Assessment of Clinical Skills and Professionalism

Depression and burnout plague physicians across fields though neurologists are more likely than the average physician to experience burnout. We developed a simulation to effectively train neurology residents to identify and help impaired colleagues. A standardized professional portrayed a depressed co-resident who was abusing alcohol. Residents were evaluated and received feedback regarding their ability to identify and screen for depression and substance use. Early identification of burnout can allow for early implementation of interventions to counteract burnout.

There is an increased awareness among healthcare professionals to discuss social determinants of health (SDOH) information with patients. However, the awareness does not necessarily translate into effective response to the situation. In order to better understand the nuances in such conversations between patients and providers, we reviewed qualitative responses from Unannounced Standardized Patient (USP) portraying patients with SDOH concerns who were seen as part of a study to investigate healthcare teams’ management of SDOH information.

Effectively presenting the diagnosis of psychogenic nonepileptic seizures (PNES) is important to optimize patient outcomes. We designed an OSCE in which a resident had to inform a standardized patient of her PNES diagnosis and discuss a treatment plan, with real time feedback by the SP and an observing attending. Residents found the OSCE helpful with the greatest room for improvement being in the domain of psychosocial assessment.

The transition from internal medicine to neurology can be jarring for many residents, and presents a host of challenges. In 2018 a one-week intensive “boot camp” was developed for incoming residents in place of clinical duties. During the first week of July, they completed a series of interactive didactics covering basic neuroanatomy and physiology, the neurologic exam, urgent clinical presentations, neuroradiology, and simulation sessions.

Not infrequently, healthcare providers are subject to patient or family biases, even racism. As part of professionalism training they need to learn how to master their emotional impact and optimize effectiveness of such challenging clinical encounters. OSCEs provide unique opportunities to simulate difficult clinical situations and help learners develop effective strategies through skills practice, feedback and reflection.

Point of care ultrasound (POCUS) is widely used in medicine to enhance decision-making processes for providers; however, formal training is lacking. A curriculum for POCUS training was initiated by the NYU Department of Medicine with standardized patients (SP’s) used for skills assessments. However, the use of SP’s is costly, time consuming, requires large numbers of trained faculty, and is limited to normal ultrasound findings.

We sought to quantify ordering behaviors in primary care practice across three unannounced standardized cases by comparing patterns of preventive vs diagnostic test/lab ordering and looking at specific test ordering correlates. USPs portrayed three clinical scenarios a “Well” visit, a chief complaint of “Fatigue,” and “Asthma.” USPs were scheduled to visit residents in an urban, safety-net hospital. Electronic orders were extracted via chart review and compared to scenario-specific practice guidelines.

Healthcare professionals require education and practice to master their communication and procedure skills, especially in potentially distressing circumstances such as palliative extubations. The Palliative Extubation OSCE involved part 1: the family meeting and part 2: the extubation procedure. The OSCE provided learners the opportunity to assess their communication and procedural skills in a low stakes environment in order to maximize learning and evaluate their preparedness prior to completion of fellowship.

Pregnancy, once believed to be protective against mental illness, is now recognized as a risk factor. Training in medical school is key to addressing the needs of the peripartum population. We developed a three-pronged women’s mental health curriculum embedded in the Psychiatry Clerkship consisting of: 1) a multimedia reproductive psychiatry eBook; 2) a graded psychopharmacology quiz question; and 3) a postpartum depression OSCE case.

Family centered rounds (FCR) are performed across the country to encourage the patient and family to be an integral part of the health care team. Although the concept of FCR is consistent across different organizations, there are elements that vary in different institutions.