Test of Integrated Professional Skills: Objective Structured Clinical Examination/Simulation Hybrid Assessment of Obstetrics-Gynecology Residents' Skill Integration

摘要

What was known Performance in practice requires physicians to integrate clinical judgment, technical ability, and interpersonal skills.;What is new A 5-station assessment using hybrid simulation that combined standardized patients and simulated scenarios to test a higher order and integrated skills.;Limitations Single-institution study limits generalizability. Some skills were assessed only once; the 5 scenarios do not provide a comprehensive assessment of a resident's skills.;Bottom line A simulation-based, objective structured clinical examination facilitated assessment of competencies that are difficult to observe and measure in a standardized way. Debriefing allowed for identification of performance gaps.;Introduction Physician competence is difficult to capture,1 and deconstructing competence into measurable segments may result in loss of the overall sense of a physician's ability.2–6 The heterogeneous nature of residents' on-the-job training7 necessitates standardized assessment tools that mitigate inherent rater bias.8,9 Reliable evaluation tools are essential for Milestone assessment in the Next Accreditation System for graduate medical education.9 Objective structured clinical examination (OSCE) tools generate information about several dimensions of performance, including those difficult to evaluate by traditional means. OSCEs have high validity and educational impact in graduate medical education.10–19 Trained standardized patient raters provide important measures of performance.4,13,20 Educators in procedural-based specialties have developed a proliferation of bench models and simulated environments to evaluate procedural skills.3,21 Skill assessments for procedures using global rating scales and checklists display moderate interrater reliability for performance.22,23 Obstetrician-gynecologists must be able to integrate a wide range of skills, but there are limited tools for assessing integrated skills. The Test of Integrated Professional Skills (TIPS) requires residents to interact with standardized patients in clinical scenarios and perform skills on models for forceps delivery, transvaginal ultrasonography, intrauterine device placement, and laparoscopic suturing. The aim of TIPS is to assess integration of skills on an individual resident. Faculty observers can identify gaps in resident ability and provide immediate feedback and directed teaching. We describe the implementation of the TIPS examination and a comparison of resident performance data from the examination with faculty data obtained during regular rotation evaluations.;Results Twenty-four residents, postgraduate year (PGY)–1 through PGY-4, participated in the TIPS examination. Mean scores across ACGME competencies appeared to improve with level of training (figure 1), although the difference between PGY levels was found to be significant only for procedural skills (1-way analysis of variance F??=??6.92, P?