内科インターンのコア臨床スキル形成評価のためのOSCEの開発と実施

Direct observation and feedback are essential for developing core intern skills including communicating with consultants, obtaining informed consent, providing handoffs, and responding to nursing concerns. Early in training, the amount of direct observation of these skills varies and is often limited.

We created a 2-hour, 4-station OSCE for internal medicine interns after completion of inpatient rotations. Stations included (1) calling a consult, (2) obtaining informed consent, (3) providing sign-out, and (4) triaging and responding to nursing pages. Each station was scored using a checklist, and interns received immediate formative feedback from faculty after completing each station. Interns completed pre- and postsession surveys (ratings on 5-point scale).

Thirty-five interns completed the OSCE. The survey response rate was 93%. Checklist data revealed areas for improvement in all stations. Interns reported highly valuing the OSCE, resulting in increased satisfaction (pre- to postsession) with observation and feedback in calling consults (mean 3.69 to 4.15, p < .01), obtaining informed consent (mean 3.0 to 4.0, p < .01), and responding to nursing pages (mean 3.41 to 4.06, p < .01), and increased confidence in obtaining informed consent (mean 3.38 to 4.09, p < .01), providing sign-out (mean 3.5 to 4.06, p < .01), and responding to nursing pages (mean 3.75 to 4.18, p < .01).

The OSCE effectively provided direct observation and formative feedback to interns on core clinical skills. It is applicable for internal medicine residency programs to assess interns' skills and identify areas for improvement early in their training.