1. Using an ‘Oral Board’ exam to assess for EPA 10 in
the Emergency Medicine Rotation
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G Carmelli MD, R Sinert DO, L Fan MD
Department of Emergency Medicine at SUNY Downstate Medical Center and Kings County Hospital Center
INTRODUCTION
RESULTS (DATA)
Impact
BACKGROUND:
The Association of American Medical College (AAMC) encourages medical schools to use 13 Entrustable Professional Activities (EPAs) as a framework for assessing student preparedness for residency.
The Emergency Medicine clerkship provides an appropriate clinical setting to observe, practice and therefore assess EPA 10:
“recognize a patient requiring urgent or emergent care and initiate evaluation and management.”
This important skill is one in which many medical students have shown difficulty with.
Medical schools use various techniques to evaluate for EPA 10, some using simulation, while others using an Objective Structured Clinical Exam (OSCE).
The ‘oral board’ exam is used by the American Board of Emergency Medicine (ABEM) to certify practitioners as competent in all aspects of EM care.
Oral exams have been studied in other specialties, but haven’t been studied in EM medical students or in evaluating for EPA 10.
OBJECTIVE:
Develop an assessment tool to evaluate students in EPA 10.
Design case scenarios to evaluate student performance in identifying critical actions for assessing emergent conditions.
RESEARCH QUESTION
Do the oral exams evaluate different or redundant variables to that of the medical students’ clinical scores or their NBME shelf exam scores?
NULL HYPOTHESIS
There is no difference between the oral exam scores and that of the clinical scores and the NBME shelf scores
SUBJECT SELECTION
We looked at all medical students (N = 233) who rotated in the Emergency Department between the time period of April 2016-October 2017, who had recorded scores for the oral exams, clinical scores and the NBME shelf exam.
MEASUREMENT TOOL
We calculated a Spearman Rank Order Correlation to see if the plots for the oral exams correlated with that of either the clinical scores of the NBME shelf exam scores.
RESULTS
Comparing the oral exam to the NBME shelf exam produced a p-value of 0.558, so the correlation was not statistically significant.
Examining the oral exam to the clinical scores produced a p-value of 0.457, also not statistically significant.
Curricular Design
We use an oral exam to assess EPA 10 during our EM rotation.
We created the following 3 case scenarios, which were administered by faculty and/or selected senior residents:
Trauma with pneumothorax and intraperitoneal bleeding
Chest pain secondary to a pulmonary embolism
Altered mental status with UTI/sepsis
All cases were scored for assessing the ABC’s, initiating correct treatment, obtaining help and communicating with consults.
CONCLUSION
In this retrospective study, there was no statistically significant correlation between a student’s oral and NBME shelf exams, nor with their oral exams and clinical scores.
This suggests that the oral exam is an evaluation tool assessing unique metrics to that of the NBME shelf and clinical scores, and may be a useful tool in evaluating for EPA 10.