Objective Structured Clinical Exam Research Articles

Analysis of a Near Peer Tutoring Program to Improve Medical Students’ Note Writing Skills

Problem: The ability to document a patient encounter is integral for any physician. Previous studies indicate that medical students’ note writing skills are poor due to a lack of formal clinical documentation instruction. Barriers to formally teaching students how to write patient notes include the significant time burden and variability in faculty feedback. Implementing a near-peer teaching program to teach students how to write a patient note can overcome these barriers and fill this curricular gap. Intervention: Fourth year medical students who completed a Teaching in Medicine elective course were trained to provide individual feedback to 1st and 2nd year students on note writing as a part of their Introduction to Clinical Medicine course. In order to determine the effect of this two year, near-peer feedback program on note writing skills, we analyzed students’ scores on the note writing portion of two Objective Structured Clinical Exams that took place at the end of the 2nd and 3rd years of medical school. Context: The near-peer feedback sessions were implemented in the Fall of 2013 during the preclinical years of the medical school curriculum. Data from students who received near-peer feedback (N = 112) were compared to a historical control group who did not receive near-peer feedback on their note writing (N = 110). Objective Structured Clinical Exam scores that were specific to note writing skills, including the history, physical exam, and differential diagnosis subscales were examined. Impact: The near-peer feedback had a positive impact on the quality of patient notes. On the end of the 2nd year Objective Structured Clinical Exam, the near-peer feedback intervention group outperformed the no feedback group on the history and physical exam subscale scores but not on the differential diagnosis subscale score. One year later, the near-peer feedback intervention group continued to outperform the no feedback group on the physical exam subscale score, but not the history or the differential diagnosis subscale scores. Lessons Learned: Near-peer teaching improves student documentation of the history and physical exam, however only the effects on the physical exam portion persist into the clinical years of training. Writing up a differential diagnosis is a skill that develops through the clerkship experience regardless of exposure to feedback in the preclinical years. Implementing near-peer teaching in the medical school setting is feasible and can provide students with valuable learning experiences without relying on clinical faculty.

SIMplifying Palliative Extubations: A Two-Part OSCE in a Simulation Center to Assess Entrustable Professional Activities (EPAs) in Hospice and Palliative Medicine (TH315)

•Identify the critical steps of a palliative extubation procedure.•Assess how the Palliative Extubation objective structured clinical exam (OSCE) applies to the clinical competencies of EPAs in Hospice and Palliative Medicine.•Demonstrate the innovative Palliative Extubation OSCE simulation.•Construct an educational toolkit in order to adapt and implement the Palliative Extubation OSCE simulation to your own institution. Healthcare professionals require education and practice to master their communication and procedure skills, especially in potentially distressing circumstances such as palliative extubations. Palliative extubation refers to removal of mechanical ventilator support when, based on an individual's goal of care, it is thought to be prolonging the dying process rather than helping to support through a reversible illness. Removing the endotracheal tube will allow a natural death to occur. In order to provide competent and compassionate care for patients and family members before, during, and after a palliative extubation, healthcare providers must provide a clear explanation of this complex procedure, show proficiency in performing the procedure, and demonstrate leadership skills. One method of evaluating a healthcare provider's competency in the domains of performing a palliative extubation and communication, is through use of an objective structured clinical exam (OSCE). An OSCE in a simulation center is an effective method to teach theoretical knowledge, improve hands-on skills, and assess clinical competencies while also reducing the risk of harm to patients and providers, especially for scenarios that do not occur on a daily basis. A simulation provides the advantage of providing a controlled, standardized situation, allowing for multiple interventions to be applied. This concurrent session describes an innovative Palliative Extubation OSCE in a simulation center using a mannequin as the patient and a standardized patient (SP) actor as a family member. The OSCE is divided into two parts—part 1: the family meeting and part 2: the extubation procedure. This session describes how the OSCE is structured to teach and assess the clinical competencies of the 17 EPAs in Hospice and Palliative Medicine. The session will conclude with a demonstration of the Palliative Extubation OSCE followed by small group discussions on how to implement the OSCE at participants' own institutions.

Simulated patient\u2019s feedback to improve communication skills of clerkship students

BackgroundThe changing trends of the society and revisions to medical education have changed the way medical students are trained to adroitly care for patients hence, patient centered care has become need of today’s society and communication skills are imperative in developing patient physician relationship. Increasingly, simulations are being used to aid medical students to incorporate theoretical knowledge into practice. There are innumerable studies regarding communication skills in terms of reliability, validity and feasibility but no such study has been documented using simulated patient’s feedback in improving communication skills in Pakistan. The aim of this study is to explore whether simulated patients’ feedback improves the communication skills of undergraduate medical students.MethodsDuring a randomized control trail a group of eighty students in the final year clerkship at Al-Nafees Medical College have participated in pre-post Objective Structured Clinical Exam (OSCE) on communication skills. The students were selected through convenience sampling technique. Four Objective Structured Clinical Exam (OSCE) stations based on different scenarios of communication skills were developed. Each station of fifteen minutes duration was assessed by both simulated patients and faculty using a validated tool LCSAS (Liverpool Communication Skills Assessment Scale). The difference between the pre and post-tests of two groups was explored by applying independent t-test. Cronbach’s alpha was used to check the reliability of scores and effect size was calculated.ResultsResults of this study have showed that there is significant improvement in communication skills after receiving feedback from simulated patients (p value ≤0.05) was observed. An overall Cronbach α = 0.83 on LCSAS reveal a high internal consistency and there was adequate demonstration of effect size(r = 0.8).ConclusionThe results on the scores of the students on the Liverpool Communication Skills Assessment Scale confirm that simulated patient’s feedback is essential to enhance the communication skills of the medical students. This study offers significant evidence towards successful conduction of a formal communication skills development initiative at Al-Nafees Medical College using simulated patient feedback during teaching and assessments.

An exploratory analysis of factors contributing to resident pass rates on a national licensure OSCE in the United Arab Emirates.

Purpose:To explore resident perceptions of factors contributing to pass rates on a high-stake licensing objective structured clinical exam (OSCE).Materials and Methods:A cross-sectional survey was administered to all 51 applicants of the April 2019 internal medicine Arab Board OSCE examination in Abu Dhabi, United Arab Emirates (UAE), and included questions on preparedness, stress level, and prior educational experiences. Exposures were evaluated for correlation against Arab Board pass rates using Pearson correlation and the two-tailed significance was recorded.Results:All 51 examinees completed the survey (100% response rate). Participants were primarily female n = 35 (67%) and all completed residency training in the UAE. Gender differences were noted, with higher pass rates for the male residents (13/35, 37% females vs. 8/16, 50% males, P < 0.05). Further, 65% (P < 0.001) of female examinees reported higher levels of anxiety than male residents. Examinees reported regular exposure during residency to clinical skills training (74%), standardized patients (71%), simulation (66%), and OSCEs (72%) but none of these educational modalities correlated with higher pass rates. Of multiple exam preparation modalities, only self-directed learning with deliberate practice, the intentional repetition of a task with feedback, was associated with higher pass rates.Conclusion:Clinical exam skills are vital for trainees to deliver high-quality primary healthcare services. National licensure OSCEs have become the norm in the Arab world for assessing resident clinical exam skills. Our results suggest that residency programs should encourage residents’ intentional deliberate practice and mastery learning in the acquisition and retention of physical examination techniques.

Partners in pharmacy: An intraprofessional educational event with pharmacy and pharmacy technician students

Background and purposeUpon graduation and licensing, pharmacists work very closely with pharmacy technicians. Despite this, opportunities for learning together as students are limited. We developed and implemented a pilot intraprofessional event for pharmacy and pharmacy technician students. The purpose of this study was to evaluate the perceived value and learner confidence through analysis of participant feedback. Education activity and settingPharmacy students from the University of Waterloo School of Pharmacy and pharmacy technician students from Lambton College participated in an intraprofessional event that included a three-station practice objective structured clinical exam (OSCE) and a case discussion regarding a methadone dispensing error, followed by a facilitated debrief. Upon completion of the event, students were invited to complete an online feedback questionnaire. FindingsTwenty-one pharmacy students and 22 pharmacy technician students participated in the event. Twenty-one students completed the questionnaire, for a response rate of 49%. The majority of respondents agreed or strongly agreed that the event enhanced learning and confidence in working together to provide interprofessional care. Students seemed to find the OSCE to be particularly valuable. Feedback suggestions for improvement indicated a desire for more activities and time allocated to the event. SummaryWe designed and implemented a pilot intraprofessional event that was well-received by pharmacy students and pharmacy technician students. This supports the development of future similar events.

Effectiveness of Music Therapy and Emotional Freedom Technique on Test Anxiety in Turkish Nursing Students: A Randomised Controlled Trial

IntroductionTest anxiety, one of the forms of situational anxiety, is a crucial biopsychological factor negatively affecting the wellbeing and academic performance of students throughout their education. The study aimed to determine the effects of music therapy and EFT (Emotional Freedom Technique) on situational anxiety and vital signs in nursing students before they took an OSCE (Objective Structured Clinical Exam). MethodsThis study was conducted with 90 volunteer students. A computer-based random number generator was used to randomly assign the students into three groups (Music, EFT, and control), each group consisted of 30 students. Data was collected using a Student Identification Form, the Situational Anxiety Scale, and the Vital Signs Form. ResultsBefore the interventions, the mean anxiety scores of the students were similar. After the interventions, however, the mean anxiety scores of those in both experimental groups were significantly lower (p < .05). The difference between the mean vital signs of the groups was not statistically significant, except the pulse rate in the EFT and peripheral capillary oxygen saturation (SpO2) in the music group. ConclusionsAccording to the results of the study, both music therapy and EFT led to a decrease in the nursing students’ average scores before the OSCE, as measured by the Situational Anxiety Scale.

Medical Students' Experiences and Outcomes Using a Virtual Human Simulation to Improve Communication Skills: Mixed Methods Study.

BackgroundAttending to the wide range of communication behaviors that convey empathy is an important but often underemphasized concept to reduce errors in care, improve patient satisfaction, and improve cancer patient outcomes. A virtual human (VH)–based simulation, MPathic-VR, was developed to train health care providers in empathic communication with patients and in interprofessional settings and evaluated through a randomized controlled trial.ObjectiveThis mixed methods study aimed to investigate the differential effects of a VH-based simulation developed to train health care providers in empathic patient-provider and interprofessional communication.MethodsWe employed a mixed methods intervention design, involving a comparison of 2 quantitative measures—MPathic-VR–calculated scores and the objective structured clinical exam (OSCE) scores—with qualitative reflections by medical students about their experiences. This paper is a secondary, focused analysis of intervention arm data from the larger trial. Students at 3 medical schools in the United States (n=206) received simulation to improve empathic communication skills. We conducted analysis of variance, thematic text analysis, and merging mixed methods analysis.ResultsOSCE scores were significantly improved for learners in the intervention group (mean 0.806, SD 0.201) compared with the control group (mean 0.752, SD 0.198; F1,414=6.09; P=.01). Qualitative analysis revealed 3 major positive themes for the MPathic-VR group learners: gaining useful communication skills, learning awareness of nonverbal skills in addition to verbal skills, and feeling motivated to learn more about communication. Finally, the results of the mixed methods analysis indicated that most of the variation between high, middle, and lower performers was noted about nonverbal behaviors. Medium and high OSCE scorers most often commented on the importance of nonverbal communication. Themes of motivation to learn about communication were only present in middle and high scorers.ConclusionsVHs are a promising strategy for improving empathic communication in health care. Higher performers seemed most engaged to learn, particularly nonverbal skills.

An objective structured clinical examination to assess the communication skills of students

Abstract Background Communicative competence is one of the important components of professional competence that needs to be developed in the process of training future doctors. Methods At the end of the study of the “General Practice” module, students of the 5th year of the specialty General Medicine must pass a two-stage exam consisting of comprehensive testing and acceptance of practical skills of an objective structured clinical exam (OSKE) with the participation of volunteers. Students, who passed the exam, anonymously filled out the questionnaire on the evaluation of the organization of the OSKE with volunteers and their communication skills. Results The analysis of the questionnaires showed that 4% of the students noted the unfriendliness of the volunteers, 27% wrote that it was difficult to engage with the volunteers in the collection of the anamnesis, 2% of the students, unfortunately, had never before encountered a similar situation. 12% of students who passed the exam wished to improve the communication skills of the volunteers themselves, for example, they advised to speak louder, not to ask unnecessary and unnecessary questions, to get more real in the role of the patient. Only 10% of examinees decided that OSKE did not develop their communication skills; 24% noted individual stations, which caused them some difficulties. However, the students themselves acknowledged their poor preparedness, including during communication with standardized patients. Conclusions The analysis of the questionnaires showed that the students themselves are self-critical of their communication skills and recognize the need for their continuous improvement. Key messages The student’s communicative competence can be assessed by conducting an objective structured clinical examination. Conducting an objective structured clinical examination with volunteers can improve the communicative competence of students.

Objective Structured Clinical Exams (OSCE) are a feasible method of teaching how to discuss a nonepileptic seizure diagnosis

ObjectivePresenting the diagnosis of psychogenic nonepileptic seizures (PNES) can be a difficult task, but disclosing this information effectively is important to optimize patient outcomes. We sought to develop a standardized method to teach neurology residents how to introduce the diagnosis of PNES via an objective structured clinical examination (OSCE) with a standardized patient (SP). MethodsIn conjunction with the New York University School of Medicine Simulation Center (NYSIM), we designed an OSCE in which a resident had to inform a SP of her diagnosis of PNES and discuss a treatment plan. The SP was provided with details to gradually disclose depending on what the resident said about the history of her episodes, triggers for her episodes and her history of sexual abuse. Each encounter was observed by an attending physician who provided real-time feedback to the resident after the session. Additionally, the SP completed an objective written checklist of items the resident should have covered in the session and gave them verbal feedback. ResultsTwenty-six adult neurology (n = 22), child neurology (n = 3), and neuropsychiatry (n = 1) residents participated in this OSCE in 2018 and 2019, with full data available for 25 participants. Residents reported the OSCE was very useful (mean Likert score of 4.9/5). They felt moderately prepared (mean Likert score 3.8/5) and rated their performance as a mean of 3.3/5. On the SP's checklist, most residents were rated as Well Done in the domains of information gathering, relationship development, and education and counseling. Only in the domain of psychosocial assessment were most residents rated as Not Done (only 7/25 inquired about past trauma as a risk factor for PNES). SignificanceThe OSCEs are a feasible and useful way to teach neurology residents about discussing PNES, as they allow for provision of real-time practice and feedback in a safe environment without real patients.

Development of a Simulated Objective Structured Clinical Exam for the APPLIED Certification Exam in Anesthesiology: A Two-Year Experience Informed by Feedback from Exam Candidates

Program directors of anesthesiology residencies agree that it is the program's responsibility to prepare residents for primary American Board of Anesthesiology (ABA) certification, although few report an Objective Standardized Clinical Exam (OSCE) program reflective of the new ABA examination. We created an authentic simulated OSCE (SOSCE) using existing resources to prepare third-year clinical anesthesia residents for the ABA APPLIED exam before graduation and identify knowledge gaps relevant to the OSCE. Junior anesthesiology residents and medical students acted as standardized patients for the 7 SOSCE stations. Third-year clinical anesthesia residents were evaluated on performance by faculty educators during the SOSCE and completed surveys regarding their experience. Follow-up surveys were distributed to participants after they completed the ABA APPLIED Exam. Mean scores ranged from 82.6% correct (echocardiogram) to 97.2% correct (ultrasonography). Knowledge gaps were present in competencies explicitly stated as objectives by the ABA. Echocardiography scores improved from 76.1% in the first year to 90.0% in the second year (P = .009). Participants found the SOSCE to be valuable in preparing for the OSCE and the standardized patients' performance to be convincing. Participants felt better prepared for the ABA exam and thought that the SOSCE was authentic in content and process. An SOSCE program can be developed with preexisting resources. This program was highly rated as useful and informative, an accurate reflection of the ABA OSCE, and helpful in preparation for the examination. Development of a SOSCE program is feasible, sustainable, and valuable.

Impact of Using a 3D Visual Metaphor Serious Game to Teach History-Taking Content to Medical Students: Longitudinal Mixed Methods Pilot Study.

BackgroundHistory taking is a key component of clinical practice; however, this skill is often poorly performed by students and doctors.ObjectiveThe study aimed to determine whether Metaphoria, a 3D serious game (SG), is superior to another electronic medium (PDF text file) in learning the history-taking content of a single organ system (cardiac).MethodsIn 2015, a longitudinal mixed methods (quantitative and qualitative) pilot study was conducted over multiple sampling time points (10 weeks) on a group of undergraduate medical students at The University of Auckland Medical School, New Zealand. Assessors involved in the study were blinded to group allocation. From an initial sample of 83, a total of 46 medical students were recruited. Participants were assigned to either a PDF group (n=19) or a game group (n=27). In total, 1 participant left the PDF group after allocation was revealed and was excluded. A total of 24 students in the game group and 14 students in the PDF group completed follow-up 7 weeks later. Using an iterative design process for over a year, with input from a variety of clinical disciplines, a cardiac history-taking game and PDF file were designed and informed by Cognitive Load Theory. Each group completed its intervention in 40 min. A total of 3 levels of Kirkpatrick training evaluation model were examined using validated questionnaires: affective (perception and satisfaction), cognitive (knowledge gains and cognitive load), and behavioral attitudes (Objective Structured Clinical Exam) as well as qualitative assessment. A priori hypotheses were formulated before data collection.ResultsCompared with baseline, both groups showed significant improvement in knowledge and self-efficacy longitudinally (P<.001). Apart from the game group having a statistically significant difference in terms of satisfaction (P<.001), there were no significant differences between groups in knowledge gain, self-efficacy, cognitive load, ease of use, acceptability, or objective structured clinical examination scores. However, qualitative findings indicated that the game was more engaging and enjoyable, and it served as a visual aid compared with the PDF file.ConclusionsStudents favored learning through utilization of an SG with regard to cardiac history taking. This may be relevant to other areas of medicine, and this highlights the importance of innovative methods of teaching the next generation of medical students.

Objective structured clinical exam: how clinical nurse educators can support internationally educated nurses.

Internationally educated nurses (IENs) require robust teaching programmes to support them through the objective structured clinical exam (OSCE) process to gain registration with the Nursing and Midwifery Council. There should be measures in place to support these nurses from a clinical and pastoral perspective. It is also important to learn from IENs, because moving to a different country is an emotional and life-changing experience that affects nurses and their families. Preparation is central to completing the programme successfully, alongside having the resources required in terms of time and a dedicated facility for practise. This article describes the development and implementation of an OSCE preparation teaching programme to support IENs, discusses the challenges for teachers and participants, and shows how having a dedicated facility and programme lead has led to excellent results.

Should we video OSCEs for student appeals?

Those setting objective structured clinical exams (OSCEs) are likely to encounter candidates who dispute the examiners' scores and feedback. At our own institution, candidates have requested video recording to aid in later academic appeals. Before ceding to such requests, we wished to be certain that the marking of recorded OSCEs would give comparable results to live marking, and that technical challenges could be met within reasonable cost. We adopted a mixed-methods approach to explore the use of video recording OSCEs. Following an initial literature review, we surveyed and interviewed the assessment leads of UK medical schools and postgraduate institutions setting high stakes OSCEs to explore their views and experience in using recordings as part of summative OSCE assessments. Results from our literature review reveal inconsistent findings about the comparability of marks awarded from video marking and those awarded by examiner in-station marking, with suggestions that video marking generates lower scores. The majority of UK medical education institutions were neither videoing OSCEs nor considering doing so. Many logistical and assessor-related drawbacks to video review were identified, with significant concerns raised about how such a process could be feasibly managed. Although the videoing of OSCEs may superficially appear an easy solution to provide defensibility of the process, the potential use is beset with challenge, going beyond purely logistical and technical difficulties. The use of videoing for the purpose of OSCE appeals is not currently supported by the literature, nor by the majority of UK undergraduate and postgraduate medical education institutions delivering high-stakes summative OSCEs.

Triage Performance of School Personnel Using the SALT System.

The aim of this study was to determine if school personnel can understand and apply the Sort, Assess, Life-saving interventions, Treat/Transport (SALT) triage methods after a brief training. The investigators predicted that subjects can learn to triage with accuracy similar to that of medically trained personnel, and that subjects can pass an objective-structured clinical exam (OSCE) evaluating hemorrhage control. School personnel were eligible to participate in this prospective observational study. Investigators recorded subject demographic information and prior medical experience. Participants received a 30-minute lecture on SALT triage and a brief lecture and demonstration of hemorrhage control and tourniquet application. A test with brief descriptions of mass-casualty victims was administered immediately after training. Participants independently categorized the victims as dead, expectant, immediate, delayed, or minimal. They also completed an OSCE to evaluate hemorrhage control and tourniquet application using a mannequin arm. Subjects from two schools completed the study. Fifty-nine were from a private school that enrolls early childhood through grade eight, and 45 from a public school that enrolls grades seven and eight (n=104). The average subject age was 45 years and 68% were female. Approximately 81% were teachers and 87% had prior cardiopulmonary resuscitation (CPR) training. Overall triage accuracy was 79.2% (SD=10.7%). Ninety-six (92.3%) of the subjects passed the hemorrhage control OSCE. After two brief lectures and a short demonstration, school personnel were able to triage descriptions of mass-casualty victims with an overall accuracy similar to medically trained personnel, and most were able to apply a tourniquet correctly. Opportunities for future study include integrating high-fidelity simulation and mock disasters, evaluating for knowledge retention, and exploring the study population's baseline knowledge of medical care, among others.

Impact of tablet-scoring and immediate score sheet review on validity and educational impact in an internal medicine residency Objective Structured Clinical Exam (OSCE)

Introduction: The Objective Structured Clinical Examination (OSCE) is used globally for formative and summative purposes. The objective of this study was to examine the impact of tablet-scoring on sources of validity evidence for an Internal Medicine residency OSCE.Methods: We compared paper-scored OSCEs from 2014 to tablet-scored OSCEs in 2015 for missing data, amount of comments, and time to pass/fail decision. We then examined in 2016 the impact on learning of showing residents their score sheets and asking them to write an action plan immediately after an OSCE.Results: Tablet-scoring significantly reduced stations with missing data from 1.8 to 0.2%, and stations without comments from 42 to 28% with an increase in word count per comment. Time to official results reduced from 3 weeks to 12 h with tablet-scoring. Residents who wrote a learning plan after reviewing their OSCE score sheets were more likely (with medium to large effect sizes) to pursue further studying and/or change their behavior (e.g. history taking or physical examination) in the clinical environment.Conclusions: OSCE tablet-scoring improved many sources of validity evidence, especially educational impact with timeliness of feedback supporting a change in behavior, a hard to achieve goal of educational interventions.

P110: Are there differences in student academic and clinical performance after rotations at tertiary or community care Emergency Medicine teaching sites?

Introduction: Canadian undergraduate medical Emergency Medicine (EM) rotations are often completed at either tertiary care centres or regional community hospitals. While the latter offer students exposure to different practice settings and population needs, many students perceive that teaching at tertiary care EM departments is superior to that in community hospitals. At our institution, third year undergraduate medical students complete three-week EM rotation at either a tertiary centre or a community hospital. We compared academic and clinical performance between students trained in tertiary care centres and students trained in community hospitals. Methods: Academic and clinical performance in EM was evaluated based on the results of an EM-specific multiple choice examination (MCQE) and an annual Objective Structured Clinical Exam (OSCE) assessing competency in a broad range of clinical scenarios commonly addressed in EM. The 40-question MCQE is administered quarterly and a mix of old and new questions are used to ensure consistency. The OSCE is administered annually and relies on the same principal to remain consistent. OSCE scores are binary: pass or fail. We reviewed MCQE and OSCE scores from three consecutive cohorts of students. Students were pooled into two groups, tertiary and community, based on the site of their EM rotation. Mean MCQE and OSCE performance were compared between the two groups of students using two-tailed unpaired T tests. Chi squared tests were used to identify significant differences in scores between cohorts. Results: MCQE and OSCE scores from 312 students over three consecutive cohorts were analyzed. Cohorts included 104, 100, and 108 students with 61% trained in tertiary centres (N = 191). Students trained in tertiary centres had a mean MCQE score of 77%. Students from community centres had a mean score of 78%. There was no significant difference in MCQE scores between tertiary- and community-trained students (p = 0.6099). The OSCE pass rate was 97% for students trained in tertiary centres and 98% for students trained in community centres. OSCE pass rates were not significantly different between the two groups (p = 0.8145). Conclusion: Despite student perceptions that training in tertiary care EM centres was superior, objective analysis showed that academic and clinical performance were similar regardless of training site.

Delivering Challenging News: An Illness-Trajectory Communication Curriculum for Multispecialty Oncology Residents and Fellows.

Published curricula to teach communication skills for postgraduate fellows in oncology are few in number despite the fact that oncologists conduct many difficult discussions with their patients and their families. Such discussions may include disclosing initial diagnosis or relapse of a patient's cancer or relaying a poor prognosis or change to palliative care. An eight-module course on communication in oncology practice was delivered over 2 months for palliative and oncology fellows and radiation oncology residents. Learners were given a precourse survey in which they were asked to rate their proficiency in various communication tasks. Each learner then participated in a videotaped precourse objective structured clinical exam (OSCE) on breaking bad news with standardized patients (SPs). The course took place over 8 weeks with weekly didactics and role-play. At the end of the course, a second OSCE took place. After the course was completed, the fellows again filled out a proficiency survey. Twenty-two learners participated over 2 years of this course. Participants reported a significant increase in perceived competence in all areas on the postcourse survey. SP feedback on OSCEs pre- and postcourse indicated improvement in skills for learners. Pre- and postcourse OSCE video assessment revealed a significant improvement in global communication skills. Initial data show that this course successfully improved communication skills and increased fellows' comfort level across several domains of communication. Future directions include validating our assessment tool, expanding the topic base, and investigating the impact on practice after course completion.

Parent-provider paediatric literacy communication: Acurriculum for future primary care providers.

BackgroundReach Out and Read promotes early literacy and school readiness by incorporating book delivery and anticipatory guidance into well-child visits. There is a need to train future healthcare providers in the knowledge and skills to communicate with parents/caregivers about early childhood literacy. We developed and evaluated a curriculum to improve learners’ knowledge, attitudes, and skills towards the incorporation of parent-provider literacy communication into well-child visits.MethodsFamily medicine residents (n = 30), physician assistant students (n = 36), and medical students (n = 28) participated in a curriculum consisting of service learning, online didactic training, objective structured clinical exams (OSCEs) and a debriefing session. Standardized patients (SPs; 6 months to 5 years) and standardized patient caregivers were recruited and trained. Learners were evaluated on their abilities to offer books to patients, provide anticipatory guidance, and demonstrate parent-provider communication skills. Knowledge, attitudes, and satisfaction were collected pre- and post-curriculum.ResultsSignificant increases in total knowledge were observed after completing curriculum activities (p < 0.001). All attitudes improved after training (p < 0.05). All learners (100%) recommended that caregivers talk back and forth with their 6‑ to 12-month-old babies and make eye contact. Few (18.2%) learners recommended playing games like ‘peek-a-boo’ while reading. When caregivers evaluated learners’ basic parent-provider communication skills, all reported that the learners treated them with respect and used plain language.DiscussionOur curriculum extends beyond previous studies by measuring recommended books, anticipatory guidance, and communication skills using paediatric SPs and standardized patient caregivers. Curriculum activities can be tailored to best promote parent-provider literacy communication training in other programs.Electronic supplementary materialThe online version of this article (10.1007/s40037-019-0503-8) contains supplementary material, which is available to authorized users.

An independent appraisal of an electronic OSCE management software system in a Psychiatry examination

This article was migrated. The article was not marked as recommended. BackgroundThe Objective Structured Clinical Exam (OSCE) is a method of assessment in psychiatry but is high in expenditure, requiring large amounts of staff time and an extensive paper trail. The Online Management Information System (OMIS) for OSCEs is a software system that proposes to reduce these drawbacks.AimsThe aim of this study was to independently evaluate the use of OMIS through feedback from all key stakeholders involved in developing, administering and implementing an OSCE in a medical school. MethodThe independent appraisal of the system was done by an anonymous survey of four major participants in an OSCE; examiners, students, the academic team in charge of preparing and implementing the OSCE and an independent Information Technology (IT) team from the university who appraised the software. ResultsFeedback from examiners, academic team and IT experts was positive indicating a preference for OMIS over the typical paper format. Students mostly indicated a neutral response stating that OMIS had neither a positive nor negative effect on them during the exam. A few participants expressed concerns over data security, difficulty with some software features and the system not being optimised for hand-held devices. ConclusionIn general, OMIS is presents as a promising tool to enhance the implementation and delivery of an OSCE exam over the typical paper format of the exam.

Preseason Pediatrics: an Interactive Preclinical Curriculum Enhances Knowledge and Skills in Medical Students.

Medical students have limited preclinical exposure to pediatrics. We created an optional preclinical curriculum for first-year medical students called "Preseason Pediatrics" (PSP). This 6-month curriculum teaches pediatric-specific knowledge and clinical skills, consisting of monthly resident-led didactic sessions followed by complementary resident-mentored clinical experiences. Participants completed a survey before and after completion of PSP. Knowledge was assessed with multiple-choice questions pertaining to each topic covered in PSP and perceived skills, with a 5-point Likert scale ranging from not at all (1) to extremely (5) for skills taught. Skill maintenance was assessed with a newborn objective structured clinical exam (OSCE) 6months after PSP completion in 2016. Students beginning their pediatric clerkship also completed a survey, comparing students who did and did not complete PSP. From 2014 to 2017, 135 first-year medical students participated. Percent correct scores on pediatric knowledge increased in 4/5 topics covered, and students perceived increases in their pediatric skills in all course domains. 86.8% (n= 92/106) of students reported feeling more prepared for the pediatric clerkship. 94.3% (n= 100/106) would recommend the PSP experience to other students. Third-year students who participated in PSP reported higher comfort with pediatric patients prior to their clerkship. PSP is a successful novel preclinical program introducing students to pediatrics. We demonstrated that didactics paired with resident-mentored clinical experiences improved pediatric knowledge, clinical-based skills, and perceived clerkship preparedness. Students may academically and professionally benefit from such earlier exposure to pediatrics.