P-088 A Longitudinal OSCE Experience: A Pilot of Progressive Testing to Assess Inflammatory Bowel Disease Training for Gastroenterology Fellows. (March 2016) - Lopatin, Sarah
Abstract : Background: The Observed Structured Clinical Examination (OSCE) is a well validated as a tool for assessing medical trainee performance, and has been identified by the Accreditation Council for Graduate Medical Education (ACGME) as a method for assessing the core competencies of interpersonal skills, communication and professionalism. Recently, the use of OSCEs in gastroenterology fellowship training has been shown to be a useful method for evaluating fellows' skills of these competencies relating to IBD education. Here, we report a pilot study of implementing a longitudinal OSCE experience to assess fellow's competency in IBD management. Methods: Four GI fellows from 2 programs participated in an identical 4-station OSCE for 2 consecutive years. The first case ("UC Flare") evaluated communication between the GI fellow and an Emergency Department physician pertaining to initial triage and management of a patient with an ulcerative colitis flare. The second case ("Shared Decision Making") focused on shared decision making in a patient with Crohn's disease who was deemed to benefit from combination therapy. The third case ("Transition of Care") evaluated the GI fellow's ability to communicate with a young patient transitioning from pediatric to adult IBD care. The final case ("Geriatrics") addressed discharge planning and education for a geriatric patient being discharged from the hospital after an IBD flare. Each station was observed by an attending gastroenterologist in addition to the standardized patient/physician (SP). Previously validated checklists utilizing 3 and 5-point Likert scales were scored across multiple domains by SPs, who each provided feedback after each case. After the completion of all cases, the fellows attended a debriefing session to review key IBD teaching points and communication skills, and completed a survey assessing the educational value of the experience. Results: Four fellows participated in the longitudinal OSCE experience, representing 33% of the total participants each year. Notable improvement was observed in the domain of Communication (average score 3.6 versus 4.3 in 2014 and 2015, respectively), with 4/4 fellows improving in this domain. More modest improvements were observed in the domains of Relationship Development (average score 2.6 versus 2.8 in 2014 and 2015, respectively), with 4/4 fellows improving in this domain, and in the domain of Information Gathering (average score 2.7 versus 2.8 in 2014 and 2015, respectively) with 3/4 fellows showing improvement in score. No change in score was observed in the domain of Patient Education (average score 2.7 in 2014 and 2015), with only 2/4 fellows improving their score. There was net improvement in scores in the UC Flare and Geriatrics cases, and a net decrease in scores in the Transition of Care case. On post-OSCE survey, 50% of the fellows rated the repeat experience as useful. Conclusions: To our knowledge, this is the first use of an OSCE to evaluate longitudinal development of skills in IBD management for gastroenterology fellows. This pilot study identified both areas of improvement and decline in fellow performance, and could be useful in development of targeted educational interventions for areas of weakness in the form of continuing medical education (CME) activities after fellowship completion.