The PrOSTE: Identifying Key Components of Effective Procedural Teaching

Rationale: Novel approaches for faculty development and assessment of procedural teaching skills are needed to improve the procedural education of trainees. The Objective Structured Teaching Exercise (OSTE) entails a simulated encounter in which faculty are observed teaching a standardized student and has been used to evaluate teaching skills. Use of an OSTE to assess the teaching of central venous catheterization has not been reported. Objectives: The purpose of this study was to develop a procedural OSTE for subclavian central venous catheter (CVC) insertion and to determine specific aspects of procedural teaching associated with improved skills in novices. Methods: Critical care faculty/fellows taught a standardized student to insert a CVC in a simulator. We assessed the instructor's teaching skills using rating scales to generate a procedural teaching score. After this encounter, the instructor taught novice medical students to place CVCs in simulators. Novices then independently placed catheters in simulators and were evaluated by trained observers using a checklist. Generalized estimating equations were used to examine the correlation between specific teaching behaviors and the novices' skills in CVC placement. Measurements and Main Results: We recruited 10 participants to serve as teachers and 30 preclinical medical students to serve as novice learners. The overall mean procedural teaching score was 85.5 ( +/- 15.4). Improved student performance was directly related to the degree to which the teacher "provided positive feedback" (beta = 153, SE = 0.44, P = 0.001), "offered learner suggestions for improvement" (beta = 1.40, SE = 0.35, P < 0.001), and "demonstrated the procedure in a step-by-step manner" (beta = 2.50, SE = 0.45, P < 0.001). There was no significant correlation between total scores and student skills (beta = 0.06, SE = 0.46, P = 0.18). Conclusions: The OSTE is a standardized method to assess procedural teaching skills. Our findings suggest that specific aspects of procedural teaching should be emphasized to ensure effective transfer of psychomotor skills to trainees.