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Abstract: FR-OR004

Breaking Bad News: An Objective Structured Clinical Examination (OSCE) of Renal Replacement Therapy (RRT) and Kidney Biopsy Communication Skills

Session Information

Category: Nephrology Education

  • 1301 Educational Research


  • Prince, Lisa K., Walter Reed National Military Medical Center, Silver Spring, Maryland, United States
  • Howle, Anna M., Walter Reed National Military Medical Center, Silver Spring, Maryland, United States
  • Yuan, Christina M., Walter Reed National Military Medical Center, Silver Spring, Maryland, United States

Group or Team Name


There are few reported simulation-based assessments for nephrology-specific interpersonal communication skills (ICS) and professionalism (PROF). We developed a “Breaking Bad News” OSCE that assesses fellow competence in counseling a surrogate decision maker for acute RRT, a patient with advanced chronic kidney disease for RRT, and a patient for kidney biopsy.


The OSCE was designed for the 2-year nephrology fellowship cycle, with 2 sets of scenarios. Fellows are provided with a brief clinical summary before counseling a simulated patient (SP). SP are trained to portray a nephrology patient with a specific condition, to provide feedback and rate fellows. SPs receive a medical and social history designed to stimulate fellows to demonstrate ICS. After each encounter SPs rate ICS and PROF using the Essential Elements of Communication-Global Rating Scale 2005 (EEC-GRS). Faculty assess performance using a 5-point Likert Mini-Clinical Examination Exercise (Mini-CEX). The two scenario sets were beta-tested in Spring 2015 (3 second year fellows and 2 first year fellows) and 2016 (2 second year fellows and 1 first year fellow).


The OSCE is being evaluated prospectively at 5 training programs (16 first-year; 10 second-year fellows) over a two year period. There are 3 faculty per training site. Primary outcome is overall score on the EEC-GRS for each scenario (first vs. second year fellow performance for each scenario, and individual fellow scores between first and second year). Secondary outcomes include score < 3 (Satisfactory for level of training) on any subsection of the mini-CEX and overall score < 3 on the EEC-GRS. Preliminary satisfaction survey data indicate that 100% of faculty (6/6) and fellows (7/7) rated the OSCE as having met objectives, and 86% (6/7) fellows rated the experience as being “good” or better.


The Breaking Bad News OSCE, designed for a 2-year fellowship cycle, uses previously validated instruments (EEC-GRS; MiniCEX) to assess nephrology-specific ICS and PROF skills. Fellows and faculty report satisfaction with the OSCE, and indicate that it meets objectives.

The views expressed are those of the authors and do not reflect the official policy of the Department of the Army, the Department of the Navy, the Department of Defense or the United States Government.


  • Other U.S. Government Support