Medical College of Wisconsin
Fellowship Programs must soon comply with the ACGME's Next Accreditation System (NAS) Milestone performance tracking and reporting requirement and consider Entrustable Professional Activities (EPAs) to measure fellow performance. At the Medical College of Wisconsin (MCW), geriatricians and cardiologists worked together to create and implement a geriatric cardiology education OSCE for cardiology fellows. Key curriculum content gaps (identifying end stage heart disease, identifying and discussing palliative care goals in cardiac patients), were identified through cardiology fellow and faculty knowledge/performance gaps on a needs assessment survey/pretest. Curriculum content was delivered using the Objective Structured Clinical Examination (OSCE) educational method. Fellows self-assessed their competency level in those EPAs both pre and post OSCE curriculum intervention. The curriculum session included the OSCEs station followed by a debriefing session and learner self-evaluation.
This OSCE station may be given alone or combined in a two station OSCE session, with our other geriatric cardiology OSCE titled, "Geriatric Cardiology OSCE: The Hidden curriculum, Identifying Hypoactive Delirium when Obtaining Procedural Consent."
This resource, also available on MedEDPortal, contains all materials for the geriatric cardiology OSCE regarding end stage heart disease and end of life goal setting, but also contains an additional agenda & timeline and a second evaluation form to be used if the two stations are combined.
- Identify end stage cardiac disease in an elderly patient.
- Determine the patient’s cognitive and functional capabilities.
- Elicit the patient’s goals of care.
- Make care recommendations that are consistent with the patient’s life and care goals.
As educators, our goal was to see if the learners were able to recognize that the cardiac disease was at an end stage process, and then follow with an exploration of cognitive, functional and social situations in the context of the patient's goals and wishes to discuss a hospice/palliative care approach. To increase clinical relevance and keep the simulation closer to the reality of clinical care, learners were asked to review the patient's case and discuss plans for his treatment and care. This allows for some learners to make the clinical error of only adjusting medications and suggesting AICD battery replacement if they do not fully assess the patient holistically and delve into their care goals. We believe that this to be a more realistic and powerful way to learn.
This curriculum was successfully implemented in the cardiology fellowship core curriculum but could also be implemented with other levels and types of learners (residents, medical students). Resource limitations may include space and standardized patients.