Objective Structured Teaching Exercise Research Articles

Teaching the tutors: use of an OSTE to train medical students to be peer tutors.

First-year medical students are often challenged by the rapid pace and large volume of content that must be learned. Peer teaching has emerged as a supportive educational strategy. However, the most effective strategies for training peer tutors (PTs) for their role are not known. This paper examines the use of an Objective Structured Teaching Exercise (OSTE) to augment PT training sessions. Applying deliberate practice as a conceptual framework, an OSTE was used to provide tutors with an opportunity to practice their skills and receive feedback about their performance when meeting with a student presenting with a challenge. The newly trained PTs were required to assess a standardized student, determine challenge(s) being experienced, and present options to address the challenge(s). Standardized students evaluated the tutors' performance and a pre- and post-OSTE questionnaire was used to determine whether the OSTE was effective in increasing the confidence level of PTs to effectively assess and support students seeking help. Participants reported an increase in confidence in their ability to assess areas requiring improvement, understand the active learning strategies, and suggest appropriate active learning study strategies. Evaluations completed by standardized students documented that newly trained PTs accurately diagnosed the challenge presented in the OSTE and in most cases PTs asked all relevant questions to assess. Increased self-efficacy promotes PT's capacity to perform their work and feedback during an OSTE can further advance required skills. Aggregate OSTE results can also inform efforts to enhance the PT training program.NEW & NOTEWORTHY This novel application of the Objective Structured Teaching Exercise (OSTE) was done to enhance tutors' skills as valued members of our integrated academic support program. The OSTE provided feedback to the tutors and enabled us to identify a need for enhanced tutor training in active learning strategies. The OSTE can be adapted for use in other health science educational programs to enhance their training programs and to assess tutor's skills in preparation for their role.

Lessons Learned from a Novel Three-year Longitudinal Stepwise "Residents-as-Teachers" Program.

Most residents-as-teachers (RaT) programs are delivered over days to weeks without comprehensive evaluation, and stepwise approaches have rarely been applied to RaT activities. This study aimed to depict the implementation experience and evaluate the effectiveness of a novel longitudinal three-year, stepwise RaT program. The longitudinal RaT program included three once yearly face-to-face courses according to the different teaching roles of the residents. To evaluate the effectiveness of the new longitudinal program, we designed a randomized controlled study for first-year residents of all specialties in one medical center. The effectiveness was evaluated by the objective structured teaching exercise (OSTE), feedback from participants and medical students, and evaluation of clinical practice performance by program directors. A total of 35 (37.6%) of 93 residents participated in this study, and 13 (37.1%) of all enrolled residents completed all three-year courses, including seven for the longitudinal program and six for the traditional. The serial OSTE revealed significantly higher scores in the longitudinal group in the second and third years (13.43 vs. 9.50, p=0.001 and 14.29 vs. 10.33, p=0.015). Satisfaction was higher when advanced topics were taught in the second and third years compared with those taught in the first year (4.43 vs. 3.89, p=0.02). The feedback from medical students was similar between the two groups, and the evaluation from program directors revealed insignificantly better clinical performance among the longitudinal course participants. It is challenging to conduct a multi-year longitudinal RaT program on young residents. Nevertheless, this longitudinal program was potentially associated with better learning retention and higher satisfaction and worthy to be promoted.

Seeing Yourself Through the Learner's Eyes: Incorporating Smart Glasses Into Objective Structured Teaching Exercises for Faculty Development.

Although physicians gain clinical knowledge in their specialty, it does not mean they receive adequate instruction to teach and provide feedback. Using smart glasses (SG) to provide educators with a first-person learner perspective has not been explored in faculty development such as Objective Structured Teaching Exercises (OSTEs). Integrated within a 6-session continuing medical education-bearing certificate course, this descriptive study involved one session where participants provided feedback to a standardized student in an OSTE. Participants were recorded by mounted wall cameras (MWCs) and SG. They received verbal feedback on their performance based on a self-designed assessment tool. Participants reviewed the recorded content and identified areas for improvement, completed a survey about their experience with SG, and wrote a narrative reflection. Seventeen physicians at the assistant professor level participated in the session; data were analyzed on the 14 who had both MWC and SG recordings and who also completed the survey and reflection. All were comfortable with the standardized student wearing SG and indicated it did not affect communication. Eighty-five percent of the participants felt the SG provided additional feedback not available with the MWC, with majority noting additional feedback was related to eye contact, body language, voice inflection, and tone. Eighty-six percent see value in using SG for faculty development, and 79% felt that periodically using SG in their teaching would improve quality. Use of SG during an OSTE on giving feedback was a nondistracting and positive experience. SG provided affective feedback otherwise not perceived from a standard MWC.

Going Virtual: Objective Structured Teaching Exercises as an Innovative Method for Formative Resident Education

BackgroundThe coronavirus disease 2019 pandemic forced residency programs to adapt teaching to the virtual arena. Objective Structured Teaching Exercises (OSTEs) are a simulation-based session we previously implemented in our in-person pediatric curriculum. We aimed to assess feasibility of and resident satisfaction with the transition to virtual learning for simulation-based OSTEs. MethodsThe pediatrics residency program at our hospital has a weekly academic half-day for residents where the OSTEs were held annually in person 2018 to 2019 and virtually in 2020. Surveys were collected from participating residents and faculty to compare teaching experience, feedback quality, and satisfaction with the session. ResultsOver 3 academic years, there were 159 total teaching sessions, 3 of which were OSTEs. The OSTE session was highly rated each year and was the second highest rated virtual session. Residents felt the OSTEs improved their teaching regardless of the virtual versus in-person platform (P = .77), and the quality of feedback as rated by the resident teacher was higher for virtual sessions (P < .001). ConclusionsTransitioning the OSTE to a virtual platform was both feasible and effective when compared to the in-person OSTE. In the transition to virtual learning, educators should consider opportunities for simulation-based teaching such as OSTEs.

&lt;p&gt;Receiving Real-Time Clinical Feedback: A Workshop and OSTE Assessment for Medical Students&lt;/p&gt;

BackgroundMany programs designed to improve feedback to students focus on faculty’s ability to provide a safe learning environment, and specific, actionable suggestions for improvement. Little attention has been paid to improving students’ attitudes and skills in accepting and responding to feedback effectively. Effective “real-time” feedback in the clinical setting is dependent on both the skill of the teacher and the learner’s ability to receive the feedback. Medical students entering their clinical clerkships are not formally trained in receiving feedback, despite the significant amount of feedback received during this time.MethodsWe developed and implemented a one-hour workshop to teach medical students strategies for effectively receiving and responding to “real-time” (formative) feedback in the clinical environment. Subjective confidence and skill in receiving real-time feedback were assessed in pre- and post-workshop surveys. Objective performance of receiving feedback was evaluated before and after the workshop using a simulated feedback encounter designed to re-create common clinical and cognitive pitfalls for medical students, called an objective structured teaching exercise (OSTE).ResultsAfter a single workshop, students self-reported increased confidence (mean 6.0 to 7.4 out of 10, P<0.01) and skill (mean 6.0 to 7.0 out of 10, P=0.10). Compared to pre-workshop OSTE scores, post-workshop OSTE scores objectively measuring skill in receiving feedback were also significantly higher (mean 28.8 to 34.5 out of 40, P=0.0131).ConclusionA one-hour workshop dedicated to strategies in receiving real-time feedback may improve effective feedback reception as well as self-perceived skill and confidence in receiving feedback. Providing strategies to trainees to improve their ability to effectively receive feedback may be a high-yield approach to both strengthen the power of feedback in the clinical environment and enrich the clinical experience of the medical student.

Training junior faculty to become clinical teachers: The value of personalized coaching

Background: Junior clinical faculty require institutional support in the acquisition of feedback and clinical supervision skills of trainees. We tested the effectiveness of a personalized coaching versus guided self-reflection format of a faculty development program at improving faculty skills and self-efficacy.Methods: Participants were evaluated both before and after the program using a four-station Objective Structured Teaching Exercise (OSTE). A gain-score analysis, one-way ANOVA, and paired t-tests were used to evaluate both groups. The impact on the learning environment was measured by resident ratings of the Maastricht Clinical Teaching Questionnaire.Results: One hundred and twenty-seven participants completed the study over a three-year period. Both groups had significant improvements in self-efficacy. Participants in the coaching group demonstrated superior performance in encouraging learner self-reflection, teaching effectiveness, verifying learner understanding, exploring feelings/needs, and defining learning objectives. Over a 5-year period, the overall institutional learning climate significantly improved concerning faculty role-modeling, coaching, articulation, and explorations skills.Conclusion: Offering a contextualized faculty-development program using OSTEs that provides multiple opportunities for feedback and is focused on creating a community of practice is an effective method to facilitate the transfer of skills to the clinical environment, supports teacher identity development, and favorably impacts the learning climate.

Micro-feedback skills workshop impacts perceptions and practices of doctoral faculty

BackgroundDoctoral supervision is a distinct form of supervision with clearly defined responsibilities. One of these is the delivery of effective face-to-face feedback to allow supervisees to improve upon their performances. Unfortunately, doctoral supervisors, especially of health sciences, are often not trained in supervisory skills and therefore practice mostly on a trial and error basis. Lack of understanding of the feedback process leads to incongruence in how supervisors and supervisees perceive feedback. However, standardized training practices like microteaching can allow supervisors to acquire effective feedback practices. In this study we employed a schematic approach of microteaching, that is micro-feedback, in a workshop to develop feedback skills of doctoral supervisors, and assessed the overall effectiveness of this training using the Kirkpatrick evaluation framework.MethodologyThis was a Quasi-experimental study with a repeated measures and a two-group separate sample pre-post test design. A micro-feedback skills workshop was organized to enhance feedback skills of doctoral supervisors using microteaching technique. The first two levels of the Kirkpatrick evaluation model were used to determine the workshop’s effectiveness. An informal Objective Structured Teaching Exercise (OSTE) was used to assess feedback skills of the supervisors, both before and after the workshop. A questionnaire was developed to compare pre-and post-workshop perceptions of the supervisors (n = 17) and their corresponding supervisees (n = 34) regarding the ongoing feedback practice.ResultsDespite the hectic schedule, most doctoral supervisors (17 of 24, 71%) were willing to undertake faculty development training. Participants indicated a high level of satisfaction with the workshop. A learning gain of 56% was observed on pre-post OSTE scores. Prior to the workshop, perceptions of how supervisees should be given the feedback differed significantly between supervisors and supervisees with an effect size difference of r = 0.30. After the workshop there was a negligible difference in perceptions between supervisors and supervisees (r = .001). Interestingly, supervisors shifted their perceptions more toward those that were originally held by the supervisees.ConclusionsThese findings suggest that well-designed and properly assessed structured programs such as micro-feedback workshops can improve how doctoral supervisors provide feedback to their supervisees and align supervisors’ perceptions of that feedback with those of their supervisees.

A Novel Curriculum to Prepare Internal Medicine Residents for Fellowship Interviews.

Background:Applications to the Fellowship Match through the National Resident Matching Program (NRMP) Specialties Matching Service (SMS) are at an all-time high. Data regarding the preparedness of medical residents who go through the interview process is limited.Objective:To assess whether the implementation of an interview curriculum could improve medical resident preparedness for and performance during fellowship interviews.Methods:All third-year internal medicine residents (N = 18) at the Zucker School of Medicine at Hofstra/Northwell (Northwell) applying to subspecialty fellowship participated in an interview curriculum that comprised a didactic session and an Objective Structured Teaching Exercise (OSTE). Participants were surveyed on preparedness before and after the curriculum and medical residents and faculty were surveyed on medical resident performance after their OSTE and after their Northwell fellowship interview.Results:Out of the total possible number of participants, 16 (89%) were included in our analysis. Pre and post-test statistical differences in survey responses were evaluated using the Wilcoxon signed rank test. Medical resident preparedness and resident perceived performance increased in all measured categories, including overall preparedness (P = .001) and overall interview skills (P = .008). No significant change in faculty-rated resident performance was observed.Conclusion:The development and institution of a formal interview curriculum improved medical resident preparedness and perceived performance. However, this significant improvement seen between medical resident pre and post surveys did not translate to improvement between faculty pre and post surveys. Future studies should look at fellowship match rates to objectively assess the impact of the curriculum.

An objective structured teaching exercise for faculty training and assessment of teaching ability in interprofessional collaborative practice and education.

Objective:Improving clinical teachers’ ability to teach interprofessional collaborative practice warrants development in current faculty training programs; in particular, current education training emphasizes experiential learning and multiple teaching strategies. The purpose of this study was to establish a teaching model to apply interdisciplinary collaborative care and to improve clinical teachers’ execution of interprofessional practices.Materials and Methods:Health-care faculty members were studied; this study assessed a teacher education curriculum for interprofessional education (IPE) and applied an objective structured teaching exercise (OSTE) to evaluate IPE execution by clinical teachers.Results:The OSTE improved clinical teachers’ IPE execution, verifying the necessity for multistrategy teaching in faculty training programs.Conclusions:This study provides different types of interprofessional faculty training and assessments. Development of an OSTE requires long-term planning, and IPE should also be incorporated into formal programs.

Promoting innovation in the objective structured teaching examination and feedback: clustering teachers to aid teaching evaluation

ABSTRACTProblem: This study used the principles of feedback in a faculty development curriculum to enable clinical teachers to conduct objective structured teaching exercises for performance assessment. Intervention: the Flanders System of Interaction Analysis (FIA) was given to analysis of the data collected from a particular situation, to videotapes of simulated clinical teaching skills. Context: The Sparse K-Means clustering method, one-way ANOVA and post hoc tests were employed to cluster the most commonly used skills by teachers and compare the features of different clusters were then discussed. Outcome: The evaluation method employed in this study can be extended to more teaching methods and skills. Lessons Learned: that through teaching observation, clinical teaching skills and reflection teaching can be improved.

Fellow as Clinical Teacher (FACT) Curriculum: Improving Fellows' Teaching Skills During Inpatient Consultation.

Multiple barriers, including time constraints, a demanding teaching environment, and lack of longitudinal relationships with residents, make it challenging for fellows and learners to engage in effective teaching during consultation. The Fellow as Clinical Teacher (FACT) curriculum was developed to overcome such barriers and improve fellow teaching in the setting of inpatient consultation. The FACT curriculum consists of two 45- to 60-minute small-group sessions designed for subspecialty fellows. The first session focuses on overcoming barriers to teaching and application of the principles of adult learning theory. The second introduces the PARTNER (partner with resident, assess the learner, reinforce positives, teaching objectives, new knowledge, execute recommendations, review) framework for teaching during consultation and uses video examples to model the application of this framework, allowing fellows to practice its implementation through role-play. Previously, the FACT curriculum was shown to improve teaching skills of rheumatology and pulmonary/critical care fellows as evaluated by objective structured teaching exercises. Here, the curriculum has been expanded to 51 internal medicine and pediatrics fellows in 15 different training programs. The curriculum improved fellow teaching skills as assessed by self-assessment surveys. It was highly rated by participants, and fellows reported being more likely to teach during consultation following this educational intervention. The FACT curriculum can be integrated into subspecialty training programs to improve the teaching skills of internal medicine and pediatrics fellows in the setting of inpatient consultation. Ultimately, improved teaching from fellows may have broad-reaching effects for residents, patients, and the fellows themselves.

Tackling Implicit and Explicit Bias Through Objective Structured Teaching Exercises for Faculty.

Tackling Implicit and Explicit Bias Through Objective Structured Teaching Exercises for Faculty.

Medical students’ professional identity development from being actors in an objective structured teaching exercise

Introduction: Medical students develop professional identity through structured activities and impromptu interactions in various settings. We explored if contributing to an Objective Structured Teaching Exercise (OSTE) influenced students’ professional identity development.Methods: University clinical faculty members participated in a faculty development program on clinical supervision. Medical students who participated in OSTEs as simulated residents were interviewed in focus groups about what they learnt from the experience and how the experience influenced their vision of learning and teaching. Transcripts were analyzed using the Goldie’s personality and social structure perspective model.Results: Twenty-five medical students out of 32 students involved in OSTEs participated. On an institutional level, students developed a feeling of belonging to the institution. At an interactional level, students realized they could influence the teaching interaction by actively seeking or giving feedback. On the personal level, students realized that errors could become sources of learning and felt better prepared to receive faculty feedback.Conclusion: Taking part in OSTEs as a simulated resident has a positive impact on students’ vision regarding the institution as a learning environment and their own role by actively seeking or giving feedback. OSTEs support their professional identity development regarding learning and teaching while sustaining faculty development.

Interprofessional objective structured teaching exercise (iOSTE) to train preceptors

Background and purposeInterprofessional education (IPE) is important in the education of all health care students, yet limited IPE training has been provided to preceptors who train these students in the clinical setting. Simulation using the standardized student model has been used to train health care preceptors in medicine. To our knowledge, there are no reports utilizing interprofessional objective structured teaching exercises (iOSTE) to train pharmacy preceptors. The primary objectives of this pilot study were to evaluate the effects of iOSTE on the pharmacy preceptors’ perceived importance of the Interprofessional Education Collaborative (IPEC) core competencies and confidence in precepting interprofessional students. Additionally, data were collected regarding pharmacy preceptors' prior experiences in simulation and debriefing. Educational activity and settingPreceptors (n=23) participated in an iOSTE and debriefed with trained standardized nursing and pharmacy students caring for a trained standardized asthma patient. FindingsPre- versus post-iOSTE survey data showed statistically significant improvements in all self-confidence related items, including the following abilities: precept students from different disciplines (p=0.004), facilitate a simulation activity (p=0.001), conduct the debriefing process (p<0.001), and discuss with students the IPE core competencies (p=0.001). Additionally, responses to post-iOSTE survey questions assessing the learning activity showed high ratings (median=5, interquartile range=4 to 5). Pharmacy preceptors increased their teaching ability and confidence level in communicating with students from other health care professions. SummaryThese findings indicate that iOSTE is a useful and well-received method for preceptor development.

Use of Fellow as Clinical Teacher (FACT) Curriculum for Teaching During Consultation: Effect on Subspecialty Fellow Teaching Skills.

Subspecialty consultation in inpatient care is increasing. Teaching by subspecialty fellows in a consultation setting may be an important source of work-based learning for students and residents. However, teaching and evaluation of learners in this context may be challenging due to personal and systems-based barriers. We developed and evaluated a framework designed to overcome barriers to teaching and to improve fellow teaching skills during inpatient consultation. The PARTNER (Partner with resident, Assess the learner, Reinforce positives, Teaching objectives, New knowledge, Execute recommendations, Review) framework was delivered to rheumatology and pulmonary and critical care medicine fellows at 3 academic medical centers as part of a 2-session Fellow as Clinical Teacher (FACT) curriculum. Fellows' teaching skills were evaluated using an objective structured teaching exercise (OSTE) pre- and postcurriculum, and at the end of the academic year. Self-assessment surveys were used to evaluate fellows' self-perception of teaching skills. Twelve of 16 eligible fellows (75%) participated in the program and completed 73 OSTE cases. Teaching skills measured by OSTEs and self-assessment surveys improved after administration of the FACT curriculum. There was no significant skill decay at the end-of-year evaluation. The curriculum was rated highly, and 73% (8 of 11) of fellows stated they would teach more frequently as a result of the intervention. The FACT curriculum was practical and feasible, and significantly improved fellows' teaching skills teaching during inpatient consultation.

The Development and Evaluation of a Nursing One-Minute Preceptor Program in Taiwan

The One-Minute Preceptor is a tool that is relatively easy to learn and apply in the clinical setting by medical doctors, , but little is known about the effects on clinical nursing preceptors. Study Aim was to develop and evaluate the effects of a One-Minute Preceptor program on the clinical nursing preceptors in Taiwan. Method: quasi-experimental design with a purposive sample, including two categories of study subjects-nurse preceptors, and their preceptees the new nurses. Sixty participants were reandomly assigned into the experimental and control groups with 35 and 25 subjects. Tool:  Objective Structured Teaching Exercise(OSTE) rating score, and subjective structured questionnaires of novice nurse’s self-evaluation to assess the benefit of the preceptor’s teaching. Results: the average OSTE scores of experimental group on two assessments were higher than those in the control group (p < .001 ; p < .001). The OMP program in this study could enhance the teaching competency of the nursing preceptors. The novice nurses in the experimental group felt more benefited from the preceptors, who had received intervention at  test two, than those in the control group. The study result showed an objectively structured nursing OMP Program can effectively improve their teaching ability and enhance their subjectively evaluated benefit level for new nurses.

Improving Residents’ Ability to Teach Complex Skills Through the Use of Objective Structured Teaching Exercises

Although studies have been conducted in various medical disciplines on the use of objective structured teaching exercises (OSTEs) to improve teaching skills, there are no OSTE studies specifically addressing internal medicine residents and their ability to be effective teachers, more specifically their self-perceptions of confidence and competence in teaching. This study explores the use of OSTEs as a means of deliberate practice in order to improve internal medicine resident performance in teaching complex skills. Twenty-eight internal medicine residents were invited to participate in the study. The primary outcome was measured by a survey-based assessment of resident self-perceptions of confidence and competence before and after two OSTEs. Residents reported a significant increase in their confidence in teaching medical students a complex oral presentation skill (SNAPPS method) after the two OSTEs. OSTEs can be used to boost resident confidence and competence in teaching complex oral presentation skills to medical students.

Fellow As Teacher Curriculum: Improving Rheumatology Fellows' Teaching Skills During Inpatient Consultation.

Enhancing rheumatology fellows' teaching skills in the setting of inpatient consultation may have a broad positive impact. Such efforts may improve fellows' clinical skills and overall patient care. Most importantly, effective resident-fellow teaching interactions may not only increase residents' knowledge of rheumatology but may influence their career choice. However, a number of barriers to the resident-fellow teaching interaction have been identified, including fellows' teaching skills. We developed the Fellow As Clinical Teacher (FACT) curriculum in order to enhance fellows' teaching skills during inpatient consultation. The FACT curriculum was delivered in two 45-minute workshops during the 3-day Winter Symposium of the Carolinas Fellows Collaborative. We evaluated its effect with self-assessment surveys and fellow performance on the objective structured teaching exercise (OSTE) before and after participation in the curriculum. Nineteen fellows from 4 rheumatology training programs participated in the pre- and post-curriculum OSTEs and 18 fellows completed pre- and post-curriculum surveys. OSTE scores improved on 5 of the 8 items assessed, and the total OSTE score improved as well (34.7 versus 29.5; P < 0.01) after the FACT curriculum. Fellows' self-assessment of their teaching skills and intent to teach during consultation also increased after participation in the curriculum. The FACT curriculum, focused on teaching during consultation, improved fellows' teaching skills and attitudes toward teaching. Improving and increasing fellow teaching, particularly in the consultation setting, may impact patient care, resident and fellow learning, and teaching skills of future faculty, and could potentially influence residents' career choice.

The Development and Evaluation of a Nursing One-Minute Preceptor Program in Taiwan

The One-Minute Preceptor is a tool that is relatively easy to learn and apply in the clinical setting by medical doctors, , but little is known about the effects on clinical nursing preceptors. Study Aim was to develop and evaluate the effects of a One-Minute Preceptor program on the clinical nursing preceptors in Taiwan. Method: quasi-experimental design with a purposive sample, including two categories of study subjects-nurse preceptors, and their preceptees the new nurses. Sixty participants were reandomly assigned into the experimental and control groups with 35 and 25 subjects. Tool:  Objective Structured Teaching Exercise(OSTE) rating score, and subjective structured questionnaires of novice nurse’s self-evaluation to assess the benefit of the preceptor’s teaching. Results: the average OSTE scores of experimental group on two assessments were higher than those in the control group (p < .001 ; p < .001). The OMP program in this study could enhance the teaching competency of the nursing preceptors. The novice nurses in the experimental group felt more benefited from the preceptors, who had received intervention at  test two, than those in the control group. The study result showed an objectively structured nursing OMP Program can effectively improve their teaching ability and enhance their subjectively evaluated benefit level for new nurses.

Using Objective Structured Teaching Exercises for Faculty Development

Abstract Introduction Objective structured clinical encounters (OSCEs) have become a widely-used tool to teach, provide feedback on, and evaluate clinical skills for both medical students and resid...