The objective structured teaching exercise (OSTE) is a high-fidelity training method for advancing the teaching and interpersonal communication skills of faculty members and preceptors. This paper is a primer for implementation of OSTEs as part of a comprehensive faculty development program. This primer addresses teaching and precepting skills that can be most effectively enhanced and assessed by the OSTE method. Development of case scenarios, recruitment and training of standardized students, OSTE session implementation processes, and OSTE evaluation methods are discussed. The experience of the authors as well as recommendations from a review of the literature and discussions with educators with OSTE experience are included.Keywords: faculty development, standardized student, professional competence INTRODUCTIONThe objective structured teaching exercise (OSTE) is a high-fidelity training and assessment method for advancing the teaching and interpersonal communication skills of faculty members, preceptors, and residents.1 First introduced in the medical literature in the early 1990s, OSTE engages learners in performance-based teaching activities with a standardized student. The OSTE method not only provides a unique and innovative way to teach, enhance, and evaluate educational skills, but also presents an ideal platform for future scholarship.The body of OSTE literature is primarily descriptive in nature and not as robust as the literature regarding standardized patients in health profession curricula. However, interest in the OSTE technique stems from the postulation that standardized student interactions will provide benefits to teachers similar to those that standardized patient interactions provide to students. In the 1960s, neurologist Dr. Howard Barrows was seeking a better method than traditional clinical observations to assess the clinical skills of his medical residents. He developed the concept and first used standardized patients by tapping into an available pool of actors in Southern California.2 Using cases of actual neurology patients, Barrows trained the actors to present the same signs, symptoms, history, emotional state, and, in some cases, physical examination findings to learners. Using the standardized patient, he could then educate, observe, and assess each learner in a safe and controlled environment. Standardized patients are now used extensively throughout health professional education and the technique has been adapted for use with individuals portraying students for faculty development. Standardized student encounters can be used for instruction and practice of skills, performance evaluation, program assessment, and research. These encounters allow for repeated experiences in which the learner can attend to the critical aspects of a situation and improve performance in response to feedback. The learner is an active participant in the experience rather than a passive observer. Standardized student encounters enable expert educators to observe and improve the interaction of the participa...
To the Editor: We read with interest the comments regarding use of objective structured teaching exercises (OSTE) for summative evaluations made by Drs. Peeters, Kelly, and Cor. 1 We hope that readers ultimately view OSTE as a tool best reserved for formative skill development as opposed to summative evaluation. However, we agree that should OSTE be used for a true "high stakes" summative evaluation of preceptor or faculty teaching performance, then careful attention during OSTE development to minimize construct underrepresentation and construct-irrelevant variance must be made.2 It should be noted, however, that Quirk et al did demonstrate a generalizability coefficient nearing the ideal of 0.70-0.80 in a 5-station OSTE that utilized a single rater per station 3 -a number of stations far fewer than the 14-18 stations recommended for achieving similar generalizability coefficients in high-stakes objective structured clinical examinations (OSCE). 4 This difference may perhaps be attributed to a narrower scope of focus of their OSTE compared to high-stakes OSCEs.We feel it is unlikely that an OSTE would be used as the sole determinant of teaching effectiveness in decisions regarding promotion and tenure, the only true "high stakes" endpoint for most faculty members and preceptors. We intended to promote "summative" OSTE as a method for identifying those with weaker teaching skills who require further development and/or as an evaluation component of other faculty development efforts. In both situations, an OSTE with a small sampling of stations that focus on a single teaching skillset (eg, addressing lapses in student behavior) would likely suffice. We also encourage investigators with interest in the method to continue to grow the body of literature that identifies the optimal number of OSTE stations appropriate to its intended use.
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