Changing an existing OSCE to a teaching tool: the making of a teaching OSCE.

OBJECTIVE: The teaching OSCE (objective structured clinical examination) was developed from existing OSCE materials to provide direct observation and feedback to students on their doctor-patient relationship skills, students' abilities to do a focused history and physical examination, and to familiarize students with this type of examination.

DESCRIPTION: Existing OSCE cases were modified to ten minutes and to focus on case scenarios using standardized patients. Faculty facilitators were trained in giving feedback and oriented to the new OSCE format. Clerkship students are told in advance the general topics of the Teaching OSCE stations, so they can prepare. Students are divided in three groups of six to eight students and each group is assigned a faculty facilitator. Each student performs a ten-minute OSCE station and is observed directly by the faculty facilitator and the remaining students in the group using a video monitor. The faculty facilitator then leads a 12-minute feedback session on focused history-taking skills, physical examination skills, and the doctor-patient relationship skills. Students selected at random by the faculty facilitator also give feedback to their peer. Teaching OSCEs take three hours and are held twice during the clerkship such that each student is actively observed twice and watches a total of ten to 14 additional interactions. Facilitators grade students on attendance, participation, and evidence of preparation. The actual interaction with the standardized patient is used entirely for formative purposes and is not graded.

DISCUSSION: Our department has used OSCEs for six years to evaluate students at the end of the third-year family medicine clerkship. Even after continuous improvement, our OSCE did not meet higher standards of reliability and would need at least three hours of testing per student to meet those standards. The low number of students in the rotation and limited resources to increase the duration of the OSCE made it very difficult to construct a more reliable examination. At the same time, both faculty and students wanted more direct observation and feedback on performance with clinical scenarios. Using existing OSCE resources to change the OSCE to a teaching tool proved to be an efficient use of teaching resources while increasing our educational impact. Students report that they appreciate the opportunity to have constructive discussions of their strengths and weaknesses in clinical encounters, observe a variety of doctor-patient interaction styles, and practice for future OSCE-type examinations. Faculty members enjoy this active teaching format and find the process of students giving feedback to their peers educationally useful. The teaching OSCE has been extremely well rated in the end-of-rotation evaluations and will be continued in future clerkships.