The pediatric rheumatology objective structured clinical examination: progressing from a homegrown effort toward a reliable and valid national formative assessment

Abstract

BackgroundOf 37 pediatric rheumatology fellowship training programs in the United States, many have three or fewer fellows at a given time, making large-scale assessment of fellow performance difficult. An objective structured clinical examination (OSCE) is a scenario-based simulation method that assesses individual performance, thus indirectly measuring training program effectiveness. This study describes the development and implementation of two national pediatric rheumatology OSCEs and methods used for programmatic improvement.MethodsOSCEs for pediatric rheumatology fellows were held in 2009 and 2011 during national rheumatology meetings using scenarios and assessment forms originally developed by a fellowship program director. The seven scenarios tested medical knowledge, physical exam and interpersonal skills. Pediatric rheumatologist evaluators assessed fellows’ performance using checklists and gave immediate feedback. Program directors were sent summaries of their fellows’ performances. Fellows evaluated the OSCE, providing organizational and scenario improvement suggestions. Programmatic changes to the 2011 OSCE were based on 2009 performance data and program evaluation feedback.ResultsTwenty-two fellows participated in 2009 and 19 in 2011. Performance scores in similar scenarios did not change considerably over the two iterations. In 2009, 85.7% of participants reported desire to change clinical behavior. Assessors’ 2009 program evaluation data prompted changes in rating scales and removal of invalid or unreliable assessments. Negative evaluation data about individual stations decreased from 60% in 2009 to 15.4% in 2011. Fellows’ ratings of the experience’s overall value were similar in 2009 and 2011. The average experience ratings were lower among fellows who proposed scenario-specific improvements and higher among those who recommended organizational improvements.ConclusionsThe 2011 examination exhibited programmatic improvement via reduction in fellows’ scenario-specific negative feedback. Fellows’ overall satisfaction did not change. Further work in scenario selection, assessment validation and inter-rater reliability will improve future pediatric rheumatology OSCEs.

Assessing Pediatric Rheumatology Fellow Competence in the Milestone Era: Past, Present, and Future

“…The toolbox suggests assessment methods, including the use of anatomic models, direct observation, objective structured clinical examinations, and faculty evaluations, some of which have feasibility or validity data for rheumatology trainees. [38][39][40][41] Of note, few publicly-available assessment forms exist, and none are directly included in the toolbox. Examples of published curricula with assessment tools include the Fellow as Clinical Teacher curriculum and a workshop to measure performance of knee and shoulder arthrocentesis.…”

“…No analogous curricular document exists for pediatric rheumatology. The toolbox suggests assessment methods, including the use of anatomic models, direct observation, objective structured clinical examinations, and faculty evaluations, some of which have feasibility or validity data for rheumatology trainees 38–41 . Of note, few publicly‐available assessment forms exist, and none are directly included in the toolbox.…”

Assessment of Resident Knowledge in Pediatric Rheumatology

“…Megan Curran and David Sherry have been involved in developing and testing the objective structured clinical exams (OSCE) for pediatric rheumatology fellows to evaluate their communication and professionalism skills. 14 A pre-test and post-test design was used to evaluate the fellows’ change in skills. The study results showed that there was improvement in post-test scores as well as professionalism after training using the OSCE.…”

Multi-pronged approach to enhance education of children and adolescents with lupus, caregivers, and healthcare providers in New Jersey: Needs assessment, evaluation, and development of educational materials

“…22–24 Therefore, additional and ongoing educational interventions are needed at the level of the HCPs, other pediatric providers as well as the community, patients and caregivers; however, a more methodologically sound evaluation is needed. We will consider holding pediatric rheumatology objective structured clinical examination sessions (OSCE), a scenario-based simulation method that assesses individual performance, 25 and case-based education to HCPs throughout the state. A randomized control trial of educational interventions can provide true measures of knowledge gain rather than perceptions of knowledge gain.…”