title: Fellow use of medical jargon correlates inversely with patient and observer perceptions of professionalism: results of a rheumatology OSCE (ROSCE) using challenging patient scenarios.
abstract: The NYC Rheumatology Objective Structured Clinical Examination (NYC-ROSCE) is held annually to assess fellow competencies. We recently redesigned our OSCE to better assess subspecialty trainee communication skills and professionalism by developing scenarios in which the patients encountered were psychosocially or medically complex. The objective of this study is to identify which types of verbal and non-verbal skills are most important in the perception of professionalism in the patient-physician interaction. The 2012-2013 NYC-ROSCEs included a total of 53 fellows: 55 MD evaluators from 7 NYC rheumatology training programs (Hospital for Special Surgery-Weill Cornell (HSS), SUNY/Downstate, NYU, Einstein, Columbia, Mount Sinai, and North Shore/Long Island Jewish (NSLIJ)), and 55 professional actors/standardized patients participated in 5 stations. Quantitative fellow performance assessments were made on the following: maintaining composure; partnering with the patient; honesty; professionalism; empathy; and accountability. Free-text comments were solicited regarding specific strengths and weaknesses. A total of 53/53 eligible (100 %) fellows were evaluated. MD evaluators rated fellows lower for professionalism than did the standardized patients (6.8 ± 0.6 vs. 7.4 ± 0.8, p = 0.05), suggesting that physicians and patients view professionalism somewhat differently. Fellow self-evaluations for professionalism (6.6 ± 1.2) were concordant with those of the MD evaluators. Ratings of empathy by fellows themselves (6.6 ± 1.0), MD evaluators (6.6 ± 0.7), and standardized patients (6.6 ± 1.1) agreed closely. Jargon use, frequently cited by evaluators, showed a moderate association with lower professionalism ratings by both MD evaluators and patients. Psychosocially challenging patient encounters in the NYC-ROSCE permitted critical assessment of the patient-centered traits contributing to impressions of professionalism and indicate that limiting medical jargon is an important component of the competency of professionalism.
authors.affiliation: Division of Rheumatology, Weill Cornell Medical College, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA. bermanj@hss.edu.
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Berman
authors.affiliation: Division of Rheumatology, Weill Cornell Medical College, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Juliet
authors.initials: J
authors.lastname: Aizer
authors.affiliation: Division of Rheumatology, Weill Cornell Medical College, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Anne R
authors.initials: AR
authors.lastname: Bass
authors.affiliation: Division of Rheumatology, Albert Einstein College of Medicine, 1300 Morris Park Ave., Forchheimer 107N, Bronx, NY, 10461, USA.
authors.forename: Irene
authors.initials: I
authors.lastname: Blanco
authors.affiliation: Division of Rheumatology, Hofstra North Shore LIJ School of Medicine, Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY, 11030, USA.
authors.forename: Anne
authors.initials: A
authors.lastname: Davidson
authors.affiliation: Division of Rheumatology, Columbia U. College of Physicians and Surgeons, 630 West 168th St., P&S 10-508, New York, NY, 10032, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Dwyer
authors.affiliation: Division of Rheumatology, Weill Cornell Medical College, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Theodore R
authors.initials: TR
authors.lastname: Fields
authors.affiliation: PAREXEL International, 22F. No. 200, Sec.1, Keelung Road, Taipei, Taiwan, 11071, Republic of China.
authors.forename: Wei-Ti
authors.initials: WT
authors.lastname: Huang
authors.affiliation: Division of Rheumatology, Columbia U. College of Physicians and Surgeons, 161 Fort Washington Avenue, Herbert Irving Pavilion, 2nd floor, New York, NY, 10032, USA.
authors.forename: Jane S
authors.initials: JS
authors.lastname: Kang
authors.affiliation: Icahn School of Medicine at Mount Sinai, Box 1244, Division of Rheumatology, Mount Sinai Medical Center, 1 Gustave Levy Place, New York, NY, 10029, USA.
authors.forename: Leslie D
authors.initials: LD
authors.lastname: Kerr
authors.affiliation: Division of Rheumatology, NYU School of Medicine, NYU Hospital for Joint Diseases, Room 1410, 301 E 17th Street, New York, NY, 10003, USA.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Krasnokutsky-Samuels
authors.affiliation: Division of Rheumatology, SUNY Downstate College of Medicine, VA- New York Harbor Healthcare System Brooklyn, Medical Service (III), 800 Poly Place, Brooklyn, NY, 11209, USA.
authors.forename: Deana M
authors.initials: DM
authors.lastname: Lazaro
authors.affiliation: Division of Rheumatology, North Shore University Hospital - LIJ, 865 Northern Blvd, Suite 302, Great Neck, NY, 11021, USA.
authors.forename: Julie S
authors.initials: JS
authors.lastname: Schwartzman-Morris
authors.affiliation: Division of Rheumatology, Weill Cornell Medical College, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Paget
authors.affiliation: Division of Rheumatology, NYU School of Medicine, NYU Hospital for Joint Diseases, Room 1410, 301 E 17th Street, New York, NY, 10003, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Pillinger
mesh_terms: D002983:Clinical Competence / Q000592:standards* / Q000706:statistics & numerical data; D004645:Empathy; D005257:Fellowships and Scholarships; D006801:Humans; D016014:Linear Models; D000068616:Professionalism / Q000592:standards*; D012219:Rheumatology / Q000193:education*; D012647:Self-Assessment; D014481:United States
keywords: Assessment; Education; Medical jargon; Professionalism; Rheumatology fellowship