From the Department of Internal Medicine.
the Department of Family Medicine, University of Iowa Hospitals and Clinics, Iowa City.
South Med J. 2023 Mar;116(3):312-316. doi: 10.14423/SMJ.0000000000001525.
OBJECTIVES: Objective structured clinical examinations (OSCEs) provide reliable and standardized means for assessing the performance of specific clinical skills. Our previous experience with entrustable professional activity-based multidisciplinary OSCEs suggests that this exercise offers just-in-time baseline information regarding critical intern skills. The coronavirus disease 2019 pandemic forced medical education programs to reimagine such educational experiences. For the safety of all of the participants, the Internal Medicine and Family Medicine residency programs pivoted from an in-person OSCE to a hybrid model (combination of in-person and virtual encounters) while maintaining the goals of the OSCEs administered in previous years. Here, we describe an innovative hybrid approach to redesigning and implementing the existing OSCE model while maximizing risk mitigation. METHODS: In total, 41 interns from Internal Medicine and Family Medicine participated in the 2020 hybrid OSCE. Five stations allowed for clinical skills assessment. Faculty completed skills checklists with global assessments and simulated patients completed communication checklists with global assessments. Interns, faculty, and simulated patients completed a post-OSCE survey. RESULTS: Informed consent, handoffs, and oral presentation were the lowest performing stations (29.2%, 53.6%, 53.6%, respectively) as assessed by faculty skill checklists. One hundred percent of interns (41/41) indicated that immediate faculty feedback was the most valuable part of the exercise, and all of the participating faculty believed that the format was efficient, allowing ample time to provide feedback and complete checklists. Eighty-nine percent of simulated patients cited they would be willing to participate again if the same assessment were to be held during the pandemic. The limitations of the study included the lack of demonstration of physical examination maneuvers by interns. CONCLUSIONS: A hybrid OSCE to assess interns' baseline skills during orientation using Zoom technology could be delivered successfully and safely during the pandemic without compromising the program's goals or satisfaction.
目的:客观结构化临床考试(OSCE)为评估特定临床技能提供了可靠和标准化的手段。我们之前使用可委托的专业活动为基础的多学科 OSCE 的经验表明,这种练习可以为关键实习技能提供及时的基准信息。2019 年冠状病毒病(COVID-19)大流行迫使医学教育计划重新构想此类教育经验。为了所有参与者的安全,内科和家庭医学住院医师培训计划从面对面 OSCE 转变为混合模式(面对面和虚拟接触相结合),同时保持前几年实施的 OSCE 目标。在这里,我们描述了一种创新的混合方法,重新设计和实施现有的 OSCE 模型,同时最大限度地降低风险。
方法:共有 41 名内科和家庭医学实习医生参加了 2020 年的混合 OSCE。有 5 个站点可进行临床技能评估。教师使用全球评估完成技能检查表,模拟患者使用全球评估完成沟通检查表。实习医生、教师和模拟患者完成 OSCE 后调查。
结果:根据教师技能检查表评估,知情同意、交接和口头报告是表现最差的站点(分别为 29.2%、53.6%和 53.6%)。100%的实习医生(41/41)表示,即时教师反馈是练习中最有价值的部分,所有参与的教师都认为该格式效率高,有足够的时间提供反馈和完成检查表。89%的模拟患者表示,如果在大流行期间进行相同的评估,他们愿意再次参与。研究的局限性包括实习医生未能展示体格检查操作。
结论:使用 Zoom 技术在定向期间评估实习医生基线技能的混合 OSCE 可以在不影响计划目标和满意度的情况下成功和安全地在大流行期间进行。
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