Assessing Professionalism Using the Objective Structured Clinical Exam

The Objective Structured Clinical Exam (OSCE) is widely used as an assessment tool. Traditionally, the OSCE measures history taking, physical exam, and interview skills. More recently, the OSCE has also been utilized to assess professionalism. Because episodes of unprofessional behavior are situational and therefore difficult to track, a case was designed to present a special challenge that might identify shortfalls in professionalism. A scale was also developed to measure this behavior in each OSCE encounter. The purpose of this study was to determine whether professionalism could be adequately assessed by using common OSCE cases or whether a designated case with a specific formal component is needed. Presented at the AAMC (Association of American Colleges) Annual Meeting, RIME (Research in Medical Education) Program, November 2003

Setting the Standard for a High-Stakes End of Third Year Assessment

Purpose: - Conduct modified Angoff standard setting procedure due to planned move to “high-stakes” End of Third Year Assessment (EOTYA) - Assess the result of applying cutoffs to EOTYA student performance data - Analyze judges’ perceptions and confidence in setting cutoffs for three skill areas across seven Objective Structured Clinical Examinations (OSCEs) Presented at the AAMC (Association of American Colleges) Annual Meeting, RIME (Research in Medical Education) Program, November 2007

The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP)

In this paper, we define the Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP) for those working with human role players who interact with learners in a wide range of experiential learning and assessment contexts. These human role players are variously described by such terms as standardized/simulated patients or simulated participants (SP or SPs). ASPE is a global organization whose mission is to share advances in SP-based pedagogy, assessment, research, and scholarship as well as support the professional development of its members. The SOBP are intended to be used in conjunction with the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice: SimulationSM, which address broader simulation practices. We begin by providing a rationale for the creation of the ASPE SOBP, noting that with the increasing use of simulation in healthcare training, it is incumbent on ASPE to establish SOBP that ensure the growth, integrity, and safe application of SP-based educational endeavors. We then describe the three and a half year process through which these standards were developed by a consensus of international experts in the field. Key terms used throughout the document are defined. Five underlying values inform the SOBP: safety, quality, professionalism, accountability, and collaboration. Finally, we describe five domains of best practice: safe work environment; case development; SP training for role portrayal, feedback, and completion of assessment instruments; program management; and professional development. Each domain is divided into principles with accompanying key practices that provide clear and practical guidelines for achieving desired outcomes and creating simulations that are safe for all stakeholders. Failure to follow the ASPE SOBP could compromise the safety of participants and the effectiveness of a simulation session. Care has been taken to make these guidelines precise yet flexible enough to address the diversity of varying contexts of SP practice. As a living document, these SOBP will be reviewed and modified periodically under the direction of the ASPE Standards of Practice Committee as SP methodology grows and adapts to evolving simulation practices

The Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP)

In this paper, we define the Association of Standardized Patient Educators (ASPE) Standards of Best Practice (SOBP) for those working with human role players who interact with learners in a wide range of experiential learning and assessment contexts. These human role players are variously described by such terms as standardized/simulated patients or simulated participants (SP or SPs). ASPE is a global organization whose mission is to share advances in SP-based pedagogy, assessment, research, and scholarship as well as support the professional development of its members. The SOBP are intended to be used in conjunction with the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice: SimulationSM, which address broader simulation practices. We begin by providing a rationale for the creation of the ASPE SOBP, noting that with the increasing use of simulation in healthcare training, it is incumbent on ASPE to establish SOBP that ensure the growth, integrity, and safe application of SP-based educational endeavors. We then describe the three and a half year process through which these standards were developed by a consensus of international experts in the field. Key terms used throughout the document are defined. Five underlying values inform the SOBP: safety, quality, professionalism, accountability, and collaboration. Finally, we describe five domains of best practice: safe work environment; case development; SP training for role portrayal, feedback, and completion of assessment instruments; program management; and professional development. Each domain is divided into principles with accompanying key practices that provide clear and practical guidelines for achieving desired outcomes and creating simulations that are safe for all stakeholders. Failure to follow the ASPE SOBP could compromise the safety of participants and the effectiveness of a simulation session. Care has been taken to make these guidelines precise yet flexible enough to address the diversity of varying contexts of SP practice. As a living document, these SOBP will be reviewed and modified periodically under the direction of the ASPE Standards of Practice Committee as SP methodology grows and adapts to evolving simulation practices

Measuring Unprofessional Behavior During an 8-Station OSCE

Standardized patients (SPs) are widely used in medical education but their use to assess professionalism is limited. This study investigated the utility of SPs assessing unprofessional behavior during an annual end of third year Objective Structured Clinical Examination (OSCE). Presented at the AAMC (Association of American Colleges) Annual Meeting, RIME (Research in Medical Education) Program, November 2006

Using a Targeted OSCE Station to Measure Unprofessional Behavior

Standardized patients are widely used in medical education but their use to assess professionalism is limited. With grant support from the Edward J. Stemmler, MD Medical Education Research Fund (“Stemmler Fund”) of the National Board of Medical Examiners (NBME), the usefulness of standardized patients (SPs) in the assessment of professional behavior was investigated. A targeted professionalism OSCE station featuring a values conflict was written. A professionalism instrument was developed and subsequently revised during the course of the study, with the final version containing various components of American Board of Internal Medicine (ABIM) core set of eight professionalism attributes and several other scales in recent medical research. Presented at the Ottawa Conference, 2006

Pre/Post Comparison of Medical Students\u27 Self-Reported Competence Ratings for Content and Skill Areas Included in an End of Third Year Assessment

The End of Third Year Assessment (EOTYA) evaluates medical students using multiple objective Structured Clinical Examinations (OSCE) and offers comprehensive feedback to students on their content knowledge and skills. This study measures the change in students\u27 perceived level of competence before and after completing the EOTYA. Presented at the AAMC (Association of American Colleges) Annual Meeting, RIME (Research in Medical Education) Program, November 2004

The effect of a domestic violence interclerkship on the knowledge, attitudes, and skills of third-year medical students

PURPOSE: To determine whether participation in an intensive domestic violence interclerkship (DVI) improved the knowledge, attitudes, and skills of two successive cohorts of students at the University of Massachusetts Medical School. METHOD: The authors measured the knowledge, attitudes, and skills pertaining to domestic violence of third-year students in the classes of 1997 and 1998 using a validated written examination administered before, immediately after, and six months after participation in a 3.5-day or two-day DVI, respectively; they compared the scores using paired t-tests. Nine months after the DVI, the students\u27 domestic violence screening skills were measured by a performance-based assessment (OSCE); using unpaired t-tests, the authors compared the OSCE scores with those of a previous third-year class that had not participated in a DVI. Immediately after the OSCE, the students reported their levels of confidence in domestic violence screening and their satisfaction with the domestic violence curriculum; using chi-square analysis, those self-reports were compared with those of the class with no DVI. RESULTS: The students who participated in the DVIs immediately and significantly improved their knowledge, attitudes, and skills (p \u3c .001), and fully or partially sustained those improvements six months later (p \u3c .001). Nine months after the DVI, the students performed domestic violence screening more effectively (p \u3c .001), expressed greater comfort with domestic violence screening (p \u3c .001), and felt better-prepared by the curriculum to address domestic violence issues (p \u3c .001) than did the students with no DVI. CONCLUSION: Participation in a short, focused DVI curriculum produced sustainable improvements in knowledge, attitudes, and skills that were successfully applied by third-year medical students to effective domestic violence screening. Interclerkships are an effective way to fit into the clinical curriculum those subjects that transcend the traditional biomedical domain and intersect all areas of medical practice

Randomized Noninferiority Trial of Telephone Delivery of BRCA1/2 Genetic Counseling Compared With In-Person Counseling: 1-Year Follow-Up

The ongoing integration of cancer genomic testing into routine clinical care has led to increased demand for cancer genetic services. To meet this demand, there is an urgent need to enhance the accessibility and reach of such services, while ensuring comparable care delivery outcomes. This randomized trial compared 1-year outcomes for telephone genetic counseling with in-person counseling among women at risk of hereditary breast and/or ovarian cancer living in geographically diverse areas

Identification of four novel susceptibility loci for oestrogen receptor negative breast cancer

Common variants in 94 loci have been associated with breast cancer including 15 loci with genome-wide significant associations (P<5 × 10−8) with oestrogen receptor (ER)-negative breast cancer and BRCA1-associated breast cancer risk. In this study, to identify new ER-negative susceptibility loci, we performed a meta-analysis of 11 genome-wide association studies (GWAS) consisting of 4,939 ER-negative cases and 14,352 controls, combined with 7,333 ER-negative cases and 42,468 controls and 15,252 BRCA1 mutation carriers genotyped on the iCOGS array. We identify four previously unidentified loci including two loci at 13q22 near KLF5, a 2p23.2 locus near WDR43 and a 2q33 locus near PPIL3 that display genome-wide significant associations with ER-negative breast cancer. In addition, 19 known breast cancer risk loci have genome-wide significant associations and 40 had moderate associations (P<0.05) with ER-negative disease. Using functional and eQTL studies we implicate TRMT61B and WDR43 at 2p23.2 and PPIL3 at 2q33 in ER-negative breast cancer aetiology. All ER-negative loci combined account for ∼11% of familial relative risk for ER-negative disease and may contribute to improved ER-negative and BRCA1 breast cancer risk prediction