Using an Inflammatory Bowel Disease Objective Structured Clinical Examination to Assess ACGME Milestones in Gastroenterology Fellows

Abstract

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) has identified six core competencies in which trainees are expected to demonstrate proficiency. Milestones have been developed to provide a framework for evaluating trainee performance within these competencies. We used an objective structured clinical examination (OSCE) focused on inflammatory bowel disease (IBD) to assess the milestones in gastroenterology (GI) fellows. METHODS: Ten second-year fellows from six GI fellowship programs participated in a four case OSCE. In the “Transition of Care” case the fellow was to assess a patient's readiness on the planned transition from child-centered to adult-centered care. In the “Shared Decision Making” case the fellow was to evaluate a patient with Crohn's disease who would benefit from combination therapy. In the “ER Flare” case the fellow was to triage and suggest management of a flaring ulcerative colitis patient. In the “IBS in IBD” case the fellow was asked to discuss irritable bowel syndrome in the context of quiescent IBD. Previously validated OSCE checklists were used to assess the GI fellows' performance using a 3- and 5-point behaviorally-anchored Likert Scale. Checklists were scored by the standardized patient. Checklist items were mapped to appropriate ACGME milestones by a GI medical educator. Scores within each milestone were normalized on a scale from 0-9 as utilized by the ACGME in the Next Accreditation System milestone initiative. Fellows were provided feedback on their performance. RESULTS: The majority of fellows scored between 6 and 9 in the milestones assessing patient care (PC), medical knowledge (MK), interpersonal and communication skills (ICS), professionalism (Prof), and systems-based practice (SBP). Composite average scores for all participants were as follows: PC1 7. 7, PC2 6. 9, MK1 6. 9, MK2 7. 0, ICS1 7. 4, Prof1 7. 6, Prof3 6. 9, and SBP4 6. 4. Fellows scored highest in the “Shared Decision Making” case and scored lowest in the “Transitions of Care” case. CONCLUSION(S): In this OSCE GI fellows performed well in the majority of milestones evaluated, however areas of less optimal performance were identified, providing areas for future focus in fellow training. The OSCE is a well-validated standardized tool for evaluating trainees, and with appropriate mapping of checklists to ACGME milestones, it can serve as an objective method to assess GI fellows' progress in the core competencies.