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AUTHOR(S)

Jackson Herzog, Kenzie Cameron, Maria Badaracco, Robert Kushner

Competencies

  • Language for obesity
  • Obesity as a disease
  • Obesity care strategies

Professions

  • Allopathic Medicine
  • Nursing
  • Osteopathic Medicine
  • Pharmacy
  • Psychology

Learner Level

  • Educator
  • Pre-licensure

Instructional Methods

  • Clinical Experience
  • Curricular Framework
  • Supplemental Materials

OSCE for Assessing Resident Competency in Weight Loss Counseling

| HRS Explaining The hours

Medical educators developed and implemented an objective structured clinical examination (OSCE) for the assessment of resident physician weight loss counseling. The skills checklist allows for the identification of individual and overall counseling skills in need of improvement, and provision of targeted feedback.

Despite the need to provide weight management counseling to patients with obesity, resident physicians receive little relevant education and practice in performing this skill. As a result, residents report low levels of self-efficacy and often demonstrate limited performance competency. Structured educational interventions providing opportunities for residents to practice weight loss counseling along with objective assessment are lacking. This article describes the development and implementation of an objective structured clinical examination (OSCE) for the assessment of resident physician weight loss counseling. The OSCE included a brief (10-15 minute) educational session on the 5As counseling framework, followed by an 18-minute encounter with a standardized patient (SP). Resident performance in the OSCE was measured by use of a skills checklist composed of 23 pre-specified counseling skills. Each skill represents a specific element of communication used in effective weight loss counseling, and is based on the 5As counseling framework. The checklist was completed by the SP immediately following the encounter, and the percentage of skills performed was calculated.

OSCE Content and Format
The SP case was developed by the principal investigator along with another clinical medicine faculty member. The case is also used to assess medical student motivational interviewing competence in the primary care clerkship of the Feinberg School of Medicine. For additional information about the study and process for developing the OSCE, please see:

OSCE Assessment Tool

Each skill is rated dichotomously, as “performed” or “not performed.” Five of the 23 items include four response options (not at all, only a little, somewhat, very). These five skills were rated as “performed” if the SP responded “only a little, somewhat, or very” to the scale, and as “not performed” if the SP responded “not at all.”

5As Counseling Assessment Instrument (completed by SP)
ASSESS – 5 Skills
Did you and your doctor discuss your weight today?
Did your doctor ask you about or discuss your diet?
Did your doctor ask you about or discuss your physical activity/exercise?
Did your doctor ask you about how important it is to you to try to lose weight?
Did your doctor ask you how confident you are that you can lose weight?
ADVISE – 4 skills
Did your doctor tell you that you should lose weight?
Did your doctor discuss making changes in your diet with you today?
Did your doctor discuss making changes in how much physical activity you should get?
Did your doctor inform you that weight loss will improve your health (such as your blood glucose, depression or quality of life)?
AGREE – 11 skills
Did the doctor solicit your opinion about what changes you can make in your diet?
Did the doctor solicit your opinion about what changes you can make in your physical activity/exercise?
Did the doctor help you set goals (make specific plans) to improve your diet?
How much were you involved in setting the diet goals?
[not at all, only a little, somewhat, very involved]
How realistic do you think it is that you will meet these diet goals?
[not at all, only a little, somewhat, very realistic]
Did the doctor help you set goals (make specific plans) to improve your physical activity/exercise?
How much were you involved in setting the physical activity/exercise goals?
[not at all, only a little, somewhat, very involved]
How realistic do you think it is that you will meet these physical activity/exercise goals?
[not at all, only a little, somewhat, very realistic]
The recommended changes provided were clear.
[not at all, only a little, somewhat, very clear]
I received adequate guidance on what to do with my diet.
I received adequate guidance on what to do with my physical activity/exercise.
ASSIST – 1 Skill
Did your doctor talk with you about potential barriers to implementing the behavior changes, such as stress, finding time, child care, etc.?
ARRANGE – 2 skills
Did the doctor tell you when he or she wanted to see you again for follow up?
Did the doctor recommend any other referral resources, such as a dietitian, commercial or internet weight loss program, health psychologist?