Practice Makes Perfect: Using the Objective Structured Teaching Exercise (OSTE) to Improve In-Patient Geriatrics Teaching Skills—Description of a Pilot Program.


Don Scott, MD, MHS; Sandy Cook, Ph.D.; Greg Sachs, MD. The University of Chicago and the Pritzker School of Medicine

Project Goal
To describe an OSTE module designed for use with the University of Chicago’s faculty development program  CHAMP: Curriculum for the Hospitalized Aging Medical Patient
 
Project Objectives
1)The creation of 6 OSTE Stations designed to assess teaching skills focused on in-patient geriatric medicine content. 
2)The design of procedures for training standardized learners using a cadre of 4th year medical students, senior residents and geriatric fellows as standardized learners
3)The creation of assessment forms for the standardized learners to use for assessment
4)The creation of self-assessment procedures for Faculty-Learners
5)The creation of Pre and Post OSTE-Module measures for use in the initial phase of Geriatrics OSTE-Module evaluation

 

OSTE Station Logistics
  • •Setting—Clinical Performance Center (CPC) University of Chicago
  • •All OSTE’s video-taped for Faculty-Learner Self-Assessment
  • •OSTE’s will allow Faculty-Learner to practice encounter 2 times per station

                            Bedside OSTE 1st Time Through (5 min.)

                            Video Self Assessment & SL-Feedback (10 min.)

                            Bedside OSTE 2nd Time Through (5 min.)

                            Video Self-Assessment & SL-Feedback (10 min.)

  • •Standardized Students Trained by PI and CPC Coordinator and SP-Trainer
•
OSTE Station Content
  1. 1)Geriatric Medicine Content
  • Incident Delirium in the Hospitalized Older Adult
  • •Inappropriate Use of Foley Catheters
  • Assessing Decision Making Capacity
  • •Polypharmacy & Drug-Drug Interactions
  • •Discussing Advance Directives
  • •Assessment & Treatment of Pressure Ulcers
    2.   Teaching Skills Content
         a)     Bed-side or Door-side Teaching
                    One-Minute Preceptor Micro-Skills
•
                    Get a Commitment

                   

Probe for Supporting Evidence
•
                    Teach General Rules
                    Reinforce What Was Done Right
                    Correct Mistakes
          b) Conference Room Teaching
                    Case Audit Method
                    Census Audit Method
 
OSTE Scripts (Example)
Case: Work Rounds--Delirium in a Hospitalized Older Adult

 

Learning Objectives:
    1) The faculty-learner will articulate one or more options for a Teachable Moment.
    2) The faculty-learner will demonstrate the 5 Micro-Skills of the One-Minute Preceptor Model during the door-side encounter.  
    3) The faculty-learner will identify one skill step for improvement after Video Self-Assessment and Feedback 1.
    4) The faculty-learner will practice the encounter again, trying a different approach to the skill-step identified above.   

 

Setting: Work Rounds--Outside Patient’s Room

 

Cast: Attending (Learner), Senior Resident , 2 Interns, 3rd Year Medical Student

 

[The  Intern  is opening chart and looking at vital signs, with student and resident looking on]
Attdg: OK Holly, so what’s going on with Mr. Jones this morning? 

 

The Intern  [Turning to Attending]: Right, so this is our 86 year old man with Parkinson’s, admitted with an aspiration pneumonia and change in mental status.  He also has a  history of CAD, dementia and diabetes.  We’ve been broadly covering him and using a sliding scale for his diabetes.  X-cover was called again last night about another confusion episode…he was trying to pull out his Foley, so they gave him a milligram of Ativan and ordered a posey, mitts and prn soft restraints.  They didn’t get called again, so he apparently did fine the rest of the night.  This morning he’s a bit lethargic, but really doesn’t seem to far off his base-line, I guess.  He’s been doing generally well.  He’s been afebrile for 24-hours and seems to be back to his baseline.  Today he’s 36.7  140/65  84  20 and 96% on RA.   He seems to be sundowning.  Perhaps we should put him on some standing Haldol or resperidone.

 

Resident: [To Intern] I’m not sure that Ativan was really the right choice last night by the cross-cover; I agree Haldol is better.  The benzo’s are associated with delirium and delirious patients always do worse and end up staying longer.  The last thing we want to do to him or us is to turn this poor old guy into a rock—the sooner we get him back home the better.

 

Student: You said he was sundowning? [To Attending] I’m sorry but I’m not real clear about what exactly that means?

 

Assessment Instruments* to be Used by Standardized Learner: Example

Bedside Teaching--Skill 5: Correct Mistakes

 

* Adapted with permission from Morrison EH, et al. Reliability and Validity of an Objective Structured Teaching Examination for Generalist Teachers. Acad. Med.2002;77(10):S29-S32

 

This work was partially funded by the Donald W. Reynolds Foundation