A Culture OSCE

Objective: Residency training programs have attempted to instill cultural competency skills by exposures to varied patient populations, lectures on cultural issues, or small-group discussions that explore the trainees' own cultural values. However, culturally appropriate care has a large skills component, and organized practice and feedback are necessary to instill these skills. Multiple-station exercises—such as teaching OSCEs that expose trainees to strategically planned clinical scenarios and provide systematic practice and feedback by faculty observers and standardized patients—are uniquely suited to impart such complex competencies. The objective of the Culture OSCE was to provide such an opportunity to develop cultural competency skills. Description: In the fall of 1999, a six-station formative cultural OSCE was developed and administered to all second-year pediatrics residents (23 residents). The residents had to explore the patient's and family's beliefs and behaviors regarding illness and treatment, recognize differences in communication styles within families and with health care providers, and address differences in perspective in order to negotiate a mutually acceptable plan of action. The OSCE stations were as follows. (1) Informed Consent—requesting consent for a child's emergency surgery and blood transfusions from a parent who is a Jehovah's Witness. (2) Lifethreatening Illness—discussing the possibility of openly addressing a teenager's cancer with his Nigerian parents who are opposed to such practices. (3) Pelvic Exam—explaining the need for pelvic exam to rule out pelvic inflammatory disease to a girl from a traditional Muslim background who fears her sexual activity will be severely punished. (4) Down's Syndrome—exploring the expectations of a couple about their Orthodox Jewish community's reactions to the birth of a child with Down's Syndrome. (5) Suspected Child Abuse—discussing suspicions of child abuse with an Orthodox Jewish family. (6) Alternative Medicine (paper-and-pencil task)—match questions about alternative treatments and photo identification of skin marks that result from traditional healing practices but can be mistaken for child abuse (e.g., cupping, coining). The residents received verbal and written feedback on their performances, based on rating scales developed for each scenario. Input from the residents, faculty observers, and standardized patients was gathered to assess the educational value of this experience and to continue to develop the exercise. Discussion: The results of this initial cultural OSCE were quite promising. The residents and faculty found it a useful learning experience, and it generated much discussion about how to deal with challenging situations. We are now in position to build on these experiences by expanding and improving the station pool and undertaking a rigorous evaluation study to delineate the learning gains from such a program. Over the next year, we plan to repeat this training exercise with a new class of second-year residents and to assess their cultural skills before and after the OSCE exercise. It is hypothesized that residents who have an opportunity to deal with standardized patients and to receive specific feedback about their performances and the issues related to the case will be better able to recognize culturally related issues and deal openly and respectfully with differences in perspective.