The patient safety OSCE for PGY-1 residents: a centralized response to the challenge of culture change

Teach Learn Med. Jan-Mar 2009;21(1):8-14. doi: 10.1080/10401330802573837.


Background: Accreditation and Institute of Medicine mandates require retooling of graduate medical education curriculum and assessment processes. This Objective Structured Clinical Exam (OSCE) focused on patient safety-specific skills important to stakeholders from multiple institutions.

Purposes: A 10-station OSCE was designed to assess patient safety-related competencies in new Postgraduate Year 1 (PGY-1) residents. The OSCE emphasized performance of essential skills and teamwork, and it provided early formative feedback to trainees and leadership.

Methods: Group nominal process selected 10 final OSCE stations. Two stations were designed to assess team competencies and response to feedback. Two hundred thirty-five trainees enrolled in 64 programs participated during summer 2006. Skill-set aggregation was employed to improve the validity of individual feedback.

Results: Significant performance deficits were noted. Trainee and administrator evaluation of the experience was positive.

Conclusions: Multi-institutional test development and centralized testing was well received and produced worrisome results. Early assessment can guide the development of task-specific personalized learning plans and systemwide curricular improvement. Further research is needed to determine whether such an effort directed at PGY-1 trainees can improve trainee performance and patient safety.

MeSH terms

  • Curriculum
  • Education, Medical, Graduate
  • Educational Measurement
  • Humans
  • Internship and Residency*
  • Medical Errors / prevention & control
  • Organizational Culture*
  • Professional Competence
  • Program Evaluation
  • Safety Management*