1. Introduction The importance of shared decision-making (SDM) in medical care is the hallmark of providing individualized, patient-centered care SDM is taught and referenced throughout the literature yet there is a lack of published data on how to best evaluate such skills We developed an Observed Structured Clinical Exam (OSCE) to evaluate our PGY3 Family Medicine residents in the ability to define a clinical question, research it, and perform SDM in a brief clinical encounter Curriculum Patient-Centered Communication (PCC) Skills: OARS (Open-ended questions, Affirmations, Reflective listening, and Summarization), asking permission, and patient agenda-setting skills Evidence Based Medicine/Information Mastery (EBM/IM) Skills: Searching the literature, statistics for clinical practice, patient-oriented evidence that matters, developing a PICO (Population, Intervention, Comparison, Outcome) clinical question Competencies evaluated included: Patient Care, Communication, Problem Based Learning and Improvement, Professionalism Demonstration of Level 2-4 Milestones Behaviors Methods OSCE scenarios were developed that measured an ability to utilize skills in evaluating information for preventive guidelines including screening as well as common clinical scenarios for treatment in daily practice. Example scenarios include: Osteoporosis screening Hyperlipidemia treatment Lung cancer screening Teaching faculty all have advanced training in communication skills and evidence-based medicine, and are interdepartmental (Family Medicine and Library Science) Standardized Patients (SP) go through a brief training process Evaluators of learners include faculty and SPs to allow for evaluation of competencies in patient-centeredness and EBM Learners must complete two OSCEs, each under 10 minutes duration in the presence of a faculty member, and demonstrate competency in PCC & IM techniques Residents were given brief formative feedback on their performance after each OSCE in the second year OSCEs were revised following each session, increasing the granularity of questions 4 & 5 on Faculty Evaluations Results Residents regularly demonstrated PCC, IM skills by achieving 70% or greater on evaluation questions Residents had the most difficulty with SDM, in ‘teach back’ technique such as Ask-Tell-Ask: 2015: Residents demonstrated 33% for all 3 questions 2016: 18% for all 3, with ≤50% for each sub- question This demonstrates that SDM can be performed in a brief encounter with real world scenarios Limitations/Future Considerations This was not a randomized trial, and we lack a comparison group This OSCE has only been performed at one site Our institution has a dedicated team and financial support for SPs, faculty time and support for our simulation center 4 faculty observers and 4 SPs were required for each 4 hour of direct observation It is uncertain if this translates into real-world data especially given the paucity of trained faculty/community physicians in these skill sets Future OSCEs for training medical students in this field are in development within our institution Long term data on providers could be collected for retention of these skills, but would be difficult to achieve after graduation Continued modification of evaluation are in progress Acknowledgments Nancy Adams, MLIS, Amy Knehans, MLIS, AHIP Observed Structured Clinical Exam in Shared Decision Making Jay Zimmermann, M.D., David Richard, M.D., FAAFP, Todd Felix M.D., F. Samuel Faber M.D., FAAFP Penn State College of Medicine, Hershey, PA jzimmermann@hmc.psu.edu Example SP Evaluation Questions: Question 1 Did the resident introduce herself/himself to the patient and approach the encounter professionally? Question 2 Did the resident turn the computer to you to look up information together or show the results of the search to you? Question 3Did the resident discuss the harms of testing/ treatment? Question 4Did the resident discuss the benefits of testing/treatment? Question 5Did you feel you shared the role in decision- making? Question 6 Were you given the opportunity or encouraged to ask questions and discuss the information presented in a shared decision-making format? Question 7 Did the student present the information in a way which was understandable to you as the patient (or did they rely on medical jargon without asking if you understood)? Example Faculty Evaluation Questions: Question 1 Was the resident able to develop a clinical question to search at the time of the SP interview? Question 2 Did the source(s) allow for an up-to-date, best evidence answer to the question (evidence-based source/review versus expert opinion)? Question 3 Was an answer acquired in an efficient manner, (under 3 minutes) ? Question 4 Did the resident present and discuss the findings with the patient in a patient-centered format (Sub- questions: Asking permission, Open-ended questions, Summarization techniques) to allow for shared decision-making? Question 5 Was the patient encouraged to ask questions and discuss the information at hand to assure that shared decision-making occurred? (Did a ‘teach back’ occur?) Discussion Evaluation of competencies expected for future patient care is complex, but an achievable exercise for residency training programs This OSCE maps to higher level ACGME milestones for Family Medicine residents, and was used for CCC reporting To train a future generation of physicians capable of providing true SDM for ideal individualized patient care, we need to interweave clinical expertise with two aspects of care Information Mastery PCC skills This data has correlated with Physician Assistant student OSCEs at our site