1 assessment of clinical competence in health professionals education professor hossam hamdy...
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Assessment of Clinical Competence in Health Professionals Education
Professor Hossam HamdyUniversity of Sharjah
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Professional Competence
The Habitual and Judicious use of:
• Communication
• Knowledge
• Technical Skills
• Evidence-based decision-making
• Emotions
• Values and reflection to improve the health of the individual patient and the community
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WHAT Should Be Assessed?
ACGME Competencies- Patient care- Knowledge- Practice-based learning and
improvement - Interpersonal and communication skills- Ethics & Professionalism- System-based practice
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Blueprinting
Test content matches objectives
• Assessment matches competencies learnt
• Assessment matches format of learning, “PBL”
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A Simple Model of Competence
Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S7.
Knows
Shows how
Knows how
Does
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Written, Oral orComputer based assessment
Performance or hands on assessment
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Validity Climbing the Pyramid . . .
Knows
Shows how
Knows how
Does
Knows Factual tests: MCQ, essay type, oral…..
Shows howPerformance assessment in vitro:OSCE, SP-based test…..
DoesPerformance assessment in vivo: Masked SPs, Video, Audits…..
Knows how(Clinical) Context based tests:MCQ, essay type, oral…..
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Assessment of Clinical Performance
Fundamental to “Good Medical Practice”
“What doctors do in controlled representations” of practice e.g. “OSCE”
“What doctors do in real life”
Rethans et al, Med Ed 2002.
Effective Workplace Training
“The ability of faculty to accurately observe trainees performing
these (history-taking and physical examination) tasks and provide
effective feedback is thus one of the most important aspects of medical training.”
Learning
Effective Workplace-Based Assessment
“sampling collection of data concerning specific patient encounters for a number of different domains”
Reflects routine performance
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•Unobserved 30 – 45 minute interview and examination on a selected patient
•Candidates present only their findings to the examiner
The Traditional Long Case Examinations (LCE)
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• It assesses the integrated interaction between the student/doctor and the real patient
• Authenticity high
• More valid than the task given in an OSCE
• Little is known about the construct validity and consequential validity “Educational Impact”
)LCE (Validity
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• Poor intercase reliability
• Content specificity is the most crucial issue in the assessment of clinical competence
• Broad sampling across cases is essential “Multiple Biopsies”
• Logistics will be difficult
)LCE (Reliability
Mini-CEX
Real patients 12 - 14 ~ 6 / years Only components of the encounter
observed 15-20 minites (Norcini 2003) Formative
Four real patients The whole encounter is observed Focused history & examination Clinical reasoning & decision-making Communication skills 20-30 minutes Summative / formatives
Direct Observation Clinical Encounter Examination “DOCE”
(Hamdy et al, Med Educ, 2003)
Case Based Discussion
Trainees select two case records for discussion with assessment
Focus on evaluating clinical reasoning and decision making
Clinical Work Sampling (CWS)
Sample performance in the workplace
Collection of information concerning specific patient encounters, admission, discharge, ward follow up
Portfolios
Direct Observation Practical Procedure Skills “DOPS”
Whole procedure observed from start to finish Simulators Or Real Patient
Multi-source Feedback (MSF) 360 Degree Assessment
Peers Supervisors Nurses Secretary Lab Technicians Patients
Feedback
"The most basic focus of feedback addresses the quality of the task performed. Using well defined criteria, trainees are given specific information about whether they achieved the required level of performance " .
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