Team-Based Decision-Making in an Objective Structured Clinical Examination (OSCE): Are Pre-Licensure Healthcare Students "Collaborative Practice-Ready"?

A teamwork OSCE station - Encompassing shared decision making between a doctor, pharmacist and patient

BACKGROUND AND PURPOSE

Teamwork with a focus on incorporating interprofessional education (IPE) is a core skill taught in pharmacy curriculum. Including the patient in shared decision making has become a more empathetic and holistic approach to care. Teamwork skills and approaches are usually assessed by peers via group work.

EDUCATIONAL ACTIVITY AND SETTING

A teamwork Objective Structured Clinical Examination (OSCE) station was implemented in 2022 in two countries, conducted in final year pharmacy students where students had to solve a clinical scenario with a doctor and patient in the room and manage any resistances to therapy recommendations. Students were marked on their collaborative skills and how they articulated clinical evidence to justify their therapy recommendations to reach an optimal goal to suit the team. Perception data from students simulated patients and doctors were also collected.

FINDINGS

Across both countries (n = 414), the overall mean score was 79.1% (24.0%SD) across six different OSCE cases. Students generally struggled with the concept of engaging in a two-way conversation, and often presented their full recommendations without any breaks to confirm understanding or agreement. Simulated patients appreciated the OSCE showing a patient role in decision making. Simulated doctors valued the OSCE for its assessment of clinical justification in times of disagreement. Overall, 86.2% of students (n = 354) agreed or strongly agreed the station assessed their teamwork skills adequately.

SUMMARY

A teamwork OSCE station is a valuable assessment for assessing shared decision making skills and more work around prepare students to engage in two-way conversations is needed.

Pharmacy Education Needs to Address Diagnostic Safety

The American Association of Colleges of Pharmacy, the Accreditation Council for Pharmacy Education, and the Center for the Advancement of Pharmacy Education frame patient safety from the perspective of medication management, which is also the current focus of pharmacy education and training. With the growing appreciation that diagnostic errors represent an urgent and actionable patient safety concern, the National Academy of Medicine has recommended diagnostic safety training for all health care professions. The Society to Improve Diagnosis in Medicine has worked with an interprofessional consensus group to identify a set of 12 key competencies necessary to achieve diagnostic quality and safety that focuses on individual, team-based, and system-related competencies. Much of this already exists in pharmacy education, but pharmacy training programs need to give graduates more guidance on how they contribute to the diagnostic process and the prevention and detection of diagnostic errors. We describe the current state of progress in this regard, and what steps are needed by training programs to provide content and assessment so that graduates achieve the requisite competencies. Governing and advisory bodies need to expand the expectations around patient safety to include diagnostic safety.