Original Publication
Open Access

An OSCE to Assess Trainee Management of Complex Older Adults and to Teach Documentation, Coding, and Billing

Published: September 29, 2014 | 10.15766/mep_2374-8265.9903

Included in this publication:

  • Instructor's Guide.doc
  • Case 1 - Falls.docx
  • Case 2 - Dementia.docx
  • Case 3 - Advance Directives.docx
  • Case 4 - End Stage CHF.docx
  • Case 5 - Malnutrition.docx
  • Case 6 - Family Meeting.docx
  • Case 7 - Stroke.docx
  • Case 8 - Pneumonia-Delirium.docx
  • Case 9 - Polypharmacy.doc

To view all publication components, extract (i.e., unzip) them from the downloaded .zip file.

Editor's Note: This publication predates our implementation of the Educational Summary Report in 2016 and thus displays a different format than newer publications.


Introduction: Our geriatric fellowship assessment was initially developed in 2010 as a full-day objective structured clinical evaluation (OSCE) to provide formative feedback for geriatric fellows throughout the Michigan State University College of Human Medicine Fellowship Network. Our OSCE has since been expanded by using a blueprint to capture various aspects of clinical care that fellows are likely to encounter: geriatric syndromes, end-of-life care, geriatric practice sites, and varying patient complexity (robust, frail, dying). Methods: This resource provides nine comprehensive geriatric assessment OSCEs. Material relevant to all the OSCES includes the blueprint for fellowship assessment, Geriatric Fellowship Curriculum Milestones by the American Geriatrics Society referenced in the blueprint, billing help sheet, and standardized patient (SP) training checklist. Each of the nine OSCES has its own doorway information (for learners), case synopsis (for faculty), SP instructions and script, SP evaluation checklist, faculty evaluation checklist, example documentation, documentation audit (with billing codes), and necessary supplemental documents. Each case requires 30 minutes with the SP (and family or support staff), followed by 15 minutes to complete documentation and billing. Each fellow is observed by a single faculty member. Faculty have access to their checklists throughout the case and can make comments for formative feedback as the case evolves. Results: Since 2010, we have evaluated 10 geriatric fellows, eight of whom have participated in two OSCE events, allowing for assessment of clinical improvement. Fellow performance was rated well by all SPs for both midyear and end-of-year performance. Faculty evaluations suggested that fellows improved their performance of cognitive assessments and ability to counsel impaired drivers and appropriately referred for formal driving evaluations. Review of fellows’ documentation suggested that trainees frequently omitted the chief complaint, which is a necessary component of all billing encounters. Discussion: Our geriatric OSCE cases represent real-life situations that geriatricians encounter in practice. While the cases we present are comprehensive, they are by no means exhaustive. We feel that our OSCE could be improved by development of additional cases. Furthermore, we are in the process of validating our SP and faculty evaluations by performing interrater reliability analyses, which will strengthen these tools. Funding remains a future challenge, as direct costs for this assessment are approximately $3,000 at a dedicated simulation center. To date, we have received grant funding, with the remaining costs shared between the various fellowship network sites that participate in the events.

Educational Objectives

By using these objective structured clinical evaluations, faculty will be able to:

  1. Directly observe fellows’ clinical skills in history, examination, and complex patient management.
  2. Provide fellows with timely formative feedback so that deficiencies can be addressed early in their training.
  3. Provide an adjunct assessment of fellows’ mastery of the American Geriatrics Society Geriatric Fellowship Curriculum Milestones.
  4. Teach principles of documentation, coding, and billing for geriatric care provided in various sites (outpatient, nursing home, and inpatient).

Author Information

  • Erin Sarzynski, MD, MS: Michigan State University College of Human Medicine
  • Kevin Foley: Michigan State University College of Human Medicine
  • Robert Riekse: Michigan State University College of Human Medicine
  • Heather Laird-Fick: Michigan State University College of Human Medicine
  • Linda Keilman: Michigan State University College of Human Medicine
  • Tina Barnikow: Michigan State University College of Human Medicine
  • Kristine Cuddy: Michigan State University College of Human Medicine
  • Dianne Wagner: Michigan State University College of Human Medicine
  • Mary Noel: Michigan State University College of Human Medicine
  • William Wadland: Michigan State University College of Human Medicine

None to report.

None to report.


Sarzynski E, Foley K, Riekse R, et al. An OSCE to assess trainee management of complex older adults and to teach documentation, coding, and billing. MedEdPORTAL. 2014;10:9903. https://doi.org/10.15766/mep_2374-8265.9903