Academic journal article American Journal of Pharmaceutical Education

A Primer for Objective Structured Teaching Exercises

Academic journal article American Journal of Pharmaceutical Education

A Primer for Objective Structured Teaching Exercises

Article excerpt

INTRODUCTION

The objective structured teaching exercise (OSTE) is a high-fidelity training and assessment method for advancing the teaching and interpersonal communication skills of faculty members, preceptors, and residents. (1) First introduced in the medical literature in the early 1990s, OSTE engages learners in performance-based teaching activities with a standardized student. The OSTE method not only provides a unique and innovative way to teach, enhance, and evaluate educational skills, but also presents an ideal platform for future scholarship.

The body of OSTE literature is primarily descriptive in nature and not as robust as the literature regarding standardized patients in health profession curricula. However, interest in the OSTE technique stems from the postulation that standardized student interactions will provide benefits to teachers similar to those that standardized patient interactions provide to students. In the 1960s, neurologist Dr. Howard Barrows was seeking a better method than traditional clinical observations to assess the clinical skills of his medical residents. He developed the concept and first used standardized patients by tapping into an available pool of actors in Southern California. (2) Using cases of actual neurology patients, Barrows trained the actors to present the same signs, symptoms, history, emotional state, and, in some cases, physical examination findings to learners. Using the standardized patient, he could then educate, observe, and assess each learner in a safe and controlled environment. Standardized patients are now used extensively throughout health professional education and the technique has been adapted for use with individuals portraying students for faculty development. Standardized student encounters can be used for instruction and practice of skills, performance evaluation, program assessment, and research. These encounters allow for repeated experiences in which the learner can attend to the critical aspects of a situation and improve performance in response to feedback. The learner is an active participant in the experience rather than a passive observer. Standardized student encounters enable expert educators to observe and improve the interaction of the participant with the standardized student.

There is a paucity of published literature regarding OSTEs, particularly regarding effectiveness of the technique. Nevertheless, when OSTEs have been used as a teaching and learning tool, participants have been uniformly positive about the experience. Participants like the technique, feel the cases are realistic, and self-perceive that their teaching skills have improved as a result of participation. (1,3) In the only published study that has attempted to examine if participation in an OSTE changed teaching behaviors, no differences were found in student evaluations of preceptor performance 6 months prior to and 6 months after participating in an OSTE. (4) However, student ratings of preceptor performance were high at baseline, thus, a ceiling effect may have limited the ability to note any meaningful change.

There is slightly stronger evidence that OSTEs can be an effective method for evaluating the benefits of faculty development efforts. Morrison et al created a 13-hour curriculum to help develop the teaching skills of second-year generalist medical residents. (5) Residents were randomized into 3 study groups; 2 of these groups served as controls and 1 as the intervention group. (6) The intervention group participated in a pre-curriculum, 8-station OSTE, completed the 13-hour teaching curriculum, and then repeated the OSTE 6 months after curriculum completion. The first control group only completed the 2 OSTEs, without participation in the 13-hour curriculum. The second control group only completed the final post-curriculum OSTE so that the investigators could determine if participation in the pre-curriculum OSTE "primed" the teaching behavior of the residents independent of curriculum participation. …

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