3rd-year OSCEs

[ButterButter]

*I originally posted this in another forum; my apologies if you're reading this for the 2nd time:

I'm curious how other schools handle 3rd year OSCEs. At my school, students are brought back for a didactic week at the end of every 3rd rotation, during which time they do OSCEs. These OSCEs are graded quantitatively (not just pass/fail, or pass/no pass if faculty want to be polite) and are factored into the rotation grades along with evaluations and shelf scores. Under this scenario, a single bad 14-minute encounter can ruin 4 weeks of great performance on a rotation and can significantly impact a rotation grade. I'm curious how many schools out there have pass/fail OSCEs and how other schools handle them?

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[Drrrrrr. Celty]

Do all schools do this?

 

[ButterButter]

Some schools only do OSCEs prior to Step 2, some do them periodically throughout 1st-3rd year, etc. A number of different variations exist, and many schools don't quantify OSCE grades or report them in the MSPE.

 

[Ismet]

Several of our core rotations had OSCEs, but only a couple were graded. Mostly they were for formative feedback, aka "this is how you're doing, this is what you need to improve." I don't remember how much weight the graded ones were given, but it wasn't huge, I want to say less than 10% of the final grade.

They ended up being excellent prep for Step 2 CS. I read through FA just to familiarize myself with the structure of the exam and how they wanted the PN, but taking all the OSCEs seriously really helped me with timing and interacting with the SP - never ran out of time on an encounter and scored way above average on the CIS portion. I know CS has a 95%+ pass rate so it's obviously not impossible to pass or do well, but it's nice having that comfort and peace of mind that you had good prep while you're waiting months for your score.

TL;DR it sucks that you have one extra thing you have to worry about adding to your grade, and maybe the benefit isn't that huge, but taking the OSCEs seriously should really help when it comes time for CS.

 

[lunalight]

Agree with above. We have SP encounters for every block during 1st and 2nd year and for every rotation during 3rd year. They are all pass/fail. If you fail you just do it again, NBD. We also have 2 OSCEs, a shorter one early 3rd year and longer one that's basically a mock CS day late 3rd year (mine is this week). It will basically tell the faculty if I'm ready for CS and what I need to improve on on prior to taking it.

 

[KinesiologyNerd]

We have graded OSCEs after most 3rd year clerkships, but its hard to screw up too bad and all are 10% or less of your grade.

 

[GUH]

*I originally posted this in another forum; my apologies if you're reading this for the 2nd time:

I'm curious how other schools handle 3rd year OSCEs. At my school, students are brought back for a didactic week at the end of every 3rd rotation, during which time they do OSCEs. These OSCEs are graded quantitatively (not just pass/fail, or pass/no pass if faculty want to be polite) and are factored into the rotation grades along with evaluations and shelf scores. Under this scenario, a single bad 14-minute encounter can ruin 4 weeks of great performance on a rotation and can significantly impact a rotation grade. I'm curious how many schools out there have pass/fail OSCEs and how other schools handle them?

Either you go to the same school as me or our system is exactly the same. In our case, the SP department tried to change the standards earlier this year and literally a majority of the students who were not on vacation or an extended boards study period failed and were pulled from rotations for two days to remediate. They also wanted to make everyone pay $150-$300 depending on whether you failed one or both OSCEs but we pushed back and they haven't pulled that nonsense since then.

And that's a shame because I think the SP program here did do a good job of preparing us for rotations but this whole fiasco left a bad taste in my mouth.

 

[IncognitoGuy]

We have them too - they don't count for much but it's unfortunately a timesink because we take multiple shelf exams in that same week we have OSCEs.

 

[ButterButter]

Either you go to the same school as me or our system is exactly the same.

One of these must be true..

Thanks for the feedback, everyone. I understand the educational utility of having OSCEs, but it seems irrational to have SPs that are only actors/actresses with absolutely no clinical knowledge giving grades to students other than pass/fail. If students fail, it negatively effects their grade for that rotation, and it also impacts their current rotation if they're asked to leave for 2 days for remediation. Depending on the preceptor, this could be an awful scenario. I understand that glorified actors contribute to Step 2 grades, but my school's SP department has a history of being unnecessarily difficult. They aren't transparent, and they don't provide rubrics on what they'll even be grading us on.

 

[Psai]

One of these must be true..

Thanks for the feedback, everyone. I understand the educational utility of having OSCEs, but it seems irrational to have SPs that are only actors/actresses with absolutely no clinical knowledge giving grades to students other than pass/fail. If students fail, it negatively effects their grade for that rotation, and it also impacts their current rotation if they're asked to leave for 2 days for remediation. Depending on the preceptor, this could be an awful scenario. I understand that glorified actors contribute to Step 2 grades, but my school's SP department has a history of being unnecessarily difficult. They aren't transparent, and they don't provide rubrics on what they'll even be grading us on.

Oh my god some of the comments I've gotten from sps about my medical knowledge...
Come at me when you've passed step 1

 

[pd1112]

One of these must be true..

Thanks for the feedback, everyone. I understand the educational utility of having OSCEs, but it seems irrational to have SPs that are only actors/actresses with absolutely no clinical knowledge giving grades to students other than pass/fail. If students fail, it negatively effects their grade for that rotation, and it also impacts their current rotation if they're asked to leave for 2 days for remediation. Depending on the preceptor, this could be an awful scenario. I understand that glorified actors contribute to Step 2 grades, but my school's SP department has a history of being unnecessarily difficult. They aren't transparent, and they don't provide rubrics on what they'll even be grading us on.

Typically if you go to the clerkship coordinator after the OSCE/rotation (maybe before, but I haven't tried this) you can see the rubric or they'll at least explain it to you. On my first 2-3 OSCEs I kept getting 1/2 credit for the section on "Introduction" of the interview and I had no clue why. After the 3rd time, I went to the coordinator to ask about my grade; turns out our rubrics require us to introduce ourselves using first AND last name -____-
It seems ridiculous but most schools try to model the OSCEs closely off of the actual Step 2CS, so I imagine the same is true for the introduction on the real deal.

 

[Psai]

Typically if you go to the clerkship coordinator after the OSCE/rotation (maybe before, but I haven't tried this) you can see the rubric or they'll at least explain it to you. On my first 2-3 OSCEs I kept getting 1/2 credit for the section on "Introduction" of the interview and I had no clue why. After the 3rd time, I went to the coordinator to ask about my grade; turns out our rubrics require us to introduce ourselves using first AND last name -____-
It seems ridiculous but most schools try to model the OSCEs closely off of the actual Step 2CS, so I imagine the same is true for the introduction on the real deal.

Most frustrating thing about osces was that they would give us these weirdo grading schemes that had all these percentages on it with absolutely no explanation for what anything meant. There was also no rubric given for how they grade things so we couldn't even learn from our mistakes. Why even spend all that money on standardized patients then?

 

[Ismet]

Most frustrating thing about osces was that they would give us these weirdo grading schemes that had all these percentages on it with absolutely no explanation for what anything meant. There was also no rubric given for how they grade things so we couldn't even learn from our mistakes. Why even spend all that money on standardized patients then?

It's like a free for all. I had an observed OSCE with an attending in the room, we were explicitly told beforehand that we should talk to the patient during the physical exam to explain what maneuvers we were doing and briefly why we were doing them (I guess to prep for CS how you're supposed to ask permission and stuff). When it was time for feedback, the SP said it was weird that I kept telling him what I was going to do next. The attending just looked at him like "wtf did you not pay attention to the fact that they're SUPPOSED to do that?!" and turned to me and said it was great, full points. If there had not been an attending there, I'm sure that would have been arbitrary points off even though I did everything right.

 

[ButterButter]

When it was time for feedback, the SP said it was weird that I kept telling him what I was going to do next. The attending just looked at him like "wtf did you not pay attention to the fact that they're SUPPOSED to do that?!" and turned to me and said it was great, full points. If there had not been an attending there, I'm sure that would have been arbitrary points off even though I did everything right.

Again, it goes back to the absurdity of having an actor grade a student on clinical skills. It seems like SPs are trained to be as inane as possible.

Me: "Have you ever undergone treatment for any medical conditions in the past?"
SP: "What do you mean by treatment?"
Me: "Has a doctor ever told you that you have a medical problem and then developed a plan including, but not limited to: medication, lifestyle changes, physical therapy, and/or cognitive-behavioral therapy, in an effort to resolve the previously identified condition?"
SP: "What do you mean by resolution?"
Me: "F this."

 

[Postictal Raiden]

Again, it goes back to the absurdity of having an actor grade a student on clinical skills. It seems like SPs are trained to be as inane as possible.

Me: "Have you ever undergone treatment for any medical conditions in the past?"
SP: "What do you mean by treatment?"
Me: "Has a doctor ever told you that you have a medical problem and then developed a plan including, but not limited to: medication, lifestyle changes, physical therapy, and/or cognitive-behavioral therapy, in an effort to resolve the previously identified condition?"
SP: "What do you mean by resolution?"
Me: "F this."

The funny thing is that they tell you to ask open ended and general questions i.e.. "what can you tell me about your diet?", and when you do, the SP goes like "I don't know what you mean".

 

[pd1112]

Most frustrating thing about osces was that they would give us these weirdo grading schemes that had all these percentages on it with absolutely no explanation for what anything meant. There was also no rubric given for how they grade things so we couldn't even learn from our mistakes. Why even spend all that money on standardized patients then?

Same; no rubric, explanations or comments unless you seek it out on your time.


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[Tots]

It is incredibly variable for us. Anywhere from p/f to 25% of your rotation grade. And the OSCEs range from 1 encounter to 8 stations.

Most frustrating thing about osces was that they would give us these weirdo grading schemes that had all these percentages on it with absolutely no explanation for what anything meant. There was also no rubric given for how they grade things so we couldn't even learn from our mistakes. Why even spend all that money on standardized patients then?

Second this. Some of our OSCEs we just get a grade back. What a waste of resources. Might as well at least attempt to provide some constructive feedback if your going to the colossal effort to arrange these OSCEs.