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Using a Teaching OSCE to Prompt Learners to Engage With Patients Who Talk About Religion and/or Spirituality

Ledford, Christy J.W. PhD; Seehusen, Dean A. MD, MPH; Canzona, Mollie Rose MA; Cafferty, Lauren A.

doi: 10.1097/ACM.0000000000000062
Research Reports

Purpose The objective structured clinical examination (OSCE) has only occasionally been used as a teaching tool. The authors describe the initial use of an educational innovation consisting of a teaching OSCE used as “sensitizing practice,” followed by personal, guided, and group reflection.

Method Staff and resident physicians and one medical student (N = 28) at a community hospital’s family medicine residency participated in the innovation during August 2012. The initial use of the educational innovation allowed learners to engage in a potentially challenging conversation with a standardized patient about religion and/or spirituality (R/S). The aim of the innovation was not to equip learners with a particular tactic to introduce or discuss R/S but, rather, to prompt learners to engage in mindful practice with patients who identify R/S as part of their biopsychosocial contexts. Written, dyadic, and group reflection added value to the OSCE by allowing participants to reflect on a difficult learning objective over time.

Results Participants moved along the stages-of-change continuum when engaging in guided reflection compared with personal reflection. Additionally, all participants provided evidence of at least the preparation stage at the time of guided reflection. By following the OSCE’s sensitizing practice with three periods of reflection, learners were enabled first, to recognize the need for readiness to address challenging communication topics (in this case, R/S) and, second, to reflect on practiced strategies for those conversations.

Conclusions The educational innovation can help learners become more aware of and skillful in dealing with difficult physician–patient communication topics.

Dr. Ledford is assistant professor, Department of Biomedical Informatics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Dr. Seehusen is program director, NCC-Family Medicine Residency, Fort Belvoir Community Hospital, Fort Belvoir, Virginia.

Mrs. Canzona is a PhD student, Department of Communication, George Mason University, Fairfax, Virginia.

Ms. Cafferty is research associate, Department of Biomedical Informatics, Uniformed Services University of the Health Sciences, Bethesda, Maryland.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Ethical approval was waived by the Fort Belvoir Community Hospital Department of Research Programs.

Disclaimer: The opinions and assertions contained herein are the views of the authors and are not to be construed as official or as reflecting the views of the U.S. Army, the Uniformed Services University of the Health Sciences, or the Department of Defense at large.

Correspondence should be addressed to Dr. Ledford, Department of Biomedical Informatics, 4301 Jones Bridge Rd., G058D, Bethesda, MD 20814; telephone: (301) 295-2158; fax: (301) 295-3585; e-mail:

© 2014 by the Association of American Medical Colleges