G185(P) Designing transformative osces: lessons from an adolescent smoking cessation station

Background Working with patients to improve medical education can help align training with real clinical practice and empower patients to influence attributes of newly qualified doctors, including their communication skills. The benefits of effective patient-centred communication include higher patient and doctor satisfaction, shared decision making, treatment adherence and improved health outcomes. Half of the most common health problems in adults arise from behaviours that are established during adolescence; 40% of adult smokers in the UK starting smoking before the age of 16 years (Rise Above Programme, 2017). Aim To co-design a transformative OSCE station to assess medical student’s ability to motivate adolescents to stop smoking, with adolescent smokers being involved in this process from inception to final assessment. Methods We organised a workshop with medical educators and adolescent smokers to co-create the consultation narrative for a smoking cessation OSCE. The station was designed to assess the ability of medical students to practice motivational interviewing, a behavioural change technique taught in their curriculum. This OSCE station was included in the summative assessment of 364 penultimate year medical students in 2017. We recruited 12 examiners and 6 adolescent actors for this OSCE station and both examiners and actors gave written feedback to each candidate. We had ethical permission to obtain copies of this information and although we gave the students the option to opt out none did. Results Although the pass rates were similar amongst different groups, there were significant differences in the scores of students assessed by distinct examiner and role-player combinations. These differences were also reflected by the quality of written feedback provided to students. Importantly, students who received full marks from the adolescent role-player were significantly more likely to get a high overall score in the OSCE station, with substantial agreement between role-players and examiners’ marks. Most students (85.7%) were competent in employing motivational interviewing techniques, but only half were proficient in gathering sufficient information to offer a personalised management plan. Conclusion Involving adolescent patients in medical education can increase the validity of assessments and assist in identifying ways to further improve the communication skills of medical students.