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Introduction Child neurology has unique challenges in communication due to complex disorders with a wide array of prognoses and treatments. Effective communication is teachable through deliberate practice and coaching. Objective structured clinical exams (OSCEs) are one method of providing practice while assessing communication skills. Yet OSCEs have not been reported for child neurology residents. Methods We developed simulated clinical cases centering on communication skills for child neurology residents, all with challenging clinical scenarios (e.g., disclosure of a medical error, psychogenic nonepileptic events). Standardized patients (SPs) portrayed the parents of pediatric patients and, in some scenarios, an adolescent patient. We used a modified Gap-Kalamazoo Communication Skills Assessment Form to assess communication skills. The assessment was completed by faculty, SPs, and the resident, and we measured agreement among raters. Residents were surveyed afterward regarding their experience. Results Nine cases were developed and piloted. A total of 27 unique resident-case encounters with 16 individual trainees occurred over three annual implementations. Scores on the 360-degree assessment of communication skills showed that residents overwhelmingly underassessed their skills compared to other rater groups. Among 18 responses on the post-OSCE survey, the majority (77%) found the experience useful to their education and felt that the feedback from the SPs was helpful (61%) and the case portrayals were realistic (89%). Discussion We implemented simulated cases for assessment and formative feedback on communication skills for child neurology residents. We provide a blueprint to develop this educational activity in other programs.

Introduction A vital element of health care practice is evidence-based medicine, the explicit and judicious use of current, best-available evidence in making decisions about the individualized care of patients. With the use of evidence-based medicine continually increasing in clinical practice, medical schools are charged with ensuring graduates are prepared to appropriately access, appraise, and utilize clinical evidence, highlighting the need for a corresponding assessment tool. However, assessing evidence-based practice remains a challenging endeavor for medical educators. Few assessment tools capture students' ability to apply information resources in order to answer a targeted question during a medical encounter. Methods We describe a triple-jump assessment design where students access evidence, appraise information at hand, and apply it to formulate a treatment plan during an observed structured clinical encounter (OSCE). Results One hundred and five clerkship students participated in one of two OSCE scenarios. Data from this exercise underwent descriptive statistical analysis, including mean performance scores and confidence scores, and showed that accuracy and confidence in providing evidence-based care improved after the search and appraisal period. Discussion The addition of a modified triple-jump assessment to the end of the OSCE experience not only creates a more authentic experience but also allows for assessment and development of student metacognitive skills within the domain of knowledge gap assessment. The ease of integrating this assessment into the structure of an already-developed OSCE allows for different types of assessment to be achieved without writing entirely new OSCE cases, but rather by modifying existing scenarios.

The use of standardized patients (SPs) in an objective structured clinical examination (OSCE) format is well documented as a successful means of training students in the basics of clinical skills since it provides a rehearsal for students to practice in a safe environment. These five neurological-based SP cases were developed at the Morehouse School of Medicine. They include cluster headache, multiple sclerosis, neurologic exam for preemployment, Parkinson disease, and lateral femoral cutaneous nerve entrapment. All five cases were constructed to be all summative, all formative, and/or a combination of both types of assessments depending on the availability of faculty preceptors for direct feedback. In addition, most cases were written such that slight modifications could easily accommodate an SP of the opposite gender. The Morehouse School of Medicine has used these neurology cases for over 2 years. The first year, the five neurology cases were used as a summative OSCE. The following years, we made two of the cases direct feedback for formative evaluation. The learners appreciated the direct feedback much more than a pure summative assessment. The limitation with having a formative was that faculty members had to be available at each OSCE in order to provide the direct feedback. Future plans include implementing evaluations to gather data demonstrating impact of the OSCE (i.e., if the learners' comfort levels have increased as pertains to the neurological exams). Also, OSCE evaluations from learners, SPs, and/or preceptors could help correct deficiencies in any portion of the process. We feel that the use of SPs in the OSCE setting has translated to increased diagnostic and physical examination acumen in real practice with neurological patients. However, this is our perception and is not yet supported by data.

Introduction At the Medical College of Wisconsin, geriatricians, nephrologists, and medical educators worked together to create and implement a geriatric nephrology objective structured clinical examination (OSCE) for nephrology fellows. Key curriculum content gaps (pathophysiology of the aging kidney, medication and renal dosing, and renal toxicity in elderly patients) were identified through a needs assessment including ACGME nephrology requirements, nephrology fellows' in-service exam scores, survey of fellows and faculty to identify areas of perceived weakness, literature review, and brief multiple-choice questions of basic science linked to clinical case questions. Methods Curriculum content was delivered using the OSCE educational method. The curriculum session highlighted kidney injury and pharmacology topics: drug toxicity and underlying science through an OSCE session with postsession debriefing provided by faculty. Fellows were evaluated by faculty using a checklist, and fellows evaluated the session prior to the end. Results The OSCE curriculum session (N = 6) showed strong learner evaluations (1 = poor, 7 = excellent), including “Session objectives were clearly stated and accomplished” = 6.8, “Feedback provided in debriefing will improve my ability to care for geriatric patients” = 5.8, and “Overall effectiveness of session in improving my ability to care for geriatric patients” = 6.5. Discussion Fellow performance from the OSCE rater checklists completed by faculty and standardized patients showed the fellows' extent of completion/inclusion of OSCE elements to range between 69% and 80% complete. The program director identified a discrepancy between fellows' knowledge and some communication skills in summarizing the information and providing closure to the session. The ability of the OSCE to provide direct observation of the fellows' performance was highly valued by the program director and has led to further adjustments in teaching and assessment over time.

Introduction Identification of incoming residents' unique strengths and weaknesses in a clinical setting is important for developing an individualized educational curriculum and addressing specific needs. This resource presents and describes materials for a clinical development program for first-year residents. Methods The program is structured around three educational elements: an entrance objective structured clinical examination (OSCE), an individualized learning plan (ILP), and peer clinical coaching. The included files that describe these three elements serve as a resource for residency directors and/or graduate medical education faculty interested in constructing a similar program. In the program, first-year OB-GYN residents participated in an entrance OSCE as a component of their orientation to residency. Their performance was evaluated through faculty and self-assessment tools and scored on a 9-point scale in accordance with the Accreditation Council for Graduate Medical Education's core competency scoring evaluation system. These evaluations were utilized in the creation of ILPs. Stated goals were translated into discrete learning objectives and then developed further through a learning strategy and time line using the SMART model. As a component of a research study, first-year residents were randomized into one of two groups: clinical coaching group or individual implementation group. Senior resident volunteers served as peer clinical coaches after participating in a 2-hour interactive workshop. The peer clinical coaches met with first-year residents on a monthly basis for 4 months to develop the resident's ILP. Exit questionnaires were completed at the conclusion of the yearlong program. Results Residents in both groups felt very positive about developing their ILPs, emphasizing that the program helped to map out their goals in preparation for midyear reviews. First-year residents in the clinical coaching group reported that the intervention improved their clinical experience. First-year residents who implemented the ILP alone indicated that their clinical experience was somewhat worse. Discussion The OSCE is a well-utilized tool for ensuring direct observation, evaluating clinical performance in a simulated environment, and providing timely feedback. Another potential application of the OSCE is to provide a baseline evaluation of clinical performance that may be used in determining a starting point for clinical competencies. Utilizing the feedback from the OSCE to create an ILP can translate valuable feedback into measurable objectives and competencies, while also providing a model for reassessment and follow-up.

Introduction This modified objective structured clinical exam (OSCE) is a medical knowledge assessment tool for pediatric residency training programs which can easily be implemented without the need for a simulation center, ancillary staff, or the use of expensive or technical equipment. The format is case-based, highlighting the importance of clinical application of theoretical knowledge. Methods This resource is administered over two afternoons, which allows half of our class to attend each session without significantly impacting coverage for clinical duties. A block of approximately 3 hours is needed, with 5 minutes allotted for each station. Each resident records his/her responses on the provided answer sheets. Two of the stations are interactive, with faculty or chief residents playing the role of parents and rating the residents on their interactions and knowledge. No other personnel are needed, and additional required supplies are minimal. Results Over 300 residents have completed the examination at our institution since its initiation. The annual average class score over the past 15 years of administration has ranged from 43 to 50 points (with a maximum allowable score of 65 for 13 stations). Discussion Given that the individual questions and their complexity have been modified every 2-3 years based on the program directors' evaluation of the material, it is impossible for us to compare individual years of data. However, residents who achieve low scores on the modified OSCE are encouraged to address their specific deficiencies with a more structured learning plan.

This Critical Synthesis Package contains: (1) a Critical Analysis of the psychometric properties and application to health sciences education for the Neurology Clerkship OSCE; and (2) a copy of the Neurology Clerkship OSCE instrument and case files developed by Angela Blood, MPH, MBA. The Neurology Clerkship OSCE is designed to assess the clinical skills of medical students at the end of a required 4-week neurology clerkship utilizing two 30-minute standardized patient (SP) encounters (selected from among four available cases) depicting common neurologic presentations. The score for each encounter is based on three checklists: two completed by the SP for expected elements related to history taking and the neurologic examination, and one completed by a faculty rater for expected elements in a post-encounter written formulation. Scores from each encounter are then averaged to derive an overall OSCE score. The Neurology Clerkship OSCE generates reliable assessments of medical student clinical performance that correlates with increasing clinical experience (based on clerkship order), better National Board of Medical Examiners standardized examination scores, and better categorical ratings by faculty on standard written assessment forms. Studies describe its use primarily for summative purposes (i.e., to determine clerkship grades), but the Neurology Clerkship OSCE could also be used for formative feedback or program evaluation. Studies designed to assess the reliability of the Neurology Clerkship OSCE for high-stakes assessments (e.g., using generalizability analysis) and that provide additional consequential validity evidence are needed. Studies are also needed to evaluate performance characteristics of the Neurology Clerkship OSCE among learners at different stages of training, from different health professions, in different settings, and at different time points during the academic year.

Introduction The objective structured clinical examination (OSCE) with standardized patients is commonly accepted as a reliable assessment of clinical skills. Simulation allows learners the opportunity to experience conditions and perform procedures in a safe, standardized environment. This OSCE case incorporates both the standardized patient and the high-fidelity simulator to depict a common acute clinical condition that requires emergent attention. Methods Students are presented with an asthmatic patient with shortness of breath. The patient is accompanied by a family member. The student must do a timely assessment of the situation and take corrective action. A patient care assistant/nurse is present to carry out treatment orders. The students must demonstrate competence in communication with the patient, family member, and patient care assistant. The student must recognize the acuity of the clinical presentation and apply appropriate treatment as the case evolves. Results The case was one of six cases in the multistation high-stakes OSCE given to students at the end of the third year of medical school. Students performed well on the case achieving an average score of 83% on the combined examiner and standardized patient checklists. Students rated the case difficulty as above average. Discussion Cases are typically written for standardized patients (SP) or for simulation. This case incorporates both SP and simulator in a more realistic way. The student is challenged to elicit history from the patient and the family member when the patient is incapable of speaking for himself. The student must recognize abnormal physical findings and aberrations of vital signs in order to make clinical decisions which will evolve and change with treatment; culminating in communicating a final disposition.

Introduction Neurology residents perform lumbar punctures (LPs) at least weekly on the inpatient services and regularly teach LP to rotating residents and medical students. To ensure there is explicit teaching and assessment of residency skills amidst reduced work hours, LP simulators are increasingly being utilized by residency programs. This station is part of a seven-station OSCE delivered to adult and pediatric neurology residents, but could be a stand-alone assessment. Methods The OSCE station uses a LP simulator and a standardized medical student. Resident OSCE station instructions, examiner questions and marking sheet, standardized medical student instructions, and instructor's guide are included. Formative feedback is given to examinees immediately by the examiner and standardized medical student and summative feedback is given to the residency programs. Results Residents provided immediate informal feedback of the station to the examiners during debriefing. Resident response was uniformly favorable, with many residents reporting it was fun and realistic. There were 25 senior neurology residents examined (PGY-3 to 5) from 3 universities. Using a pass threshold of 70%, 80% of residents passed the station. Resident scores ranged from 58% to 94% with a mean of 78% (SD 10%). Discussion LP and teaching skills are part of the national objectives of training for neurology in Canada, but direct supervision of resident's ability to teach LP during a clinical rotation is not always attainable, especially at night. The LP checklist was based current evidence and the teaching structure was based on a 1-minute preceptor. The LP Teaching Skills OSCE station has been used successfully assess pediatric and adult neurology resident knowledge of LP and the ability to teach the procedure to a medical student.

Introduction Stroke is a common cause of patient morbidity and mortality. Communicating its prognosis to family members, along with the establishment of goals of care, is a frequent task for neurologists and neurology residents. Given this, we felt it was an appropriate scenario from which to assess neurology resident medical expert and communication skills in an objective structured clinical examination (OSCE) setting. The OSCE station topic was created directly from objectives of training for neurology residents specified by the Royal College of Physicians and Surgeons of Canada. Methods This is a standardized case with an actor portraying a patient's relative. Residents are to give bad news of poor neurologic prognosis and establish goals of care for the patient. The case scenario, instructions to the examinee, and examiner marking sheet are included. Results The OSCE station was implemented with pediatric and adult senior neurology residents (PGY3-PGY5) from three universities. Of the 25 residents who experienced this case, 96% passed the station. Resident scores ranged from 60%-100%, with a mean of 86%. Discussion We consider the significance of the work to be the interpretation of a clinical scenario of poor neurologic prognosis of severe stroke and the communication of poor prognosis to a standardized family member with resultant establishment of code status, a task that is performed several times per week on the acute stroke service. This OSCE station is appropriate for neurology residents who participate in stroke care and will become neurologists who must communicate bad news on a daily basis.

Introduction These objective structured clinical examination (OSCE) cases were developed because we were unhappy with the current state of traditional radiology clerkship multiple-choice exams. The goal was to be able to use a more objective measure for evaluation of students on the radiology rotation. One of the critical educational objectives is for students in the radiology clerkship to become more familiar with radiology reports. As most students will not become radiologists, this experience will allow future ease of incorporating information from radiology reports into their patient's care. These cases have been developed with joint involvement of multiple members of the radiology faculty including the current clerkship coordinator, as well as the vice chair of education in radiology who has over 25 years of experience in medical student and resident education. Methods These nine OSCE cases each involve a short clinical scenario and a radiologic exam with an associated grading sheet. Each OSCE case has five open-ended questions designed to simulate a radiologic report. Each case also has a specific checklist for which points can be assigned to each correct answer. Each case attempts to assess whether students can understand straightforward radiology cases and essentially answer questions analogous to the different sections of the radiology report, including pertinent history, positive and negative findings, differential diagnosis, and recommendations. Results These OSCE cases have been used at the Boston University School of Medicine for research purposes and will now be part of the formal evaluation system Discussion These cases improved medical student evaluation in the radiology clerkship so that we could rely less on multiple-choice exams. These OSCE cases not only allowed us to test basic radiologic knowledge, but allowed us to give more specific formative feedback for students. This is important because the radiology clerkship tends to be more of a combination of didactic lectures and an observership, and students do not get the chance to show us what they know. We have been giving one case every week to students in the clerkship. As noted in many other OSCE write ups, these cases can be adapted to be used at many educational levels.

The objective structured clinical examination (OSCE) has proven to be a reliable and valid modality to assess the Accreditation Council for Graduate Medical Education (ACGME) Core Competencies of Interpersonal and Communication Skills as well as the ACGME Core Competency of Professionalism. This resource is a three-station OSCE used at the University of Pittsburgh Medical Center to evaluate the ability of general surgery residents to have “difficult conversations” with patients and patient family members in three unique cases. The resource has the case information, checklists for standardized patient feedback, and forms for self-evaluation by general surgery residents. Standardized patients should be professionally trained in delivering the case, and providing feedback based on the checklist. After rotating through all three cases and completing the self-evaluations, learners meet in the debriefing room to discuss the cases with a surgical faculty member in a nonstructured forum. This work is significant in that it directly addresses the ACGME Core Competency of Interpersonal and Communication Skills and the ACGME Core Competency of Professionalism. Currently, this resource is used only for formative feedback and not summative evaluations. Expansion to include other “difficult conversation” topics is an area we hope to explore with the results of resident performance. We are currently prospectively evaluating this curriculum, evaluating resident performance after implementation of didactic and skills-based content to the weekly curriculum for general surgery residents.

Introduction Objective structured clinical examinations (OSCEs) have traditionally been used by medical schools and residency training programs to assess baseline knowledge. Our objective was to create a medical knowledge assessment tool for pediatric residency training programs which could be easily implemented without the need for a simulation center, ancillary staff, or the use of expensive or technical equipment. Methods Our modified OSCE can be used to assess medical knowledge and clinical competence in a group of trainees. The format is case-based, highlighting the importance of clinical application of theoretical knowledge. A block of approximately 3 hours is needed, with 5 minutes allotted for each station. At the end of the session, all the forms are collected and the program director then spends approximately 90 minutes reviewing each scenario in detail with the entire group. Results Over 300 residents have completed the examination at our institution since the initiation of this educational tool. The annual average class score over the past 15 years of administration has ranged from 50–58 points (with a maximum allowable score of 75). Given that the individual questions and their complexity have been modified every 2–3 years based on the program directors' evaluation of the material, it is impossible for us to compare individual years of data. Discussion We have noted no correlation between individual scores and subsequent performance on standardized examinations; this could due to the differences in format of the exams (case-based written responses versus multiple-choice options). Of interest, anonymous surveys of residents after the exams have repeatedly stated that the experience has been extremely educational and the subsequent discussions foster a positive learning environment.

Introduction The Gina Babkins case was developed at the University of Medicine and Dentistry of New Jersey's–School of Osteopathic Medicine (UMDNJ-SOM) as one of eight stations in the objective structured clinical examination (OSCE) for third-year medical students, during their geriatric clerkship rotation. The OSCE takes place in the final days of the clerkship, and counts towards a third of their final geriatric clerkship grade. Methods Successful execution of the standardized patient (SP) role required the SP to study and commit to memory the details of the patient's life and illness complaint. SPs were required to attend training sessions on a regular basis to ensure validity and reliability in case performance. The standardized patient playing Gina Babkins portrayed herself as a 75-year-old woman who presented to the outpatient office with a complaint of lightheadedness. She asked to be seen prior to her scheduled appointment because she was concerned about her lightheadedness. The examinee's task was to obtain a focused history, perform a focused physical examination, and counsel the patient regarding her situation. Following the encounter, the examinee documents the encounter in a subjective, objective, assessment and planning (SOAP)-style patient note. Results The case was used in both the 2010 and 2011 OSCE for third-year medical students, during their geriatric clerkship rotation at UMDNJ-SOM. In both OSCEs, no major pitfalls were reported. Discussion The purpose of the Gina Babkins encounter is to challenge students to manage a common geriatric presentation as part of an eight-station OSCE for third-year medical students completing a geriatric clerkship. Some helpful suggestions when carrying out this case are to make sure the SP has been trained well, has memorized their role, and that practice runs are conducted multiple times prior to the beginning of the usage of the case.

Introduction This objective structured clinical examination (OSCE) involves a 5-minute patient encounter that aims to assess a trainees' basic resuscitation skills in responding to a patient with an un-witnessed collapse in an outpatient clinic setting. The target audience includes preclinical medical students, nursing students, junior resident physicians, and other trainees who have gone through first-responder and basic life support training. Methods The case involved a patient presenting to an outpatient clinic complaining of vague chest pain who collapsed while waiting to see the physician. The encounter began with the student entering the office and a “friend” (a standardized patient) informing him/her of the situation. The patient, “Mona,” was a mannequin on the ground. The student was expected to perform several critical actions, including assessing Mona's responsiveness, checking for a pulse, initiating and continuing chest compressions and mouth-to-mouth ventilation, calling for Emergency Medical Services (EMS) and an automated external defibrillator (AED), and communicating with EMS personnel. Timed cues are incorporated to provide a more structured flow to the case. Results The OSCE at our institution was run at the Clinical Skills Center in the spring of 2012 (n = 43) and 2013 (n = 38), with all first-year students participating. It was successful in assessing student performance of the critical actions, and highlighting areas that required emphasis and review. We found that students had the most difficulty remembering to check for a pulse prior to starting chest compressions (only 51.2% did this), open the airway using a jaw thrust (2.2%) rather than a head-tilt/chin-lift maneuver (74.4%), calling for an AED (37.2%), and the ratio of chest compressions to ventilations. Only 34.9% performed the correct number of chest compressions, while only 27.9% gave at least two breaths per cycle. Discussion The OSCE was meant to be formative for the students and to provide feedback on the course's efficacy for the course directors. The OSCE grade did not contribute to the students' overall medical school grades, although our OSCE checklist can easily be used as a grading tool as well.

Introduction The purpose of the Mary Smith encounter is to challenge students to manage a common geriatric presentation as part of an eight-station objective structured clinical examination (OSCE) for third-year medical students completing a geriatric clerkship. Students conduct a focused history to assess the patient's diabetes and counsel as needed. The educational objectives of the encounter are to assess students' abilities to address noncompliance with a diabetes self-care regimen, effectively counsel a patient on a diabetes self-care regimen, and make appropriate referrals for diabetes management. Methods The standardized patient (SP) portrays Mary Smith, a 70-year-old woman presenting to the outpatient office after her daughter has urged her to see a doctor for her diabetes. The examinee's task is to obtain a focused history and counsel the patient regarding her situation. The SP encounter is limited to 15 minutes in the actual exam room. Following the encounter, the examinee has 10 minutes to document the encounter in a SOAP-style patient note. The submission includes six case-specific documents, an instructor's guide, and an introduction to the case. Results This case was used in both the 2010 and 2011 OSCEs for 300 third-year students. No major pitfalls were reported. The case's Angoff cut score (derived from a panel of experts coming together to decide what score constitutes minimal competence) was set at 52. The overall mean (SD) for the case was 66 (11), with 92% of students scoring above the Angoff cut score. Discussion Both the faculty and the SP actors commented about the importance of this case in training and consistently reinforcing best practices for treating the geriatric diabetic patient. When carrying out the case, make sure that the SP has been trained well and has memorized the role and that practice runs are conducted multiple times prior to the beginning of the usage of the case. The case has many subtle nuisances that are very important to the delivery of the learning objectives.

This resource is a 15-minute objective structured clinical examination (OSCE) where examinee take a detailed headache history from a standardized patient, generate an initial differential diagnosis, request and interpret diagnostic tests, and defend the final diagnosis. Criteria for passing and a grading system have been established. Remediation plans are prescribed, depending on the type of error made by the examinee. The tool has content validity, as it has been developed by a neurologist and reviewed by four additional content experts. It has face validity, based on a small survey of third-year medical students. It has been administered by four different faculty members, in addition to the principal investigator. The instructions are clear and the tool is easy to use.

Medical curricula has increasingly highlighted the important of assessing medical error disclosure skills of residents. This resource is a standardized patient case used in an objective structured clinical exam (OSCE) station to assess the communication skills of family medicine residents when disclosing a medical error to a patient. It was developed to be used with a standardized patient and an examiner. The case scenario and examiner checklist are included. The residents gave excellent verbal feedback on the importance of this OSCE station in medical error disclosure. They were also satisfied with the standardized patients. Almost all of them were impressed with his skills and his ability to portray realism. The OSCE was videotaped and was evaluated by two faculty members with an interraterreliability of 0.816.

Recognizing that all primary care doctors, as well as many specialty practitioners, deliver the news of unplanned pregnancy to their patients, the ninth edition of APGO Medical Student Educational Objectives specifies that third-year medical students should attain a “does” level of competency for pregnancy options counseling. Methods of evaluation include standardized patients (SPs), direct observation, and simulation. We could not identify any published SP for evaluation of options counseling skills, so we developed a resource with feedback from colleagues nationwide with extensive experience in family planning education of both medical students and residents. This resource consists of two fully written and developed SPs, the first being married woman in her early 20s and the second an unmarried woman in her late 30s, presenting to an urgent care center with vague gastrointestinal complaints. Both SPs are diagnosed with unexpected early intrauterine pregnancy. Students are tasked with delivering the news of pregnancy after receiving a sign-out with the medical history, physical, and test results, and dispositioning the patient. The patient challenges the student with silence, ambivalence, and the questions, “What should I do?” and “What would you do?” The resource was used to assess the skills of 104 third-year medical students in an obstetrics and gynecology clerkship at the University of Miami Miller School of Medicine. Student responses in a postworkshop survey included the following results related specifically to this resource. Of the 104 students in the clerkship, 98% felt the SP scenario “came across as realistic and believable.” Ninety-six percent thought the instructions they were given “were sufficient to complete the interaction, including disclosing pregnancy results and discussing options with the patient.” One hundred percent agreed that the medical information in the SP scenario instructions “was sufficient to handle the interaction with the assumed diagnosis of pregnancy.” Eighty-eight percent felt that participating in the SP scenario “increased comfort with my skills in nondirective options counseling,” while 80% believed it “increased my moral comfort with nondirective options counseling.”

Introduction This objective structured clinical examination (OSCE) case was created for use with standardized patients (SPs), for teaching and/or evaluation purposes. Methods The case follows Dana Jones, a new patient coming in for a work physical. S/he is about to start working as a substitute teacher for the local school district, teaching middle school math and science. Dana's only complaint is that s/he recently started to miss hearing the doorbell and sometimes does not hear the phone ringing. Recommended length of the session is 15–45 minutes for the learner in the patient room, 10 minutes for the patient note (if required), and at least 30 minutes for debriefing with the faculty observer (for teaching purposes only). Results The case has been successfully implemented with 40 MS 1 students at the Texas Tech University Health Sciences Center Paul L. Foster School of Medicine. Interrater reliability was assessed on a continuous basis and, for 20 consecutive cases, was above 80%. Additionally, a case study was completed to review the interrater reliability between SPs and faculty observers in a multiple-station high-stakes OSCE examination; results indicated faculty and SPs matched in scoring. Discussion The case is intended for teaching/examination of medical students in years 1–4 (depending on a medical school's type of curriculum). The case could also be used for resident entry-level testing and faculty development in teaching.

Introduction This objective structured clinical examination (OSCE) case was created for use with standardized patients (SPs), for teaching and/or evaluation purposes. The case is intended for teaching/examination of medical students, years 1 through 4 (depending on medical school's type of curriculum), as well as residents and faculty development. Methods The case follows that of 61-year-old Alex Corason, who comes in for a scheduled annual physical exam. The resource file contains information necessary for training SPs, presented in a table format. It describes the case, and the way it was used/validated. It also contains SP training notes and additional details. A heart sounds simulator will be necessary to implement the case. The recommended length of the teaching session is 1 hour and 15 minutes. Results The case has been successfully implemented with students at the Paul L. Foster School of Medicine at Texas Tech University Health Sciences Center El Paso. Discussion The notion of training SPs in the context of a role, rather than for specific interrogative props is gaining momentum across the nation and is considered a possibility for SP training for the USMLE Step 2 CS examination.

At Penn State University, we have developed an objective structured clinical examination (OSCE) for our pain fellows. The course is designed to provide a standardized assessment tool for the fellows and is administered twice per academic year. The first case is somewhat more straightforward, where as the second is designed to require a higher level of function. Each case is divided into two sections. The first is the “History and Physical” component for which we use a standardized patient/actor. The second is the “Procedural Skills” component, for which a phantom spine/mannequin is used and an actor, in our case one of the attending physicians, plays the voice of the patient. There is an evaluation form for each component, and a postcourse survey. The cases provide an objective and standardized means of assessing our pain fellows with regards to their ability to acquire a history, perform an appropriate physical exam, develop a differential diagnosis, develop an evaluation plan, develop a treatment plan, and perform an interventional spine injection.

As the burden of unintended pregnancy and abortion in the United States now falls disproportionately to poor and uninsured women, appropriate contraceptive counseling requires strong limited health literacy communication skills. This standardized patient case was developed to assess patient-centered counseling skills for long acting reversible contraceptive (LARC) methods, low health literacy communication skills, and appropriate use of the Medical Eligibility Criteria for Contraceptive Use. The patient is a 27-year-old woman who underwent suction curettage for an incomplete abortion 2 weeks earlier in the emergency room and presents for a routine postoperative visit. The student assumes her care from an attending or resident who has already examined the patient and found her without complications, but has not yet determined possible contraceptive needs. All reviewers found the standardized patient realistic and appropriately detailed. Their recommended changes were for greater detail in risks, benefits, and efficacy for the methods and reassignment of some competencies to a higher trainee level.

Our anesthesiology department has instituted an elective advanced difficult airway curriculum for the third-year clinical anesthesiology resident. One of the metrics that is used for assessment of this rotation is the objective structured clinical examination (OSCE). Using the Difficult Airway Algorithm as a guide, three clinical skill sets and one multiple-choice question set were utilized as OSCE stations. The rotation is a multi-modal program that consists of computer and partial task simulation, web-based didactics, problem-based learning discussions and intraoperative experience. The skills tested include fiberoptic bronchoscopy, fiberoptic-guided supraglottic ETT exchange, and cricothyrotomy. The OSCE has been effective in identifying that residents are competent in airway management skills as well as those residents that may benefit from continued advanced airway management training.

Introduction In attempt to reinforce skills that are necessary and relevant to the practice of geriatric medicine, we designed this 22-station objective structured clinical examination (OSCE) for first-year geriatric medicine fellows. It is designed to assess competency in common geriatric assessment tools and interactions, as well as in interpersonal and communication skills and clinical reasoning in common geriatric syndromes. Methods Intended as a formative assessment tool, this OSCE utilizes real clinical situations, standardized patient encounters, and computer-based clinical vignettes. Scores are pass/fail, and two independent geriatric medicine attendings use a standardized checklist to score each fellow's performance. Fellows also complete a self-evaluation using the same checklist. Formative feedback and remediation takes place for all failed stations. This facilitator's manual presents the procedures to implement the OSCE as well as the resources required, guidelines for assessment, and lessons learned from our 2-year experience. Results Regarding the effectiveness of the OSCE experience, our fellows reported that the exam was well-organized, fair, and had a good balance of cases. In general, they believed they learned a great deal from participating in the OSCE and considered it a worthwhile and valuable exercise (especially the feedback and remediation sessions). They felt the OSCE tested skills relevant to geriatrics that they will incorporate into their future practices. Discussion Given that there are no specific, defined learning outcomes for geriatric fellowship programs, the educational experience varies among institutions. Some fellowships stress palliative medicine, for example, whereas others offer more exposure to inpatient-geriatric medicine consult services. The competencies covered in the OSCE comprise the minimum skills we feel graduating fellows should possess. When used as a formative assessment tool, the OSCE could serve to standardize the educational experience across various institutions.

This objective structured clinical examination (OSCE) station was developed to evaluate the motivational interviewing and counseling skills of medical students at the end of the third year. It assesses the skills recommended in the US Public Health Service guidelines for treating tobacco dependence and includes instructions for students, standardized patients (SPs), and evaluators. Tobacco dependence is the number one preventable cause of death, killing half of its continuing users. Based on the chronic care model, the US Public Health Service published detailed, evidence-based guidelines (the “5 A's”) for physician intervention, updated in 2008. This OSCE station provides the opportunity to evaluate the knowledge, attitudes, and skills required to implement these guidelines. This module requires a SP and observer to evaluate students. Fifteen minutes is required per student for testing and evaluation. Patients and observers should not prompt students beyond instructions provided. Both patients and evaluators should be trained to promote consistency.

In this 10-minute objective structured clinical exam (OSCE), the student is required to demonstrate ability to review a pediatric patient chart showing past visits, phone calls, labs, and hospitalizations. The student is first provided with a simulated patient chart for review and instructed that 5 minutes will be allowed for the chart review, after which the student will present to an attending physician. Following the brief chart review, the student is expected to present the case, highlighting historical elements of importance. Checklist items are scored according to these key items in the history along with presentation skills.

This resource is an objective structured clinical examination (OSCE) designed for fourth-year medical students. The aim of this exam is to assess the bedside skills of students in history taking and physical examination. Checklists were designed for eight history stations and 15 physical exam stations in internal medicine. Every expected action from students was put in these checklists with a corresponding mark. The examiner has to indicate either true, prompted, or false for each action based on the performance of the student. Note that the term “prompted” should be ticked when a student needed a hint or a clue to answer correctly. There is a space for comments on each action. Each student should be examined in five stations; three physical exam and two history taking. Each station is 10 minutes long. The exam is designed in blocks with three examiners for each block. Some examiners may not stick to the checklist and go beyond. They have to understand that this is prohibited. Some mark distribution was adjusted based on comments from examiners. The guidelines should be distributed in the first day of the course. A special meeting with all examiners should be arranged and a comprehensive description of the exam and how to use the checklists should be done. This preferably should be conducted a day or two before the exam. It is recommended to have a special computer program for immediate scoring of the results. A minimum of two persons should be available to help in organizing the flow of students during the examination.