First, do no harm: Evaluating clinical skills for patient safety in oncology fellows.

Abstract

e21009 Background: This study aims to present the results and design of the Observational Standardized Clinical Examination (JCO 34, e18150, 2016) IOHM-USAL 2024, which focused on evaluating the clinical skills necessary to ensure patient safety. Methods: The clinical skills essential for patient safety were assessed through a series of stations. At each station, trained observers were present to evaluate the fellows' performance and complete an evaluation form. The stations were: a) Biosecurity in drug preparation (including hand washing, proper use of disposable clothing and gloves, and drug identification), b) Laboratory assessment prior to chemotherapy or immunotherapy administration, c) Drug administration via IV catheter, d) Management of chemotherapy extravasation, e) Evaluation of clinical response in a model of breast nodules, f) Detection of errors in different medical images, and g) Conflict de-escalation in a consultation with an aggressive patient. Results: Fourteen oncology fellows were evaluated. The outcomes for each station were as follows: a) Four out of 14 (28%) did not adhere to biosecurity guidelines. b) One out of 14 (7%) authorized chemotherapy administration without adequate laboratory results. c) All fellows successfully administered the drug via IV catheter. d) One out of 14 (7%) mishandled doxorubicin extravasation. e) Six out of 14 (42%) incorrectly assessed the clinical response in breast nodules. f) Three out of 14 (21%) failed to detect errors in medical images. g) Six out of 14 (42%) were unable to de-escalate a conflict during a consultation. Conclusions: A) Clinical skills essential for patient safety can be effectively evaluated through an Observational Standardized Clinical Examination (OSCE). B) In this implementation, medical errors were identified in biosecurity practices, laboratory assessments, clinical evaluations, and image interpretation. Only one student mishandled chemotherapy extravasation, and nearly half of the students struggled with conflict de-escalation during a consultation. C) This exam serves as a valuable tool for identifying both strengths and weaknesses in oncology fellows, allowing for targeted training to address specific gaps in knowledge and skills. D) Addressing these shortcomings in medical education is critical to ensure patient safety.