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Volume 7, Issue 5 , Pages 509-514, May 2009

Teaching the Competencies: Using Objective Structured Clinical Encounters for Gastroenterology Fellows

Bani Chander
- Division of General Internal Medicine, NYU School of Medicine, New York, New York
Robert Kule
- Division of General Internal Medicine, NYU School of Medicine, New York, New York
Peter Baiocco
- Division of Gastroenterology, Lenox Hill Hospital, New York, New York
Sita Chokhavatia
- Division of Gastroenterology, Mt. Sinai School of Medicine, New York, New York
Don Kotler
- Division of Gastroenterology, St. Luke's-Roosevelt Hospital Center, New York, New York
Michael Poles
- Division of Gastroenterology, VA New York Harbor Healthcare System and NYU School of Medicine, New York, New York
Sondra Zabar
- Division of General Internal Medicine, NYU School of Medicine, New York, New York
Colleen Gillespie
- Division of General Internal Medicine, NYU School of Medicine, New York, New York
Tavinder Ark
- Division of General Internal Medicine, NYU School of Medicine, New York, New York
Elizabeth Weinshel
- Division of Gastroenterology, VA New York Harbor Healthcare System and NYU School of Medicine, New York, New York
- Reprint requests Address requests for reprints to: Elizabeth Weinshel, MD, Division of Gastroenterology (111D), VA New York Harbor Healthcare System, 423 East 23rd Street, New York, NY 10010. fax: (212) 951-3481

published online 12 November 2008.

Background Aims

Objective structured clinical encounters (OSCEs) are used widely to educate and assess the competence of medical students and residents; they generally are absent from fellowship training. The Accreditation Council for Graduate Education has cited OSCEs as a best practice for assessing the 6 core competencies. This article reports on the use of an OSCE to assess the competence of second-year gastroenterology fellows in the difficult-to-assess core competencies: interpersonal and communication skills and professionalism.

Methods

We developed a 4-station, faculty-observed OSCE with 4 standardized patients. Information gathering, relationship development, patient education, and counseling skills were assessed. Professionalism skills assessed included obtaining informed consent, delivering bad news, managing difficult situations, and showing interdisciplinary respect. In each station, faculty and standardized patients completed an 18- to 24-item checklist evaluating fellows' performance and provided feedback to the fellows. Nine fellows and 5 faculty from 4 gastroenterology training programs in NYC participated.

Results

Fellows and faculty generally highly rated the realism of the OSCE and favorably rated the OSCE for its difficulty and their overall experience. Across all cases, fellows were rated as receiving “well dones” for 56.4% of the communication items (SD, 18.3%) and for 79.1% of the professionalism items (SD, 16.4%).

Conclusions

Integrating OSCEs into gastroenterology fellowship training may help enhance communication skills and prepare fellows for dealing with difficult clinical situations and provides mechanisms for constructive feedback. OSCEs developed collaboratively can assist in program self-evaluation and reduce costs by sharing resources, in addition to fulfilling Accreditation Council for Graduate Education mandates.

Abbreviations used in this paper: ACGME, Accreditation Council for Graduate Education, GI, gastroenterology, OSCE, objective structured clinical encounter, SP, standardized patient