Original Article

Pivoting during a Pandemic: Reimagining Intern Orientation EPA-Based OSCE

Authors: Manish Suneja, MD, Kate DuChene Thoma, MD, MME, Ellen Franklin, MA, MME, Jane Rowat, MS

Abstract

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.
Posted in: Infectious Disease138

Full Article

Having trouble viewing the article content below? Click here to open it directly.

Images

Download Image

Download Image

Download Image

Download Image

References

1. Varkey P, Natt N, Lesnick T, et al. Validity evidence for an OSCE to assess competency in systems-based practice and practice-based learning and improvement: a preliminary investigation. Acad Med 2008;83:775–780.
 
2. Ogunyemi D, Dupras D. Does an objective structured clinical examination fit your assessment toolbox? J Grad Med Educ 2017;9:771–772.
 
3. Carraccio C, Englander R, Gilhooly J, et al. Building a framework of entrustable professional activities, supported by competencies and milestones, to bridge the educational continuum. Acad Med 2017;92:324–330.
 
4. Lypson ML, Frohna JG, Gruppen LD, et al. Assessing residents' competencies at baseline: identifying the gaps. Acad Med 2004;79:564–570.
 
5. Short MW, Jorgensen JE, Edwards JA, et al. Assessing intern core competencies with an objective structured clinical examination. J Grad Med Educ 2009;1:30–36.
 
6. Lomis K, Amiel JM, Ryan MS, et al. Implementing an entrustable professional activities framework in undergraduate medical education: early lessons from the AAMC Core Entrustable Professional Activities for Entering Residency pilot. Acad Med 2017;92:765–770.
 
7. Angus SV, Vu TR, Willett LL, et al. Internal medicine residency program directors' Views of the Core Entrustable Professional Activities for Entering Residency: an opportunity to enhance communication of competency along the continuum. Acad Med 2017;92:785–791.
 
8. Pearlman RE, Pawelczak M, Yacht AC, et al. Program director perceptions of proficiency in the core entrustable professional activities. J Grad Med Educ 2017;9:588–592.
 
9. Lindeman BM, Sacks BC, Lipsett PA. Graduating students' and surgery program directors' views of the Association of American Medical Colleges Core Entrustable Professional Activities for Entering Residency: where are the gaps? J Surg Educ 2015;72:e184–e192.
 
10. CarlLee S, Rowat J, Suneja M. Assessing entrustable professional activities using an orientation OSCE: identifying the gaps. J Grad Med Educ 2019; 11:214–220.
 
11. Blythe J, Patel NSA, Spiring W, et al. Undertaking a high stakes virtual OSCE ("VOSCE") during Covid-19. BMC Med Educ 2021;21:221.
 
12. Craig C, Kasana N, Modi A. Virtual OSCE delivery: the way of the future? Med Educ 2020;54:1185–1186.
 
13. O'Byrne L, Gavin B, McNicholas F. Medical students and COVID-19: the need for pandemic preparedness. J Med Ethics 2020;46:623–626.
 
14. Zoom Video Communications. Security guide. https://d24cgw3uvb9a9h.cloudfront.net/static/81625/doc/Zoom-Security-White-Paper.pdf. Published July 2016. Accessed November 29, 2022.
 
15. Lucey CR, Johnston SC. The transformational effects of COVID-19 on medical education. JAMA 2020;324:1033–1034.
 
16. Rose S. Medical student education in the time of COVID-19. JAMA 2020; 323:2131–2132.
 
17. Chan J, Humphrey-Murto S, Pugh DM, et al. The objective structured clinical examination: can physician-examiners participate from a distance? Med Educ 2014;48:441–450.