Internal Medicine Residency Program

Memorial Hospital of Rhode Island

OSCE

OSCE for PGY1 and PGY-2 Residents:

The  Internal Medicine Residency Program holds a half-day OSCE each year for PGY 2 residents. This exam has been held for three years and plans are to continue to include it as part of a resident’s overall evaluation. The goal of the exam is to provide an opportunity, away from the residents’ precepting sites, for observation and evaluation of skills related to clinical reasoning, physician-patient relationship building skills, and ability to receive verbal feedback. In keeping with the objectives outlined by the ACP-ASIM for residency training programs, the OSCE offers another critical means of assessment of skills best evaluated in an observed setting. The exam also serves to reinforce the principles of professionalism and self-evaluation.

In our preparation for the OSCE, we offer preliminary one-hour sessions for the PGY-2 residents. These sessions relieve some of the anxiety inherently accompanying this type of test. Although we have primarily used the exam results as an opportunity for feedback, rather than as an exam with a numerical score, the nature of physicians in training has been to treat the exam seriously and sometimes competitively. The content of the preliminary sessions include review the structure of the day, rotations through stations, expectations and feedback, and the interpersonal skills that will be evaluated. One additional reason for instituting the review sessions is to prepare those residents who have not been exposed to, or have limited experience with, this type of experience in the past. While most medical schools have adopted the use of standardized patients into their curricula, the contact varies in intensity and style from one school to the next.

What is an OSCE?

The letters stand for Objective Structured Clinical Exam. These exams are sometimes also referred to as a CPX or Clinical Exam. They consist of ‘stations’, usually lasting 10-15 minutes. Each station addresses an aspect of physician training and includes observation by a faculty member.

Why do we need to have this exam?

Residency programs are mandated to provide each resident with a variety of evaluation methods. This is an advantage for residents in that all aspects of a resident’s ability to care for patients will be observed and assessed. The skills associated with clinical competence, professionalism, interpersonal communication, self-reflection and respect for patient autonomy each require a particular set of formalized assessments. The OSCE provides direct observation, an opportunity for verbal feedback, and measurement of specific clinical skills such as reading an ECG or chest x-ray.

What happens with the results of the exam?

Each resident has the results of the exam’s stations reviewed with her/him on an individual basis with one of the faculty members. Suggestions for improvement and praise for well done work are also part of the feedback process. Residents are asked to formulate goals for improvement based on these conversations. The results are kept in a separate folder and are available for review by the resident at any time. The score of the exam is not part of the resident’s individual record.

How will I know what to do?

Every station is assigned to a room and every room has information posted on the door. For example, the doorway information may say:‘In this room you will meet Mrs. Aronson who comes to clinic with a chief complaint of headaches.' Please take a focused history of the patient’s complaint and offer an initial treatment plan. You have 10 minutes for the interview, after which the patient will provide you with feedback about the interview.All residents begin and end their stations at the same time. We will use a bell to notify you when you may enter the room and when to come out. Most patient stations do not require any writing on your part. However, you will be asked to write orders after being given a patient scenario, there will be ECG’s to interpret and possibly labs or x-rays to comment upon. All parts of the exam are directed at PGY-2 resident knowledge.

What happens at the end of the day?

We will debrief as a group.

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