key: cord-0766541-be1emyks
authors: Lara, Sebastian; Foster, Christopher W.; Hawks, Matthew; Montgomery, Michael
title: Remote Assessment of Clinical Skills during COVID-19: A Virtual, High-Stakes, Summative Pediatric OSCE
date: 2020-06-05
journal: Acad Pediatr
DOI: 10.1016/j.acap.2020.05.029
sha: 740224bfeb499053cf68605a8a680c546bdb7ded
doc_id: 766541
cord_uid: be1emyks

nan

Due to requirements for social distancing to protect the health of students, faculty, and standardized patients (SP) during the coronavirus pandemic, the pediatric clerkship Objective Structured Clinical Examination (OSCE) could not safely take place within our simulation center.

We adapted a previously live-only OSCE to be delivered virtually via teleconferencing software, a "teleOSCE". TeleOSCE platforms have previously been described for use in formative assessment of students in rural locales as well as in assessment of basic telemedicine skills. 1,2 More recently, educators from Singapore executed a live OSCE while respecting social distancing rules on account of coronavirus. 3 Our teleOSCE is unique in its use of an entirely virtual platform for a high-stakes summative assessment of clinical skills, while still maintaining locally established SP checklists, communication scoring tools, and faculty observation rubrics. This allowed us to preserve a core assessment that is given to all clerkship students at the completion of their pediatric rotation.

Zoom™ software was selected due to its simplicity, audio/video quality, breakout room features, and affordability. All students, faculty, SPs, and administrators participated from the privacy of their respective location. Following a thorough test run with nonclerkship student volunteers and to ensure feasibility, we settled on testing seven students per half day over 3 ½ days (n=49) whereas our standard, in-person OSCE can reliably assess up to 16 students per half day session.

Following a brief orientation in the "hallway" (i.e. main teleconference room), students were given three minutes to read the "doorway folder" (i.e. pre-encounter instructions on the web-based simulation learning management system CAELearningSpace™). Then students were moved into the "exam room" (i.e. Zoom™ breakout room) where the SP, a faculty observer, and an administrator were pre-positioned for the start of the encounter. Students had 22-minutes to complete each patient encounter, after which they left the "exam room." Back within LearningSpace™, students had 13 minutes to complete a post-encounter note while faculty and SPs simultaneously completed respective assessments of the student. Upon completion of the post-encounter note, students were then returned to the "hallway" to read their subsequent "doorway folder" and proceed into the next "exam room," ultimately working through 4 pediatric cases.

Statistical analysis suggests the teleOSCE is a comparable assessment to the live OSCE. TeleOSCE participants (N=49) were compared to live OSCE participants (N=173) from the previous 3 years. There was no difference in mean score (mean difference -1.1; 95% CI -2.8 to 0.7; p=0.2) or failure rate (rate difference 2%; 95% CI -0.7% to 10.7%; p=0.06) between the groups.

The demonstrated effectiveness of this novel teleOSCE makes it a feasible tool for both undergraduate and graduate medical education programs adjusting to the current COVID-19 restrictions. Even beyond the restrictions, this model will allow institutions with remote learners to perform summative assessments while saving on travel time and costs. Additionally, the teleOSCE is easily adjusted to accommodate telemedicine assessments (both formative and high-stakes), which are quickly becoming essential in medical education to reflect the newly increased importance of telemedicine skills in modern clinical care.

Preparing trainees for telemedicine: a virtual OSCE pilot

The feasibility and acceptability of administering a telemedicine objective structured clinical exam as a solution for providing equivalent education to remote and rural learners

Conducting a high-stakes OSCE in a COVID-19 environment