Impact of a teaching OSCE on RIME skills

Abstract

Introduction: To improve skills of 4th yr students in the evaluation of patients in shock, a new case-based practice OSCE station was developed. We hypothesized that student skills would improve and identified factors affecting OSCE performance. Methods: A practice OSCE /teaching session, based on R-I-M-E, was introduced to the Class of 2003 as a teaching tool, a practice test, and provide an opportunity for feedback. On the final OSCE, students were instructed to evaluate ICU flow sheets by identifying the abnormal data (Reporter), developing a problem list (Interpreter), and producing management recommendations (Manager). Student performance on the practice OSCE were compared with the final OSCE, and to the prior Class of 2002 (n = 86). The variables assessed for impact on the final OSCE performance were clerkship site, block (time of year), prior performance on NBME subject exam and an OSCE during the 3rd year clerkship, and the effect of the practice OSCE. Results: 107 of 108 students completed the practice OSCE session. Student skills improved significantly on the final OSCE as compared with the practice OSCE in the Reporter, Interpreter and Manager categories. The Reporter, Interpreter and Manager scores on practice and final OSCEs correlated (R = 0.5, 0.2 and 0.3; p < 0.001 by regression). Student OSCE performance in the Reporter and Interpreter categories improved after introduction of the OSCE teaching session in 2003 as compared with the Class of 2002. A stepwise regression analysis identified the new OSCE session as an independent factor affecting Reporter and Interpreter skills, P < 0.01. Block significantly affected Reporter, Interpreter and Manager skills. Performance on a prior OSCE during the 3rd year clerkship also affected Reporter skills. Clerkship site was not a significant factor. Conclusion: Student skills improved after introduction of a practice OSCE/teaching session. Application of RIME principles in a teaching OSCE may help to improve learning in complex patient scenarios.TABLE—ABSTRACT 3(Mean % ± SEM)ReporterInterpreterManagerClass 2003: Practice OSCE76.1 ± 1.658.7 ± 2.035.8 ± 2.7Class 2003: Final OSCE84.4 ± 0.8∗†79.1 ± 1.0∗†59.9 ± 1.3∗Class 2002: Final OSCE78.3 ± 1.571.0 ± 1.857.8 ± 1.6∗P < .05 by ANOVA, Pre vs. Final;†P < .05 by ANOVA 2003 vs. 2002