Abstract
In case of an emergency, a fast and structured patient management is crucial for patient’s outcome. The competencies needed should be acquired and assessed during medical education. The objective structured clinical examination (OSCE) is a valid and reliable assessment format to evaluate practical skills. However, traditional OSCE stations examine isolated skills or components of a clinical algorithm and thereby lack a valid representation of clinical reality. We developed emergency case OSCE stations (ECOS), where students have to manage complete emergency situations from initial assessment to medical treatment and consideration of further procedures. Our aim was to increase the authenticity and validity in the assessment of students’ capability to cope with emergency patients. 45 students participated in a 10-station OSCE with 6 ECOS and 4 traditional OSCE stations. They were assessed using a case-specific checklist. An inter-station and post-OSCE-questionnaire was completed by each student to evaluate both ECOS and traditional OSCE. In this study, we were able to demonstrate that ECOS are feasible as time-limited OSCE stations. There was a high acceptance on both students and examiners side. They rated ECOS to be more realistic in comparison to the traditional OSCE scenarios. The reliability estimated via Crohnbach’s α for the 6 ECOS is high (0.793). ECOS offer a feasible alternative to the traditional OSCE stations with adequate reliability to assess students’ capabilities to cope with an acute emergency in a realistic encounter.
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Acknowledgments
M. R. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy for the data analysis. None of the authors had potential conflicts of interest. We would like to thank the clinicians, paramedics and course instructors who contributed to the construction and evaluation of scenarios and marking schemes. Our special thanks go to the students, examiners, standardized patients and assistants who took part in this study.
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Appendix
Appendix
Stem
You are the emergency physician on standby service together with your paramedic.
You are called to an office, where a 54 year old male complains of chest pain.
Simulated patient’s role
- Name:
-
Frederik Wolter
- Age:
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54 (date of birth: September 16, 1954)
- Sex:
-
Male
- Weight:
-
Normal weight
- Appearance:
-
Business style (suit, shirt, tie)
- Profession:
-
Financial Manager
Actual complaints
- Main complaints:
-
Chest pain (retrosternal), tightness in the chest
- Chronology:
-
Sudden onset 20 min ago
- Intensity:
-
8 on a scale of 10
- Attendant symptoms:
-
Sweaty, radiation to the left arm no correlation to respiration
Patient’s history
- Smoking:
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Heavy smoker for 14 years, approx. 2–3 pack per day
- Alcohol:
-
Regularly 1–2 beer while watching TV
- Blood pressure:
-
“My blood pressure is increased according to my GP!”
“I don’t know how high it normally is!”
“My GP prescribed me some stuff, but what should I take it for. Tablets will not remove the stress in my job.”
- Cholesterol:
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“My GP says its increased.”
- Blood sugar:
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Until now not known
- Heart:
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Chest pain at physical strain e.g. climbing stairs
“So I take the elevator!”
- Medication:
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“My GP prescribed me some stuff, but what should I take it for. Tablets will not remove the stress in my job.”
- Stress:
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Ongoing stress due to a major project he is responsible for
- Social:
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Married, 2 children
- Family:
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Father died from a heart attack aged 51
Mother had a stroke in 2004 in nursing home since then
Siblings none
Scenario
First sentence (Answer of the reason for the emergency call)
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“I have got very bad chest pain!”
Question: Since when/What happened?
-
“I had a heavy argument with one of my colleagues about 20 min ago!”
Attitude
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Agitated, anxious, do not hyperventilate, despaired, burned out
Comments during scenario (esp. when examinee is at a loss)
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“What is wrong with me?”
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“Can I go on with my project? You must know it has to be ready in 3 days!”
-
“I should have listened to my GP!”
This data will only be mentioned when examinee asks them directly
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Onset of symptoms
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Localisation and radiation of symptoms
-
Past medical history
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Previous episodes of chest pain
-
Family history
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Smoking and alcohol
Setting
Office with two desks, each one with computer and several telephones and cell phones. Desks cramped with ring binders and papers. Phones are ringing all the time. Filled ashtray and coffee cups on the desk.
Several fully labeled white boards beside the desks.
Checklist
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Ruesseler, M., Weinlich, M., Byhahn, C. et al. Increased authenticity in practical assessment using emergency case OSCE stations. Adv in Health Sci Educ 15, 81–95 (2010). https://doi.org/10.1007/s10459-009-9173-3
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DOI: https://doi.org/10.1007/s10459-009-9173-3