SC57 Use of simulation in plastic surgery trainee assessment – the postgraduate OSCE. (3rd November 2019)

• Record Type: Journal Article
• Authors: Mungroo, Sakiinah; Khwaja, Nadeem
• Is Part Of: BMJ simulation & technology enhanced learning. Volume 5(2019)Supplement 2
• Page Start: A50
• Page End: A50
• Publication Date: 2019-11-03
• Subjects: Medicine -- Simulation methods -- Periodicals; Medical innovations -- Periodicals; 610.113
• DOI: 10.1136/bmjstel-2019-aspihconf.91
• Languages: English
• ISSNs: 2056-6697

Abstract

Abstract : Background: Doctors wishing to undertake the plastic surgery training pathway in the UK need to sit for two examinations offered by the Royal College of Surgeons – the Membership of the Royal Colleges of Surgeons (MRCS) examination and the Intercollegiate Specialty Fellowship of the Royal Colleges of Surgeons (FRCS Plast) examination. There is at least a five-year gap between the MRCS and the FRCS Plast with no formal assessment of competence in between. This is why a formative OSCE for plastic surgery was introduced in 2014 in the North West Region to measure the competence of trainees and prepare them for the FRCS Plast examination, and it has been carried out on an annual basis for the past 5 years. Project description: According to Krathwohl (2002), the main learning domains of an OSCE should assess cognitive, affective and psychomotor skills, which is why the blueprint of the formative OSCE included five main groups of stations, namely 'patient assessment', 'explanation', 'management', 'operative planning' and 'operation'. This formative OSCE has been standardised to 20 stations per year, out of which at least 50% involved simulated patients. The remaining stations included high and low fidelity models to assess surgical skills and some multiple choice questions. About 20 candidates sat for the OSCE annually and they received a percentage score – 'fail', 'borderline pass' and 'good pass' - and their ranking within the cohort. Results: On average 65.15% of the candidates passed the exam. A binomial logistic regression was performed to investigate the effect of each group of stations on the probability of passing the OSCE. It was discovered that the group of stations that had the greatest impact on passing the OSCE was 'patient assessment'; a 1 percentage point increase in 'patient assessment' score increases the odds of passing the OSCE by 63%. Discussion: This study showed that a postgraduate OSCE was feasible and sustainable as an annual event. It allowed assessment of the same areas examined by traditional examinations (FRCS Plast) such as patient assessment and management. Additionally, the OSCE allows assessment of other domains including operative planning and operative skills using a full range of simulation models and patients of varying fidelity. Conclusion: This formative OSCE is a useful tool to evaluate the competence of plastic surgery trainees and prepare them towards postgraduate professional examinations. Having a standardised benchmark for a series of simulations is a constructive way of measuring competence.