Evaluating Interns in a New Residency Program – Using a July OSCE Paul Gordon, MD, MPH Tejal Parikh, MD Vic Weaver, MD Julia Hardeman, MD

Background Information n What’s an OSCE? n What’s an intern OSCE? n Has it been done before? n Why design and put on an intern OSCE?

Steps to Design Intern OSCE n Meet with PD n Meet with Residency Faculty n Propose a list of cases covering variety of problems n Residency Faculty & PD rank order the list n OSCE Director designs cases

Our Cases n Delivering Bad News n Abdominal Pain n Acute Back Injury – drug seeking n Depression n Shortness of Breath n Well woman exam n Febrile infant telephone call from mom n Multiple Complaints

Our Intern OSCE n 8 cases n 8 faculty observers (logistics challenging) n Each faculty members observes all 8 interns on same case n 15 minutes with SP n 15 minutes with faculty observer n All cases were videotaped n Cost ~$6000

Faculty Expectations of OSCE n Provide formative feedback n Identify sub-par interns n Prevent patient harm n Prevent intern attrition n Get to know interns

Delivering Bad News You are working on the inpatient team. You just transported Christopher to the ICU after he became unresponsive during a CT scan. He had been referred for work-up of persistent lymphadenopathy with concerns for lymphoma. He was undergoing a chest CT scan when he coded, potentially due to an allergic reaction. He was resuscitated and currently is intubated on the respirator and sedated. Likelihood of complete recovery is unknown. The resident has asked you to speak with the patient’s mother, Carolyn Pierce who is in the ICU waiting room, to explain what happened. There is no physical exam to perform.

Acute Back Injury – Drug Seeking You are working in the Family Practice Office. The patient is complaining of unbearable back pain. Vital Signs: Temperature:37 C Pulse:76/minute Respirations:16/minute Blood Pressure:138/84 mm Hg Perform a focused history and physical exam. Explain your initial thoughts regarding assessment and plans to the patient.

OSCE Review at 9 Months n Paired 1:1 with faculty advisor n Questions for interns: –How have you changed because of OSCE? –What patients are scary or tough to handle? –What problems have or haven’t you overcome?

Cases residents felt most helpful n #1 Well woman exam n #2 Delivering bad news n #3 Multiple complaints n #4 Depression n #5 Acute Back Injury – drug seeking

Examples of resident feedback n Getting shadowed in clinic is preferable n Separate session for well-woman exam n Helpful to see strengths/weaknesses of interview style n Helpful to see need to focus encounter n Saw need to let patient talk more n Avoiding doubling up questions

Other ideas from the literature n Foreign language or culturally different patient n Standardized nurse call n Write orders, request labs n Encounter evolves to ACLS activity n Add EKG’s, CXR’s, lab results n Skills demonstration n Grade by ACGME competencies n EBM/information mastery station

Faculty Expectations of OSCE: Were they met? n Provide formative feedback n Identify sub-par interns n Prevent patient harm n Prevent intern attrition n Get to know interns