Objective Structured Clinical Exam

By Roslyn Joinvil

Maimonides Medical Center

Mentor: Dr. Lisa Altshuler

Ibsen Vargas

Vocabulary

• OSCE- Objective Structured Clinical Exam• Cultural- relating to the cultivation of the mind or

manners.• Culture- the customs, civilization, and achievements of a

particular time or people.• Competence- ability; adequately qualified or capable.• Standardized Patients- people who are recruited for the

relevant cultural groups or trained to understand specific cultural issues.

• Observer- a representative sent to observe but not participate officially in an activity.

What is OSCE?

• OSCE ( Objective Structured Clinical Exam) is a growing training program in a number of hospitals. This program was developed to give residents the opportunity to practice different situations on real life experiences.

• It allows for skills practice and feedback.

History

• OSCE’s have been used in the United States since 1975.

• ACGME (Accreditation Council for Graduate Medical Education ) realized that there was a gap in the residents learning and training skills.

• Came up with the one of the first OSCE’s. • This program gave residents feedback on their

performance.• The feedback targets and identifies if the resident

will require any further mediation for training.

(cont’d) History

• ACGME care specialist came about with 6 core steps to teach and evaluate the residents which are:– Patient Care

– Medical Knowledge

– Practice- based learning and improvement

– Interpersonal and communication skills

– Professionalism

– Systems-based practice

General Competencies for 6 Core Areas

• Patient CareProvide patient care that is compassionate, appropriate, and effective for the treatment of healthcare problems and the promotion of health.

• Medical Knowledgemust demonstrate knowledge about established and evolving biomedical, clinical, and cognate sciences and applying this knowledge to patient care.

• Practice-Based Learning and Improvementable to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence to improve their patient care practices.

http://www.acgme.org/outcome/comp/compFull.asp

(cont’d) General Competencies for 6 Core Areas

• Interpersonal and Communication Skillsable to demonstrate interpersonal and communication skills that result in effective information exchange teaming with patients, patients families, and professional associates.

• Professionalisma commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

• Systems-Based Practicedemonstrate an awareness of and responsiveness to the larger context and system of healthcare and the ability to effectively call on system resources to provide care that is optimal value.

http://www.acgme.org/outcome/comp/compFull.asp

Maimonides Medical Center

• Implemented the OSCE program in the Pediatrics Department.

• Realized there was a growing need for appropriate training models in the area of cultural competence.

• Since 1999 the first formative Culture OSCE at MMC was developed.

MMC OSCE Curriculum

• Communication OSCE- 1st year Residents

• Culture OSCE- 2nd year Residents

• Genetics OSCE- 3rd year Residents• 5 Scenarios or stations are present in all

three areas.• All OSCE’s involve communication skills.

Communication OSCE

• 1st year residents

• Residents are beginning to be in contact with patients.

• It will offer them practice in communicating with patients.

Culture OSCE

• 2nd year residents

• These residents have some experience with communicating with patients.

• MMC serves a diverse population. They serve them with respect and understand why they treat them or respond to them in another way.

(Parents’ Report)

Other

White (Non-Hispanic)

56%

African-Am.

3%

* Categories used by MMC

Jewish41%

Other7%

Christian

Catholic35%

Muslim 14%

PracticeHallal 11%

3%

7%

Middle East

Indian

4%

Asian 11%

White(Hispanic)

21%

Child’s Ethnicity Parent’s Religion

Kosher home38%

3%

Not Kosher

No Hallal

3%

Ethnicity* and Religion

Genetic OSCE

• 3rd year resident - Advanced group• Be able to convey genetic information to

the public in nontechnical terms.• Since genetics is much more complicated it

is given to the advanced group.• For example explaining Down Syndrome,

giving a visual diagnosis and genetic referrals.

Purpose of Stations

• Developed scenarios that would teach cultural awareness and how culture has an impact on healthcare.

• Goal is to assist the residents to explore the patient’s point of view.

• All stations give realtime feedback• At the end of each scenario residents receive comments from

the faculty observer and the standardized patients (if the station includes them).

• What is done well, quote on what is said, could be improved on body language, verbally and in writing.

Culture scenario

Lost in Translation – addressing the language barrier in a Bengali family where only the father speaks English.

Overall Evaluation of Culture OSCE

6%

33%

60%

6%

37%

53%

8%

22%

65%

14%

37%

45%

0%10%20%30%40%50%60%70%80%90%

100%

DefinitelyMaybeDefinitely Not

Overall Evaluation of

Culture OSCE

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N = 41

Conclusion

• OSCE (Objective Structured Clinical Exam) is a post resident training program which will improve residents performance skills in the office.

• Improves skills, gives a more one-on-one interaction, feedback, communication and helps residents acquire the knowledge that they didn’t receive or understand in medical school.

Bibliography

ACGME Outcome Project

– http://www.acgme.org/outcome/comp/compFull.asp Accessed from ACGME on Aug 2, 2006ALTSHULER, L., Kachur, E. (2001). A Culture OSCE: Teaching residents to bridge different

worlds. Academic Medicine, 76, 514.HARDEN, R.M., STEVENSON, M., DOWNIE, W.W., WILSON, G. M . (1975). Assessment of

clinical competence using objective structured clinical examinations. British Medical Journal, 1, 447-51.

ALTSHULER, L., Kachur, E. ( 2004). Cultural competence is everyone's responsibility! Medical Teacher, 26, 101-5

INSTITUTE OF MEDICINE ( 2002). Unequal treatment: confronting racial and ethnic disparities in healthcare. Washington (DC): National Academy Press.

ROBINS,L.S., WHITE, C.B., ALEXANDER, G.L., GRUPPEN, L.C., GRUM, C.M. (2001). Assessing medical students’ awareness of and sensitivity to diverse health beliefs using a standardized patient station. Academic Medicine, 76, 76-80.

SINGER, P.A., COHEN, R., ROBB, A., ROTHMAN, A. (1993). The ethics objective structured clinical examination. Journal of General Internal Medicine, 81, 23-8

Acknowledgements

• Thank You to:

• Harlem Children’s Society

• Dr. Sat

• Dr. Lisa Altshuler

• Ibsen Vargas

• Gateway Program

• Everyone in the audience