A Delirium OSCE to Assess Medical Trainees’ Care for Hospitalized Older Adults

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Introduction Delirium is an underrecognized medical emergency that commonly affects hospitalized older adults. Medical trainees need to be able to diagnose delirium as a core geriatrics competency. We created an objective structured clinical examination (OSCE) with a standardized patient case, pilot tested with medical students, then implemented with internal medicine residents and family medicine residents. Methods This 30-minute OSCE features an older adult who has been hospitalized for overnight observation after a procedure and develops confusion and inattention consistent with delirium. The learner interacts with the patient and bedside nurse to develop an assessment and plan. We prepared training guides for standardized patients and faculty evaluators to ensure standardization. Learners and faculty evaluated the OSCE. Results The OSCE results in the pilot group of 6 students demonstrated opportunities to integrate geriatrics content through a longitudinal curriculum. The OSCE was subsequently used among 46 internal medicine and family medicine residents. No students and only 28% of residents assessed attention; half of the students and 30% of residents also failed to assess baseline mental status. Learners had variable managerial strategies, with some mastering nonpharmacologic strategies and others relying on chemical restraints. These results informed the programs’ teaching strategies. The tool was adapted for a variety of settings, formal and informal, to the satisfaction of both learners and faculty evaluators. Discussion The delirium OSCE is a promising tool to conduct formative assessment of learner competencies in geriatric medicine, and to prepare trainee participants to deliver age-friendly care for older adults.