Miller Christina, Toy Serkan, Schwengel Deborah, Schwartz Stefani, Schiavi Adam
J Educ Perioper Med. 2021 Jul 1;23(3):E669. doi: 10.46374/volxxiii_issue3_miller. eCollection 2021 Jul-Sep.
The Objective Structured Clinical Examination (OSCE) is part of the American Board of Anesthesiology (ABA) certification process. A simulated OSCE can aid examination preparation, but the COVID-19 pandemic prevented in-person simulation training. Therefore, we adapted our in-person simulated OSCE (SOSCE) as a Zoom-based telesimulation OSCE (ZOSCE), permitting examinees to participate remotely. Comparing this process with historical in-person SOSCE cohorts, we hypothesized that this telesimulation-based format would still be well received by the trainees as a substitute when it was not possible to provide in-person practice and formative assessment. Subsequently, the ABA proposed a virtual-format OSCE.
We conducted our 7-station ZOSCE according to the ABA content outline for all graduating third-year clinical anesthesia residents (CA-3) in 2020. From a main meeting room, the facilitator paired each CA-3 with a faculty proctor, assigned them to their own breakout room for each station, and rotated standardized patients in. The faculty proctor observed the CA-3's performance in real time using an assessment tool with objectives graded on a 0-2 scale. At the conclusion of the ZOSCE, proctors reviewed the assessment tool with the CA-3 and provided personalized global feedback. Assessment tool scores were used to calculate performance data for the study group that were compared with a SOSCE historical cohort from 2017 and 2018. All parties completed a Likert-style evaluation specific to the ZOSCE.
A total of 22 CA-3 residents participated. Mean performance scores ranged from 82.2%-94.9% (minimum = 38%, maximum = 100%). Compared with the historical SOSCE cohort, ZOSCE scores for 5 of 7 stations were not different, but scores in communication with professionals ( = .007) and ultrasound ( < .001) stations were lower. Overall, CA-3 participants rated the learning experience positively and felt it was a reasonable substitution for in-person simulation, with responses similar to those of a historical in-person SOSCE cohort.
A telesimulation-based practice ZOSCE for formative examination preparation for the ABA OSCE resulted in similar institutional scoring for most stations compared with in-person SOSCE, but some stations may be better practiced in person or require modifications. The virtual format may permit flexible scheduling during nonclinical times or for learners in remote locations. These findings have implications for future formative exercises and the formal summative examination process.
客观结构化临床考试（OSCE）是美国麻醉医师协会（ABA）认证过程的一部分。模拟OSCE有助于考试准备，但新冠疫情阻碍了现场模拟培训。因此，我们将现场模拟OSCE（SOSCE）调整为基于Zoom的远程模拟OSCE（ZOSCE），允许考生远程参与。将此过程与历史现场SOSCE队列进行比较，我们假设当无法提供现场实践和形成性评估时，这种基于远程模拟的形式仍会受到学员的欢迎，可作为替代方式。随后，ABA提出了虚拟形式的OSCE。
2020年，我们根据ABA内容大纲，为所有即将毕业的三年级临床麻醉住院医师（CA - 3）进行了7站式ZOSCE。在一个主会议室里，主持人将每位CA - 3与一名教员监考员配对，为每个站点将他们分配到各自的 breakout 房间，并轮换标准化病人进入。教员监考员使用一个在0 - 2分制上对目标进行评分的评估工具实时观察CA - 3的表现。在ZOSCE结束时，监考员与CA - 3一起回顾评估工具，并提供个性化的总体反馈。评估工具分数用于计算研究组的表现数据，并与2017年和2018年的SOSCE历史队列进行比较。所有参与方都完成了一份针对ZOSCE的李克特式评估。
共有22名CA - 3住院医师参与。平均表现分数在82.2% - 94.9%之间（最低 = 38%，最高 = 100%）。与历史SOSCE队列相比，7个站点中有5个站点的ZOSCE分数没有差异，但与专业人员沟通（ = 0.007）和超声（ < 0.001）站点的分数较低。总体而言，CA - 3参与者对学习体验给予了积极评价，并认为它是现场模拟的合理替代方式，其回答与历史现场SOSCE队列的回答相似。
与现场SOSCE相比，基于远程模拟的ZOSCE用于ABA OSCE的形成性考试准备，大多数站点的机构评分相似，但有些站点可能更适合现场练习或需要进行修改。虚拟形式可能允许在非临床时间灵活安排，或为偏远地区的学习者提供便利。这些发现对未来的形成性练习和正式的总结性考试过程具有启示意义。
