Background/Purpose: For 8 years, the New York City Rheumatology Objective Self Assessment Clinical Exam (NYC-ROSCE) has been used to assess trainee competencies such as patient care and communication.  Most recently, we have refocused the NYC-ROSCE to assess professionalism, using a validated professionalism questionnaire. This year we asked which individual skills were most likely to correlate with overall achievement in the area of professionalism.

Methods: The 2012 NYC-ROSCE included 5 patient-centered stations focusing on rheumatic disease.  For the first time, stations were designed to challenge fellows with patient psychosocial dilemmas, in order to assess specific aspects of the patient-doctor relationship including physician professionalism. Rheumatology trainees (n=28) and faculty MD-evaluators (n=32) from 6 NY rheumatology training programs participated. Professional actors (n=30) were trained to role-play patients. Quantitative assessments of the trainees were made at each station (9-point Likert scale) by patient- and MD-evaluators in the areas of: maintaining composure, partnering with the patient, being open and honest, professionalism, empathy and accountability. Qualitative free text comments were solicited after each station, regarding the strengths and weaknesses of each fellow’s performance during the encounter. In addition, trainees rated their own performance after each encounter. Immediate oral feedback on professionalism was given to each trainee by both patient-actors and MD-evaluators.

Results: When assessing professionalism, MD-evaluators tended to rate trainees lower (6.74+/-0.58) than patient-actors (7.12+/-0.78), suggesting that physicians and patients may apply different criteria when assessing professionalism during observed encounters. Trainee self-evaluations for professionalism were in the range of the MD-evaluators rather than the patient-actors (6.70+/-1.16).  MD-evaluators also tended to give lower ratings for accountability (6.32+/-0.82) than patient-actors (6.68+/-0.85) or the trainees themselves (6.53+/-1.04). In contrast, ratings of empathy were found to be closely in agreement for trainees (6.62+/-1.04), MD-evaluators (6.58+/-0.69) and patient-actors (6.55+/-1.05. MD-evaluators most often commented on the trainees’ word choice and body language, ability to formulate a clear plan, ability to recognize and address patient’s fears, and the need to actively partner with the patient.  For all evaluators, excessive use of medical jargon was most often cited as the area that needed improvement. The use of jargon correlated inversely with the ratings of professionalism for MD-evaluators and patient-actors.

Conclusion: The introduction this year of new and challenging patient encounters allowed us to assess which patient-centered traits most contributed to perceptions of achievement in the area of professionalism. We found that our evaluators considered the ability to minimize medical jargon to be one of the most important markers of the competency of professionalism.  This finding suggests that patients view communication as correlating most strongly with their doctor’s professionalism.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-rheumatology-objective-structured-clinical-examination-using-challenging-patient-scenarios-shows-trainee-use-of-medical-jargon-correlates-inversely-with-patient-perceptions-of-professionalism/