Fully Integrating Objective Standardized Clinical Exams (OSCEs) and Standardized Patients in Plastic Surgery Residency Education
Eric J. Wright, MD, Gordon K. Lee, MD.
Division of Plastic Surgery, Stanford University, Palo Alto, CA, USA.
Objective structured clinical exams (OSCEs) have been shown to be a validated method for medical education. They are a mandatory component of USMLE 2, and can teach and assess all six ACGME core competencies. Given the ongoing demand to obtain additional metrics for resident evaluation and feedback, our plastic surgery residency program has conducted OSCEs as part of further resident evaluation. This study reviews our comprehensive experience with OSCEs, as we believe it should be considered an integral component of plastic surgery resident training.
Five separate OSCEs were developed by the faculty and administered to plastic surgery residents using validated methods utilized at our medical school. The OSCE scenarios were (1) general plastic surgery-melanoma, (2) microsurgery-mandibular reconstruction with fibular graft, (3) hand surgery-cubital tunnel syndrome, (4) pediatric craniofacial surgery-cleft lip and (5) cosmetic surgery-rhinoplasty. All OSCEs were digitally recorded, reviewed and scored by faculty for evaluation. Material provided for evaluation was based upon scenario specific tasks and general items such as review of standardized patient feedback, knowledge-based exam scores, review of billing and OR scheduling to give standardized scores for each of the ACGME six core competencies. Each OSCE required training for the standardized patient actors and involvement of a coordinator to ensure the developed scenarios were thorough and conducted based upon validated methods. The cost of conducting the examinations was averaged.
The OSCEs were administered over the course of five years. Based upon early poor performance scores for CPT coding, surgical scheduling and billing (Systems-Based Practice), resident lectures were instituted within the curriculum, which lead to a score of 100% for residents on the most recent OSCE, up from the initial 65% score. Medical knowledge scores continually were higher with increasing residency level. Residents’ feedback unanimously confirmed the realistic nature and educational value of the OSCEs. The average cost for conducting an OSCE was $1200. Overall, an OSCE allows for resident evaluation according to the six ACGME core competencies.
Our program has had a positive experience with implementation of OSCEs within the plastic surgery residency program. The ability to review resident trainee performance in a standardized office-based patient consultation provides a unique opportunity to identify areas of strengths and weaknesses, not only of residents, but also within the training program. As we identified systems based practice as a deficiency among our trainees, we quickly introduced more lectures and seminars on billing and coding. Subsequent OSCEs showed marked improvement in this area, and is further evidence of the power of including OSCEs into residency education. Scenarios must be thoroughly developed to provide a realistic interaction and must follow the validated methods to conduct the examination. Though there is a cost associated with OSCEs, given the comprehensive educational value that our program has experienced, conducting OSCEs is now an integral component of our plastic surgery residency program.
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