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Milestones Time Zero! Using Orientation OSCEs to improve resident clinical skills & faculty educator skills Miriam Whiteley, MD Debbie Miller, MD,

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Presentation on theme: "Milestones Time Zero! Using Orientation OSCEs to improve resident clinical skills & faculty educator skills Miriam Whiteley, MD Debbie Miller, MD,"— Presentation transcript:

1 Milestones Time Zero! Using Orientation OSCEs to improve resident clinical skills & faculty educator skills Miriam Whiteley, MD Debbie Miller, MD, MS Janice Benson, MD Anne Viollt, MD Family Medicine Residency University of Chicago/NorthShore University Health System

2 Disclosures The presenters have nothing to disclose.
Thanks to University of Chicago Simulation Center & NorthShore Simulation Center!

3 Objectives/Agenda Review Orientation OSCE /milestones journey
Resident and Faculty perspectives Video example Share & compare best practices for OSCEs Evaluation? Learning experience, or both? How do you involve faculty? Discuss future directions- Q & A Share resources

4 University of Chicago NorthShore FMR
FMR intern picture here

5 Why OSCEs in Orientation?
Background: The OSCE has been used to reliably predict resident performance later in training, as well as to teach high stakes skills OSCEs for assessment of incoming residents (2011 & 2012) Beta test Family Medicine Milestones (2013) Gap analysis (2014) Need more observational data to provide fuller picture of incoming residents Time zero assessment (ACGME requirement to evaluate incoming residents.) Delayed feedback from residents (2014, 2015) To provide framework for early formative feedback to incoming residents A Core Competency–based Objective Structured Clinical Examination (OSCE) Can Predict Future Resident Performance. Joshua Wallenstein, MD, et al. Academic Medicine 2010;17: S67-71 Making the most of medical orientation; A new approach. Tailz J, Bydon M, Duffy D. Med Educ Online 2004;9:2. Available from

6 OSCE Template Breaking Bad News/Lung Cancer Communication Skills
Case PEx Skills Dx Skills Communication/ Cognitive Skills Teaching Activity (1 week prior in orientation) Milestone Chest Pain/Domestic Violence Lung ,CV exam Uncover Bruise on chest Intimate Partner Violence vs Angina vs Anxiety Empathy Evaluate Danger Safety Plan Provide Resources Intimate Partner Violence Workshop PC1.1.1 PC1.1.2 SBP4.1 C21.1,2,3 Antibiotics for URI/Negotiating Agenda N/A URI vs OM already established Negotiate De-escalate Deal w angry Pt Agenda setting Dealing w Angry pt PC1.1.1,2 Breaking Bad News/Lung Cancer Communication Skills SPIKES SPIKES workshop C2.1.1,2,3 C2.2.3 Tobacco Cessation Counseling HEENT/LUNGS exam Bronchitis Asthma Motivational Interviewing Eg smoking cessation MI workshop C2.2.1 C2.3.1,2 DM/HTN Depression CV, LUNGs, LE neuro exam Uncontrolled DM Anxiety Depression screen History taking Depression screen in primary care PC2.1 Back Pain Osteoporosis MSK exam Neuro exam Sciatica Vertebral fracture MSK back pain Knowledge of dermatomes MSK workshop C2.1.1 C2.1.3

7 Breaking Bad News case -Lung cancer FM Milestones chosen
C2 Communicates effectively with patients, families & the public C2.1.1,2,3 Recognizes that respectful communication is important to quality care Identifies physical, cultural, psychological, & social barriers to communication Uses the medical interview to establish rapport and facilitate patient-centered information exchange C2.2.3 Participates in end-of-life discussions and delivery of bad news

8 Resources Needed for OSCEs 6 cases for 6 interns
Simulation center/facility and SP trainers $2K-8K depending on #new cases & analysis Faculty coordinator time: 80+ hrs Faculty time-varies (per faculty) Case and evaluation tool prep: 2-20 hrs Didactic prep and Delivery didactic to interns: 4-8 hrs OSCE Day: 6 hrs Debrief time with interns: 1 hr Total approximately 80+ hrs for all 6 faculty

9 OSCE as Assessment and Formative Feedback
Breaking Bad News case description (developed at U of Chicago) 52 y/o man with cough sputum report indicates lung cancer Learner task-USE SPIKES model Setting, Perception of condition, Invitation to discuss, Knowledge, Explore emotions, Summarize Baile, W. et al. SPIKES – A six step protocol for delivering bad news: application to the patient with cancer. The Oncologist 2000; 5: Buckman, R. Breaking bad news: the S-P-I-K-E-S strategy. Community Oncology 2005; 2:

10 S.P.I.K.E.S. Breaking Bad News
SPIKES video review here

11 Resident Perspective Evaluation vs. learning experience
Overall impression: goal = assessment Taking evaluation off the table allows residents to relax, think more clearly and take away more from the overall experience Opportunity to practice common but difficult conversations Transition from medical student to resident Most helpful: breaking bad news, motivational interviewing, agenda setting

12 Resident Perspective (2)
Preparation: teach skills but not cases Over-prepared, takes away from learning Topics that are more helpful are more skill based Motivational interviewing SPIKES model for breaking bad news Feedback: reflection is helpful and formative Helpful to self-reflect Good insight from seasoned faculty Need more opportunities to reinforce this learning i.e. making videos available to watch and reflect at a later day, immediately repeating a case to apply and reinforce concepts that were learned

13 Feedback on OSCEs- Multiple types & times!
To Interns on day of OSCE SP ratings & narrative, immediate Faculty ratings with verbal feedback From Interns, day after Debriefing rating form/discussion with Beh Sci faculty To Interns, Post orientation 4 weeks “Milestones time zero” session w advisor & APD Includes OSCE plus other orientation observations, assessments Delayed feedback-9 months post OSCE day Interns –focus group by peer Faculty- rating form plus discussion

14 Feedback on OSCEs-Specific examples
To Interns on day of OSCE SP ratings & narrative, immediate Residents miss summarizing, but do well on most of 31 points Faculty rating with verbal feedback From Interns, day after OSCE Rate 4.75/5 (1=not useful, 5 = very useful) “I’ve never actually done this, so this was helpful” ”Made me realize how much practice I need” Faculty Delayed feedback-March 2016-rating & discussion 100% yes, it identifies residents in need of remediation “Should focus (more) on resident self-assessment & goal setting Suggest time for interns to RE-DO selected OSCE on same day Somewhat or completely satisfied with teaching case sessions, tool used for real-time faculty observations

15 Faculty Development activities 10 residency faculty-about 8 attend consistently
Monthly 90-minute sessions About 9 sessions in last 3 years Observation training Frame of Reference training (FORT) Performance Dimension Training (PDT) (see Holmboe book with DVD) Milestones discussions, review OSCE case review/prep Rating form revisions or creation Create didactic

16 Questions/Discussion
What simulation-based assessments or OSCEs do you do ? Entry R1s, end R1s, R2s, R3s… What are the strengths & weaknesses ? What changes are you considering? How do you involve faculty? What best practices have you found?

17 Best practices OSCEs Resources(See bibliography)
Reliable, reproducible assessments Use for high stakes evaluations Entry level Assess competence for independent, less onsite supervision Assess skills for graduation Use existing cases, borrow/adapt Find helpers in your academic institution BEME guides for simulations, case based learning

18 Summary 1 program’s OSCE /Milestones journey reviewed
Shared & compared best practices for OSCEs Evaluation or learning experience for residents? Faculty Development too? Brainstormed future directions More faculty development, more learner-centered Sharing resources

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