Background/Purpose

The interaction between rheumatology fellows and Internal Medicine residents in the setting of a consult offers an important opportunity for resident learning.  However, teaching in the setting of a consult interaction can be challenging due to time constraints and lack of a longitudinal relationship between the resident and fellow.  Fellows’ teaching skills in the setting of the consult interaction have not been evaluated.  We conducted a pilot study utilizing the Objective Structured Teaching Exercise (OSTE)¹ to evaluate rheumatology fellows’ teaching skills. 

Methods

First and second year rheumatology fellows from 5 training programs participated in a one-station OSTE during a 7 station rheumatology Objective Structured Clinical Examination  (OSCE) in February 2014.  Following the OSCE format, fellows were given 10 minutes to teach a standardized resident in the setting of a simulated consult and relay their consult recommendations, followed by 2 minutes of feedback.  Prior to beginning the station fellows were given written instructions on the objectives of the exercise as well as a resident admission note describing the patient (32 year old male with monoarthritis).  The OSTE was proctored by 3 faculty members (including author [EMM]) and utilized 3 standardized residents.  Each fellow was evaluated by one faculty member and the standardized resident using an 8-point instrument adapted from a validated OSTE rating tool.¹  Prior to the OSTE, faculty and standardized residents received written materials describing the station and the rating tool and underwent a 30-60 minute training.

Results

Nineteen rheumatology fellows participated in the OSTE (11 first years and 8 second years).  Fellows’ overall teaching effectiveness had a mean score of 3.75 out of 5 (Table).  Of seven specific skills evaluated, fellows were rated highest on their ability to present organized material.  The lowest rated skills were evaluating residents’ factual knowledge, evaluating residents’ ability to synthesize knowledge and giving feedback.  No differences in teaching skill ratings were detected between first and second year fellows.  Ratings of the two evaluators had a high degree of correlation for all items (0.85-1.0).

Conclusion

Rheumatology fellows may benefit from programs designed to improve their teaching skills, particularly in the consult setting where time pressure and lack of a longitudinal relationship with learners impede the teaching interaction.  Such interventions should focus on improving fellows’ ability to engage in learner-centered teaching and feedback.  Our pilot study suggests that the OSTE may be a useful tool in assessing fellows’ teaching skills.

References

1. Morrison EH, Rucker L, Boker JR, Gabbert CC, Hubbell FA, Hitchcock MA, Prislin MD. The effect of a 13-hour curriculum to improve residents’ teaching skills: a randomized trial.  Ann Intern Med. 2004 Aug 17;141(4):257-63