在中度挑战，并表示这在认知上具有挑战性。对远程医疗能力的信心被评为“中等”到“非常”，但对远程医疗的技术方面最为明显，而不是与患者安全互动。尽管作者在 OSCE 总分数和病史采集方面没有发现两个评估组之间的显著差异，但在体检和沟通分数方面存在差异。当无法进行现场临床技能评估时，将标准化 OSCE 改编为远程医疗格式是可行的。学生对这一必要的创新给予了积极评价，它充分评估了基础临床技能表现。鉴于未来在远程医疗方面的能力需求，我们提出了一些教育和培训重点。
