What should be included in an OSCE (Objective Structured Clinical Examination) exam for a first year pediatric resident?

OSCE Exam Design for First-Year Pediatric Residents

An OSCE for first-year pediatric residents should include 8-12 stations assessing core clinical competencies including history-taking, physical examination, communication skills, procedural skills, and clinical decision-making, with each station lasting 5-10 minutes. 1, 2

Station Structure and Format

Design 8-12 stations total with alternating formats:

• Half the stations (4-6) should involve direct clinical tasks performed while being rated by an observer 1
• The other half should include written questions based on data just gathered in the preceding station 2
• Each clinical task station should last 5 minutes 2
• Include 1-2 rest stops between stations to prevent fatigue 2

Essential Clinical Competencies to Assess

History-Taking and Communication Skills (3-4 stations):

• Conduct interviews with standardized patients or real patients focusing on common pediatric presentations 2, 3
• Assess ability to gather age-appropriate history from both child and parent 1
• Evaluate communication effectiveness, including explaining diagnoses and treatment plans to families 1
• Test cultural competency and family-centered communication approaches 1

Physical Examination Skills (2-3 stations):

• Perform focused physical examinations on standardized patients or pediatric mannequins 2
• Assess proper technique for examining infants and children of different ages 1
• Evaluate ability to identify normal versus abnormal findings 1
• Include assessment of growth parameters, vital signs, and developmental milestones 4

Procedural and Technical Skills (1-2 stations):

• Demonstrate proper technique for common pediatric procedures (venipuncture, IV placement, or similar skills appropriate to PGY-1 level) 2
• Assess proper machine settings, positioning, and documentation if including point-of-care procedures 1
• Evaluate ability to interpret laboratory results or imaging studies 2

Clinical Decision-Making (2-3 stations):

• Present clinical scenarios requiring diagnostic reasoning and management planning 3
• Include written postencounter questions testing clinical judgment 3
• Assess ability to formulate differential diagnoses and appropriate workup plans 1

Specific Clinical Scenarios for First-Year Residents

Include these common pediatric presentations:

• Well-child visit assessment (4-day or 2-month visit) with feeding evaluation and anticipatory guidance 4
• Acute illness presentations (fever, respiratory distress, dehydration) 1
• Developmental screening and interpretation 1
• Newborn examination with jaundice assessment 4
• Communication of abnormal test results to families 1
• Maternal postpartum depression screening during infant visit 4

Scoring and Assessment Methods

Use a structured scoring approach for each station:

• Award 15 points for completion of specific checklist items (technical merit, not interpretative merit) 1, 3
• Include 5 points for global assessment by the observer 3
• Add 10 points for written postencounter questions 3
• Total possible score per station: 30 points 3

Assess these specific elements:

• Image quality and framing (if applicable to procedural stations) 1
• Identification of anatomic landmarks 1
• Completeness of examination protocol 1
• Communication clarity and compassion 1
• Clinical reasoning demonstrated in postencounter questions 3

Examiner Training and Standardization

Ensure all examiners are properly trained:

• Use qualified faculty members to directly observe and rate residents 1
• Train standardized patients to portray scenarios consistently 1
• Provide examiners with detailed scoring rubrics before the examination 1
• Conduct calibration sessions so examiners apply criteria uniformly 1

Logistical Requirements

Resource allocation:

• Maintain no more than 5 participants per examination room/station 1
• Assign at least one trained examiner per station 1
• Use actual patients (preferred) or simulation settings 1
• Ensure adequate space for simultaneous stations 1

Documentation requirements:

• Track each resident's performance across all stations 1
• Provide immediate verbal feedback at conclusion of OSCE 3
• Calculate and distribute scores within 1-2 weeks 3
• Document specific areas requiring improvement for remediation planning 1

Validity and Reliability Considerations

The OSCE should demonstrate construct validity by:

• Clearly separating performance levels between different training years (though this may be limited for PGY-1 residents early in the year) 2
• Assessing clinically important objectives that residents recognize as relevant to their practice 2
• Achieving internal consistency reliability of at least 0.69-0.83 with 5 stations, higher with more stations 3, 2

Common pitfalls to avoid:

• Using fewer than 5 stations, which compromises reliability 3
• Assessing interpretative merit rather than technical skill in procedural stations 1
• Failing to provide structured feedback after the examination 3
• Not correlating OSCE results with other assessment methods (in-training evaluations) to establish concurrent validity 3
• Creating stations that are too advanced for PGY-1 level, which reduces construct validity 2

Integration with Training Program

Use OSCE results to:

• Identify specific clinical skills requiring additional training 1
• Provide formative feedback early in residency 3
• Complement other assessment methods including in-training examinations and faculty evaluations 2, 3
• Guide individualized learning plans for residents scoring below 60% 3
• Assess competency at end of rotations or annually 1