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Clinical Rheumatology

, Volume 35, Issue 8, pp 2093–2099 | Cite as

Fellow use of medical jargon correlates inversely with patient and observer perceptions of professionalism: results of a rheumatology OSCE (ROSCE) using challenging patient scenarios

  • Jessica R. Berman
  • Juliet Aizer
  • Anne R. Bass
  • Irene Blanco
  • Anne Davidson
  • Edward Dwyer
  • Theodore R. Fields
  • Wei-Ti Huang
  • Jane S. Kang
  • Leslie D. Kerr
  • Svetlana Krasnokutsky-Samuels
  • Deana M. Lazaro
  • Julie S. Schwartzman-Morris
  • Stephen A. Paget
  • Michael H. Pillinger
Brief Report

Abstract

The NYC Rheumatology Objective Structured Clinical Examination (NYC-ROSCE) is held annually to assess fellow competencies. We recently redesigned our OSCE to better assess subspecialty trainee communication skills and professionalism by developing scenarios in which the patients encountered were psychosocially or medically complex. The objective of this study is to identify which types of verbal and non-verbal skills are most important in the perception of professionalism in the patient-physician interaction. The 2012–2013 NYC-ROSCEs included a total of 53 fellows: 55 MD evaluators from 7 NYC rheumatology training programs (Hospital for Special Surgery-Weill Cornell (HSS), SUNY/Downstate, NYU, Einstein, Columbia, Mount Sinai, and North Shore/Long Island Jewish (NSLIJ)), and 55 professional actors/standardized patients participated in 5 stations. Quantitative fellow performance assessments were made on the following: maintaining composure; partnering with the patient; honesty; professionalism; empathy; and accountability. Free-text comments were solicited regarding specific strengths and weaknesses. A total of 53/53 eligible (100 %) fellows were evaluated. MD evaluators rated fellows lower for professionalism than did the standardized patients (6.8 ± 0.6 vs. 7.4 ± 0.8, p = 0.05), suggesting that physicians and patients view professionalism somewhat differently. Fellow self-evaluations for professionalism (6.6 ± 1.2) were concordant with those of the MD evaluators. Ratings of empathy by fellows themselves (6.6 ± 1.0), MD evaluators (6.6 ± 0.7), and standardized patients (6.6 ± 1.1) agreed closely. Jargon use, frequently cited by evaluators, showed a moderate association with lower professionalism ratings by both MD evaluators and patients. Psychosocially challenging patient encounters in the NYC-ROSCE permitted critical assessment of the patient-centered traits contributing to impressions of professionalism and indicate that limiting medical jargon is an important component of the competency of professionalism.

Keywords

Assessment Education Medical jargon Professionalism Rheumatology fellowship 

Notes

Acknowledgments

The authors thank Yeidy Rodriguez, Maricel Galindez, Sarina Richards and Ranit Shirky for their administrative help with the exam each year. Thank you to the patient-actors, wonderful professionals without whom none of this would be possible.

Compliance with ethical standards

The manuscript does not contain clinical studies or patient data. All the fellowship trainees consented to participate in this learning assessment.

Disclosures

None.

Funding

The authors report no external funding source for this study.

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Copyright information

© International League of Associations for Rheumatology (ILAR) 2015

Authors and Affiliations

  • Jessica R. Berman
    • 1
  • Juliet Aizer
    • 1
  • Anne R. Bass
    • 1
  • Irene Blanco
    • 2
  • Anne Davidson
    • 3
  • Edward Dwyer
    • 4
  • Theodore R. Fields
    • 1
  • Wei-Ti Huang
    • 5
  • Jane S. Kang
    • 6
  • Leslie D. Kerr
    • 7
  • Svetlana Krasnokutsky-Samuels
    • 8
  • Deana M. Lazaro
    • 9
  • Julie S. Schwartzman-Morris
    • 10
  • Stephen A. Paget
    • 1
  • Michael H. Pillinger
    • 8
  1. 1.Division of RheumatologyWeill Cornell Medical College, Hospital for Special SurgeryNew YorkUSA
  2. 2.Division of RheumatologyAlbert Einstein College of MedicineBronxUSA
  3. 3.Division of Rheumatology, Hofstra North Shore LIJ School of MedicineFeinstein Institute for Medical ResearchManhassetUSA
  4. 4.Division of RheumatologyColumbia U. College of Physicians and SurgeonsNew YorkUSA
  5. 5.PAREXEL InternationalTaipeiRepublic of China
  6. 6.Division of RheumatologyColumbia U. College of Physicians and SurgeonsNew YorkUSA
  7. 7.Icahn School of Medicine at Mount Sinai, Box 1244, Division of Rheumatology, Mount Sinai Medical CenterNew YorkUSA
  8. 8.Division of RheumatologyNYU School of Medicine, NYU Hospital for Joint DiseasesNew YorkUSA
  9. 9.Division of RheumatologySUNY Downstate College of Medicine, VA- New York Harbor Healthcare System Brooklyn, Medical Service (III)BrooklynUSA
  10. 10.Division of RheumatologyNorth Shore University Hospital – LIJGreat NeckUSA

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