Subtle skills: Using objective structured clinical examinations to assess gastroenterology fellow performance in system based practice milestones

Table 1 Fellow reported preparedness for each case, n (%)

Did you feel prepared for this case?	No	Yes
Impaired colleague1	6 (24)	19 (76)
Hand off with I-PASS	6 (23)	20 (77)
PEG discussion1	3 (13)	21 (88)
Note-writing and feedback	2 (8)	24 (92)

¹Data missing due to incomplete survey responses. I-PASS: Illness severity, patient summary, action list, situation awareness, synthesis; PEG: Percutaneous endoscopic gastrostomy.

Table 2 Fellow reported performance for each case, n (%)

How would you rate your overall performance in this case?	Could have been better	Fine	Pretty good
Impaired colleague	9 (34.6)	9 (34.6)	8 (30.8)
Hand off with I-PASS	2 (7.7)	15 (57.7)	9 (34.6)
PEG tube discussion	9 (34.6)	9 (34.6)	8 (30.8)
Note-writing and feedback	2 (7.7)	13 (50)	11 (42.3)

I-PASS: Illness severity, patient summary, action list, situation awareness, synthesis; PEG: Percutaneous endoscopic gastrostomy.

Table 3 Fellows’ perceived skills and beliefs about clinical practice as reported in post-examination survey, n (%)

Items	Strongly disagree	Somewhat disagree	Somewhat agree	Strongly agree
Before today’s OSCE, I felt comfortable discussing the utility of PEG placement in a patient with neurologic compromise	1 (4)	2 (8)	16 (67)	5 (21)
After today’s OSCE, I feel more comfortable discussing the utility of PEG placement in a patient with neurologic compromise	0 (0)	0 (0)	10 (42)	14 (58)
Before today’s OSCE, I felt comfortable during hand-off discussions with my co-fellows	0 (0)	1 (4)	10 (42)	13 (54)
After today’s OSCE, I feel more comfortable during hand-off discussions with my co-fellows	0 (0)	1 (4)	8 (33)	15 (63)
Before today’s OSCE, I felt comfortable that I would be able to recognize signs of substance abuse and depression in a colleague and referring them to the appropriate resources	2 (8)	5 (21)	12 (50)	5 (21)
After today’s OSCE, I feel comfortable that I would be able to recognize signs of substance abuse and depression in a colleague and referring them to the appropriate resources	0 (0)	0 (0)	10 (42)	14 (58)
Before today’s OSCE, I felt very comfortable giving constructive criticism and feedback to my learners	0 (0)	2 (9)	13 (57)	8 (35)
After today’s OSCE, I feel more comfortable giving constructive criticism and feedback to my learners	0 (0)	1 (4)	6 (26)	16 (70)

OSCE: Objective structured clinical examination; PEG: Percutaneous endoscopic gastrostomy

Table 4 Fellows’ views of the objective structured clinical examination based on post-examination survey, n (%)

Items	Strongly disagree	Somewhat disagree	Somewhat agree	Strongly agree
OSCEs are an important part of my clinical training	0 (0)	3 (13)	11 (48)	9 (39)
My performance on this OSCE accurately reflects my performance in clinical practice	1 (4)	5 (21)	13 (54)	5 (21)
These OSCE cases are similar to actual encounters	0 (0)	4 (17)	13 (54)	7 (29)
The immediate feedback that I received is very useful	0 (0)	0 (0)	4 (17)	20 (83)
I generally perform better on the OSCE than in clinical practice	8 (33)	14 (58)	0 (0)	2 (8)
I generally do better in clinical practice than I do in an OSCE	1 (4)	2 (8)	12 (50)	9 (38)
OSCEs makes me feel anxious	3 (13)	4 (17)	12 (50)	5 (21)
OSCEs are an effective means of demonstrating my interpersonal skills	0 (0)	3 (13)	16 (67)	5 (21)
OSCEs are an effective means of demonstrating my ability to demonstrate a shared decision-making approach to patient care	0 (0)	2 (8)	15 (63)	7 (29)
My clinical training fully prepared me for this OSCE	1 (4)	3 (13)	14 (58)	6 (25)
After I receive feedback on the OSCE, I will develop a plan to improve my clinical skills	0 (0)	0 (0)	12 (50)	12 (50)
I will incorporate what I have learned from this OSCE into my clinical practice	0 (0)	0 (0)	9 (38)	15 (63)
If you have participated in this OSCE before: Did your prior OSCE experience affect your participation today?	0 (0)	0 (0)	4 (31)	9 (69)

OSCE: Objective structured clinical examination.