Objective Skills Clinical Examination: Every Day in the Field of Practice

Book Title: Objective Skills Clinical Examination: Every Day in the Field of Practice

Book Author: David R.L. Cawthorpe

Publication Information: Calgary, Alberta, Canada, self-published, 2018, 69 pp., $39, paperback

If you are an educator in a medical school or within a graduate medical education program, there is seemingly no shortage of books, presentations, and forums discussing how to efficiently and adequately provide meaningful educational experiences for our learners. Educators across these spectrums have likely utilized Objective Skills Clinical Examinations (OSCEs) in an attempt to measure a broad range of learner skills, and at a minimum medical students must complete the Step II Clinical Skills exam. Therefore, exposure to OSCEs are inevitable for medical students. As an educator in family medicine, the OSCE has been a valuable tool to evaluate residents’ performance during the intern year and at times to fine tune a particular skill in a safe, controlled environment. However, the downside to OSCEs is that they do take a great deal of time and resources to implement. This naturally leads to the question of how we might create an OSCE-like experience in our clinical settings and utilize the results for our learners while minimizing the expense and resources to develop the simulation. Therefore, when I discovered this book, I immediately had a context in mind about how it would be helpful in adapting my notion of an OSCE to everyday practice.

David Cawthorpe, PhD, an educator in epidemiology and psychiatry, attempts to answer this natural question in his book. The book is self-published, and reads as a research study completed by the author related to the data surrounding the use of the Treatment Response and Client Tracking (TRACT) method.¹ As Cawthorpe describes, the TRACT method allows for preceptors and learners to enter nonidentifiable patient data into an iPad application and track the patient history, treatment, and outcomes. The benefit to the learner is to compare their diagnoses and treatments to that of upper-level residents and preceptors and to track the patient progress over time. Preceptors and learners can also compare their treatment outcomes to the standard of care. The TRACT method and application is an attempt to provide the information gathered by an OSCE in a real-time, real-life patient setting. The benefits of this method are that the experiences are true patient scenarios, do not have to be developed, and that there are no costs of hosting and recording them in an artificial spaces. According to the author, the TRACT method was included in the World Health Organization’s (WHO) New and Emerging Health Technologies publication.²

While the concept of the TRACT method is intriguing, there are issues of accessibility, training, privacy, and application that would need to be addressed. For example, readers may be slightly disappointed to find they would have to purchase the iPad application in order to fully understand the model discussed in the book. While the appendix provides a pictorial of the application and a user manual, the application was not readily downloadable in the iPad application store. Therefore, readers are unable to walk through the application as they are reading to grasp the concepts described in the book. If educators are excited about the TRACT method, they may find it difficult to adapt and adopt. For example, there may be legal and compliance restrictions within various institutions related to the data that is entered into the application along with concerns about security of devices that are utilizing the application. In addition, the data has the potential to be exported and emailed, which could create more examination into the security of patient data, although deidentified. If educational programs were granted permission to utilize the application, there would need to be training efforts to introduce the method into the existing educational structure. Unfortunately, the author did not provide much guidance on how programs could reform their educational structure to utilize the TRACT method.

In sum, I approached the text with excitement about how I could utilize an OSCE-like method with my residents. It was a quick read and the TRACT method itself is an interesting concept that may prove beneficial if adopted in the educational environment. However, there are a number of additional resources that would be required for its implementation, and the text provides little information related to adoption of the method. The text does provide the data that the TRACT method has gathered and presents this data in the form of a research study. As a reader, this was not exactly what I expected from the book. Furthermore, without access to the TRACT application, the book alone does not provide the information needed for an educator to implement the model. With these points in mind, educators may still benefit from the knowledge of such an application and model.