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Table 4 Selected Results from Scenario Checklists in the 2009 and 2011 Pediatric Rheumatology Objective Structured Clinical Examinations

From: The pediatric rheumatology objective structured clinical examination: progressing from a homegrown effort toward a reliable and valid national formative assessment

Scenario 2009 2011
1: Gluco-corticoid explanation 10/21 did not mention risk of adrenal suppression; 6/21 did not say the risk-benefit ratio favored taking steroids 16/19 did not mention risk of adrenal suppression; 4/19 did not say the risk-benefit ratio favored taking steroids
2: Joint injection preparation 11/21 did not prepare the injection sterilely; 12/21 did not buffer the lidocaine Scenario not used
3: Joint injection explanation and simulation All fellows were respectful of parent’s concerns; 13/21 did not mention skin hypopigmentation as a side effect All fellows were respectful of parent’s concerns; 12/19 did not mention skin hypopigmentation as a side effect
4: Musculo-skeletal exam Of all assessed joints, none was examined by all 21 fellows; 7/21 fellows did not check forefoot The wrist was the only joint examined by all 19 fellows; 8/19 fellows did not check forefoot
5: Dermato-myositis diagnosis discussion 11/21 did not mention possibility of abdominal pain; 14/21 did not mention possible emotional consequences of JDM 12/18 did not mention possibility of abdominal pain; 14/18 did not mention safety precautions necessary due to muscle weakness
6: Juvenile arthritis lecture 9/21 did not mention limb growth abnormalities; 11/21 did not mention jaw disease related to oligoarticular juvenile arthritis 10/19 did not mention limb growth abnormalities; 13/19 did not mention jaw disease related to oligoarticular juvenile arthritis
7: Insurance appeal 10/21 did not cite a source correctly for the letter; 10/21 did not describe patient consequences of denied treatment Scenario not used
8: Gait analysis Scenario not used Not scored
9: Bad news delivery Scenario not used All 18 fellows were respectful of the parent; 11/18 did not ask how much information the parent wanted to know about cancer