aligning instituutional osces with cler focus areas · map osce cases with acgme com ... john...
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Aligning InstituAligning InstituOSCEs with CLLISA DILLON PH D TSVETI MARKOV
Focus Areas LISA DILLON, PH.D, TSVETI MARKOVMARIA KOKAS, PH.D, S IMONE BRENNAN, M
utional utional LER VA MD FAAFP VA, MD, FAAFP, MA, PORCERELL I , JOHN, PH.D
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Obj tiAddress institution-wide needs for r
ObjectivesAddress institution wide needs for r
Demonstrate adaptations to existinmeaningful data
Map OSCE cases with ACGME com
Develop OSCE faculty championsDevelop OSCE faculty champions
Provide feedback for residents, procontinuous improvementp
resident assessmentresident assessment
ng evaluation tools to yield
mpetencies and CLER focus areas
ograms, and the institution for
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OSCE Data-Literature SOSCE Data-Literature SSearch Results1-7Search Results
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NAS: Continuous improveement Cycle
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Seeing CLER-lyg y
Patient Safety
QI and HeDisparit
Patient Safety
Transitions in Care
Duty Hand FatMitiga
Pr
ealth ies
Supervision
ours tigue tion
rofessionalism
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Patient Safety
Profes
Patient Safety
Transitions in Transitions in Care
QI andDispa
I t l d CInterpersonal and C
ssionalism
Duty Hours and Fatigue Fatigue
Mitigation
Health arities
Supervision
i ti Skillommunication Skills
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Capturing Interpersonal Cp g p
Non-spespecific
Direct
specific
Patient Safety
Transitions in Care
QI and Health
Disparities
Duty Hours and
Fatigue Mitigation
Supervision
Professionalism
Direct Observ
Mitigation
Interpersonal and Communication Skills
Multi-soassessm
OSCE Faculty Develop
Communication and Skil
ecialty cases cases
vation
ource ment
pment
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Aligning OSCE with CLERGoal 1: Demonstrate adaptability
Aligning OSCE with CLER
• Recruit content matter exper• Simulation Center Director,• Learning Systems Director from HFH• GME Director of Research and Educ
• Analyze cases for CLER elem
G i i i l f• Generate training materials f
R of OSCE for CLER Process:R
rts
cation
ents
f f lfor faculty
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OSCE Materials- Cas• Four non-specialty-specific ca
• Bad News E Di l • Error Disclosure
• Informed Consent • Surgical Disparity or Medical DispSurgical Disparity or Medical Disp
• One assessment of InterpersoOne assessment of Interperso• Kalamazoo Essential Elements Co
ses and Assessmentases:
parity in Healthcare parity in Healthcare
onal and Communication Skills: onal and Communication Skills: ommunication Checklist (KEECC)
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alamazoo Essential Elementts Communication Checklis
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MAPPIKEECCKEECC NG
CLERCLER
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KEECC & CLER FOCUS AREA CODING AGREEMENTS
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KEECC WITH ACGME COMPEETENCY CODING AGREEMEN
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Terry Philips-Health CClinical Scenario:Terry Phillips is a middle aged ov
Terry Philips-Health C
Terry Phillips is a middle--‐aged, ovpatient. Terry is under a great deaa community health screening whblood pressure. Terry Phillips is in th
k h i l Th ti t twork physical. The patient recentscreening and was told they had
Today, the nurse took the patienty pelevated BP of 170/108.
Instructions:Please discuss with the patient themedication.
Do not perform any part of the PhDo not perform any part of the Ph
Care Disparity
verweight African American
Care Disparity
verweight, African American al of stress and recently attended here she was told she had high he outpatient clinic today for a l tt d d it h lth ly attended a community health HBP.
’s BP and patient again has p g
e need for taking HBP
hysical Examinationhysical Examination.
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CULTY DEBRIEFING MATECULTY DEBRIEFING MATEERIALSERIALS
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Results & Outcomes Ove
Resident level
Program levelg
I tit ti l lInstitution level
erview
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Resident Level• KEECC Scores for eac
• Standardized Patient• Self-evaluation• Percentile Rank agai• Percentile Rank agai
Resident Program PGY BTrapper John Surgery 3 00Trapper, John Surgery 3.00
McDreamy, Derek Surgery 5.00
h caset
inst participantsinst participantsBad News Overall Percentile Rank
31 00 64 0031.00 64.0035.00 94.60
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Program Level• KEECC averages and S• KEECC element averagg• Resources for program
B topic• By topic• By KEECC element
D by casege scoresgimprovement
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Dermatology
KEECC Average
gy
31
27.8 27
3129.
Bad News Error Disclosure Informed Consent
Surgery Disp
Total number of participants:
N Residents who are 2 SD .6
N Residents who are 2 SD from case mean:
Below AboveBad News: 2 2
Error Disclosure: 3 2
Informed Consent: 3 2
parity
Surgery Disparity: 1 1
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Dermatology—Average
Reaches Agreement
Provides closure
Understands the patient's perspective
Shares information
g
Opens the discussion
Gathers information 3
3.83.9
Builds relationship
score on each element of KEECC
4 04
4.13
4.21
4.04
4 08
3.96
4.21
4
4.25
4.08
44.1
4.24.3
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ecommendations to proeview videos with residents (g
ecommendations to pro
Use as part of remediation plaUse as part of remediation plaesidents
Challenge the known OSCE ba
ogramsgroup/individual)
ograms
an for low scoring an for low scoring
arriers
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Institutional Level• Overall program performan• Case Improvements by
Institutional Level
• Case Improvements by• Program• Case• Case and Year • PGYId tifi ti f f lt d• Identification of faculty devOSCE Retreat
• Data management (NI)Data management (NI)• Overall satisfaction• Enhancement of OSCE for 2Enhancement of OSCE for 2
nce
l t dvelopment needs
2014-20152014 2015
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Overall Program Perfo
28 928.9
27.6 27.9 27.227.6
28.5
26.526
Dermatology Family Medicine Internal Medicine Orthopaedic Surgery
2012 DATA
ormance
29.8
27.6
26 0626 4 26 2
27.7
26.8
25.4626.0626.4 26.2
Otolaryngology Phys. Medicine & Rehabilitation
Transitional Year Urology
2013 DATA
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Case Improvements
Bad News2012 Mean 2013 M
DermatologyInternalMedicine
25.32 28.89*
Orthopaedic Surgery
26.0 30.0†
Otolaryngologyy g gy
* p < .05† p < .001
by Program
Informed ConsentMean 2012 Mean 2013 Mean
24.33 26.67*
22.0 28.86*
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2012
2012 & 2013 Institutional Com2012
Bad News 26.23
Error Disclosure 25.84
Informed Consent 27 36Informed Consent 27.36
Surgery Health Disparity 28.12
Medical Health Disparity 30.22
Case average 27 18Case average 27.18
PGY 1 Improvements2012 (N = 49) 0 ( 9)
Bad News 25.80
Error Disclosure 26.18
Informed Consent 27 75Informed Consent 27.75
Surgery Health Disparity 28.73
Medical Health Disparity 29.97
C 27 32Case average 27.32
2013
mparison201328.44**
24.76
28 87*28.87
27.11
29.85
27 70 * p < .0527.70** p < .001
2013 (N = 46)0 3 ( 6)
28.78**
24.69
29 4629.46
25.58
30.85
28 10* p < .05** < 00128.10 ** p < .001
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OutcomesOutcomes
Program & faculty engage
Increased resident prepare
Higher rating of OSCE as a g g
ment
edness
learning toolg
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New Directions for 2014• Institution-wide OSCE prep
New Directions for 2014
• Early commitment• Communicate CLER-lyy• Establish predictive validity• Redesign casesRedesign cases• OSHE
L it di l i• Longitudinal comparisons
4 2015paration
4-2015
y
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Th k Thank ! you!
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