Team OSCE: A Teaching Modality for Promotion of Multidisciplinary Work in Mental Health Settings.

OBJECTIVE: The objective structured clinical examination has been in use both as an assessment and a teaching modality within the mental health profession. It focuses on individual skill enhancement, the inter-professional understanding of role obligation is helpful in promoting competence as a team as well as role of other team members. The Team OSCE (TOSCE) is an effective way in promoting inter-professional learning.
MATERIALS AND METHODS: The present work assesses the trainee experience with TOSCE and its utility in clinical care. Twenty-two mental health trainees (17 male and 5 female from psychiatry, clinical psychology and psychiatric social work) got exposure to weekly OSCAF training as well as 2-3 Team OSCAFS on various aspects of clinical work as a part of their clinical training for 3 months. Rating from the trainees were taken on TOSCE feedback checklist.
RESULTS: TOSCE was helpful in promoting the understanding role of other team members; shared decision-making, problem-solving, handling unexpected events, giving feedback and closure.
CONCLUSION: The TOSCE may be introduced as a way to work on clinical performance, shared decision-making and inter-professional understanding.

INTRODUCTION

The objective structured clinical examination has been in use both as an assessment and a teaching modality within the mental health profession. In a previous study on the use of OSCE as a training tool in India (the OSCAF), trainees were seen performing well in areas such as introduction, taking consent, establishing rapport, paraphrasing and clarity and less than satisfactory during the clinical interview in the areas of assessing confidentiality (73.5%), assessing comfort (62%), summarizing (60%), closure (62%) and assessment of whether the patient had understood what was being said (42%).[1] In a study exploring trainee comfort with the OSCAF as a training method, trainees reported comfort in conducting interviews and reported a change in their communication skills, ability to empathize, reflection of feeling and overall clinical and interpersonal skills.[23]

While the OSCAF focuses on individual skill enhancement, we must remember that most mental health interventions involve a multidisciplinary team approach. The inter-professional understanding of role obligation is helpful in promoting competence as a team as well as role of other team members. The Team OSCE (TOSCE) is an effective way in promoting inter-professional learning.[4] The present work assesses the trainee experience with TOSCE and its utility in clinical care.

MATERIALS AND METHODS

Twenty-two mental health trainees (17 male and 5 female from psychiatry, clinical psychology and psychiatric social work) got exposure to weekly OSCAF training as well as 2-3 Team OSCAFS on various aspects of clinical work as a part of their clinical training for three months at National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India. The team role play consisted of three trainees who played roles of psychiatry trainee, clinical psychologist and psychiatric social workers. Roles were swapped and the three trainees in each TOSCE played the role of a specialty other than her won. For example, the psychiatry trainee role played a psychiatric social worker, while the social work trainee played the role of a psychology trainee. Each team role play of 15-20 minute duration was evaluated using a TOSCE feedback assessment checklist which was developed by the investigators through focus group discussion of mental health professionals having 5 or more experience as OSCE trainers.

Items with high content validity that were included were introduction of topic, understanding role of other team members, shared decision-making, problem-solving, handling unexpected events and giving feedback, confidentiality, consent, establishing rapport, paraphrasing, assessing comfort, check for understanding, empathy, summarizing, closure. Rating were obtained on TOSCE feedback checklist (on 0 to 10 rating) from the trainees.

RESULTS

The present work includes feedback from 12 psychiatry, 5 clinical psychology and 5 Psychiatry social work trainees following informed consent procedures. The research was approved by the institutional ethics committee. All the trainees acknowledge the important role of TOSCE in promoting understanding of the other specialties and desired for more sessions of TOSCE [Table 1]. 85% reported role of TOSCE in promotion of team skills and 76% reported its role in enhancing the interview skills.

Table 1

TOSCE and Pattern of feedback about team and interview skills

DISCUSSIONS

The findings revealed that TOSCE was helpful in promoting understanding role of other team members, shared decision-making, problem-solving, handling unexpected events, giving feedback and closure. [Table 1] All the trainees acknowledged the role of TOSCE in understanding the role of other disciplines, inter-professional growth and asked for more sessions of TOSCE during psychiatry training. Being in ‘another person's shoes’ made them realize the importance of other discipline and the challenges that each discipline might face in communication as well as the need for role delineation and role complementarity.

Our findings have been corroborated by other available work. Foty-eight percent of students in a study believed that 15 minutes was not enough for each station and they need more time.[5] Group OSCE is a good method for formative and self-assessment.[67] Early introduction of TOSCE would also be useful for promoting shared learning even in undergraduate programmes.[8]

TOSCE has also been used as a useful examination method for measuring competency. More than 50% of students reported that success in the exam requires clinical competency, team work and problem solving ability.[5]

CONCLUSIONS

The TOSCE may be introduced in mental health training or any specialty where team approaches are needed (palliative care, diabetes) as a way to work on clinical performance, shared decision-making and interprofessional understanding.