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Geriatric Cardiology OSCE: The Hidden Curriculum, Identifying Hypoactive Delirium When Obtaining Procedural Consent


Geriatric Cardiology OSCE: The Hidden Curriculum, Identifying Hypoactive Delirium When Obtaining Procedural Consent

Medical College of Wisconsin
Kathryn Denson, MD, Gabriel Manzi, Catharine Malmsten, Judith Rehm
Donald W. Reynolds Foundation
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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 learner performance. At the Medical College of Wisconsin (MCW), geriatricians and cardiologists worked together to create and implement a geriatric cardiology educational OSCE for cardiology fellows. Key curriculum content gaps (hypoactive delirium recognition, use of cognitive assessment tools) 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/assessment method. Fellows self-assessed their competency level in those EPAs both pre and post OSCE curriculum intervention (Unable to Perform (1) - Teach Others (5)). 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 End Stage Heart Disease & Clarifying Care Goals."

This resource, also available on MedEDPortal.

Educational objectives: 
  1. Identify subacute delirium in an undiagnosed early-moderate stage dementia patient
  2. Elicit a history substantiating dementia from the patient and daughter
  3. Recognize delirium using the CAM criteria and tool
  4. Determine decisionality of the patient (non-decisional) in regards to medical decision making
  5. Determine decisionality based on the 3 primary requirements for medical decision making (take in information, apply it to self, express a choice)
  6. Identify the decision-maker in the patient’s care (POAHC—daughter) to obtain consent for the cardiac catheterization procedure

Purpose of OSCE station:

By the conclusion of this session, learners will be able to better provide care to geriatric patients in the ACGME Competency Domains including:

  1. Medical Knowledge: through identification of delirium and potential contributing factors.​
  2. Patient Care: applying knowledge of delirium identification to the process of obtaining informed consent for a cardiac procedure.
Additional information/Special implementation requirements or guidelines: 

​Two standardized patients are required for each OSCE learner case (one geriatric "patient" and one "family member/caregiver"). Examination room to conduct OSCE, either with an examination table or bed for the "patient" and two chairs, one for the "family member/caregiver" and one for the fellow.

Intended learner audience: 
Learning resource types: 
Estimated time to complete: 
1 hour
Resident Level Competencies: 
Conflict of Interest Disclosure: 
No, I (we) have nothing to disclose.
Contact Person/Corresponding Author:
Kathryn Denson, MD

Suggested Citation:
Geriatric Cardiology OSCE: The Hidden Curriculum, Identifying Hypoactive Delirium When Obtaining Procedural Consent. POGOe - Portal of Geriatrics Online Education; 2014 Available from: