Chief Resident NYU Langone Health New York, New York, United States
Background: In the wake of the COVID-19 pandemic we have seen an unfortunate, but anticipated rise in adolescent mental health issues presenting to outpatient settings. Although in-person patient volume is returning, it is clear that virtual visits will be part of pediatric healthcare in a way that was not anticipated prior to the pandemic. We developed a virtual Objective Structured Clinical Exam (OSCE) curriculum to train residents in recognition and management of adolescent mental health complaints in a virtual encounter, incorporating clinical experts and family faculty (FF), adolescent patients and parents of pediatric patients cared for at our children’s hospital.
Objective: To evaluate pediatric residents’ abilities to perform confidential adolescent visits on a virtual platform and assess the need for future educational content.
Design/Methods: We designed an OSCE in which a standardized patient (SP) playing an adolescent presents to a virtual sick visit with non-specific complaints. History and clues during the encounter reveal stress and anxiety as the etiology of the symptoms due to financial insecurity provoked by the COVID-19 pandemic. Pediatric residents at all levels of training participated in the OSCE. Deploying a patient and family faculty program developed at our institution, the residents received individual feedback after the encounter from the SP, an expert clinician (EC), and FF. The SP was trained in character portrayal and both the SP and FF were trained in the checklist evaluation of the learners. Behavioral competencies were rated as not-done, partly-done or well-done with well-done indicating mastery. Residents also participated in a large group debrief featuring content experts and FF.
Results: 89% (51/57) of our program’s residents participated. A minority of residents met skill mastery, as evaluated by the SP, in the following competencies: ensured privacy and discussed confidentiality (33%), pacing of the encounter (49%), discussed coping mechanisms (12%). Mastery was met by a majority of residents, as evaluated by the SP, in important competencies including: demonstrated acceptance and lack of judgement (96%), honestly and transparently shared information (90%). Conclusion(s): The data revealed several areas for improvement in a variety of communication competencies and rapport building skills, suggesting, as we hypothesized, that residents have minimal experience with virtual encounters and would benefit from additional education on this important and timely topic.
Authors/Institutions: Jonathan Lebowitz, NYU Langone Health, New York, New York, United States; Purnahamsi Desai, NYU Langone Health, New York, New York, United States; Meaghan Mcgrath, NYU Langone Health, New York, New York, United States; Chanelle Coble-Sadaphal, NYU Langone Health, New York, New York, United States; Karen R. Liaw, NYU Langone Health, New York, New York, United States; Sondra Zabar, NYU Langone Health, New York, New York, United States; Rachel G. Ramsey, NYU Langone Health, New York, New York, United States; Heather Howell, NYU Langone Health, New York, New York, United States