Telehealth Virtual OSCEs for Development and Assessment of Students’ Clinical Skills
Sarah Onorato BA, Rachel A. Blair MD, Susan Farrell MD EdM*, Andrea Wershof Schwartz MD MPH*
picture credit: https://cptlpulses.com/2020/06/18/virtual-osces/
Objective Structured Clinical Examinations (OSCEs)—exercises in which medical students conduct simulated visits with standardized patients—are valuable learning tools that allow for assessment of students’ history-taking, physical examination, clinical reasoning, and communication skills.1-6 As a result of changes to the learning environment at Harvard Medical School (HMS) due to COVID-19, three previously scheduled OSCEs had to be rapidly transitioned to a virtual platform. Conducted as both asynchronous and synchronous telehealth visits, these virtual OSCEs provided a strategy to assess and support learners’ clinical skills and to introduce telehealth to students.
The HMS virtual OSCE sessions are formative experiences developed for three sets of learners at different stages of clinical training. The OSCE for first-year students was designed as a recorded, asynchronous virtual visit. The case represented the second in a three-part series of longitudinal visits with an aging patient, part of the HMS Aging and End of Life and Interprofessional Care themes. A telehealth visit with a standardized patient was pre-recorded. Students independently accessed and viewed the visit and answered free response questions between each sequential section related to the history, physical exam, and clinical reasoning. At the conclusion of the visit, students recorded an oral presentation of the case. The following day, students participated in a class-wide synchronous debriefing session, during which faculty presented aggregate student response data. A physical therapist, social worker, and pharmacist joined the session to discuss a team-based approach to the case.
Two additional virtual OSCEs have been administered: one for graduating students in the Clinical Capstone course and another for Health Sciences and Technology (HST) students in their Introduction to Clinical Medicine course. Both OSCEs were conducted as synchronous telehealth visits with the student, standardized patient, and faculty preceptor simultaneously connected on an online video platform. The Clinical Capstone OSCE focused on an end-of-life goals of care discussion. In the HST experience, students evaluated a patient’s acute complaint and assessed competencies in history-taking, physical exam, communication, note documentation, and oral presentation. The synchronous telehealth visits allowed faculty to observe and give students real-time feedback at the conclusion of the encounter.
Because until recently telehealth has been used infrequently at HMS, OSCE leaders provided a faculty development session covering telehealth principles and teaching, and strategies for providing student feedback in these OSCE encounters. In addition, students received preparatory materials, including a draft of the Association of American Medical Colleges’ telehealth competencies for medical students and resources to encourage use of observation and creativity in adapting the physical examination to a telehealth context.
Educators rapidly created these virtual OSCEs to reinforce students’ clinical skills during this time of educational upheaval. The sessions allowed students to learn the basic principles of telehealth and to practice applying foundational clinical skills in this new setting, increasingly important as telehealth becomes integrated into our care delivery system. When students’ in-person learning with patients becomes difficult, virtual OSCEs offer an innovative approach to foster and assess students’ clinical skills.
Acknowledgments: The authors would like the following individual who helped with the development and administration of the virtual OSCEs: John Dalrymple, Aga Jackson, Carolyn Wood, Gilianne Jawahir, Michael Mascheri, Nestoras Nestoris, Katie Dawson, Lisa Shea, Catherine Kelly, Nicole Genovese, Kelsey Miller, and the standardized patient team.