strasbourg 10 novembre 2011

ECOS

Michel LEVEQUE

Strasbourg

10 novembre 2011

ECOS (french) OSCE (english)

• Objective

• Structured

• Clinical

• Examination

Levels for evaluation

KNOWLEDGE

SKILLS

PERFORMANCE

For what?

• Explore the competencies or performance in :– diagnostic– interview– examination– assessment– medical reasoning– sharing médical decision– treatment plan – doctor patient relationship

WHO ?

Post graduate students

– Prerequisite for ECOS:• Training in clinical

• Have skills….

WHEN ?

• Formative evaluation– During the professionnal training

• Final evaluation– Performance for professionnal certification

• Strasbourg:– First expérience for training– Today only final evaluation (efficiency)

HOW ?

• Path between stations:– 19 stations ( U Laval)– 7 stations (Strasbourg)

• On each station– simulated patient– Physician observer– document specifying the task

HOW ?

• Path between stations:– 19 station ( U Laval)

• Clinical stations• Questionnaire station related with clinical station • Questionnaire station not related with clinical station • Rest station…

– 7 station (Strasbourg)• Only clinical stations

Clinical station

• Patient (simulated)• Task, problèms

• Observer rating

Questionnaire station

• Questionnaire• Open-ended

questions and short

Recommandation to the students

need clear , précise candidate instructions

•« Red them carefully before starting !!•before any question•if you are unclear as to what you are being ask to do clarify the task with the examinator… »

Contents of stations

Commons situations in primary care

Examples …

• The diabetic foot– Examination

• Announcement of a diabetes– Explanations

• Contraception (teenager)– Explanations and

prescription

• Infant immunization– plan

• Announcement of a AD– Explanations

• Visual disorder (elderly)– Diagnostic and plan

Examples …

• Skin redness (Lyme)– Diagnostic and plan

• Chronic complaint– Relationship

• Insomnia– assement and

prescription

• Sadness– Diagnostic,

assement,suicidal risk

• Fatigue– Diagnostic and plan

Method

Team (professors, lecturers) only GP : n=15-Step 1 : choice of situations-Step 2: writing the clinical case-Step 3: selection criteria-Step 4: scientific validation-Step 5: writing evaluation grid-Step 6: test stations with GP-Step 7: plan the examination-Step 8: examination

Example (instruction for the student)

• Ms. Richard, 45, teacher, comes to you at the request of others to a "loss of form": it sleeps badly, crying often, feeling irritable and does not know what is happening.She is married with two children (16 and 20 years).

• Your task is to conduct the examination to clarify the diagnosis and propose a course of action.

Example (instructions for the actor)

• You are Ms. Richard, 45, teacher. You tell the doctor that you have at the request of your family, because you have a loss of form. Your husband has supported and is in the waiting room.

In response to questions from the doctor:• • You can not stand your students

• You are no longer the household (too tired)• Grocery shopping is a charge• unrest begins one to two months• No more appetite (loss of six pounds in 6 weeks)…

Example (evaluation grid)a

NOM et PRENOM :Grille de correction :

Note/20•Antécédents personnel

– dépression 1– tentative de suicide 0,5– épisode maniaque 0,5– consommation alcoolisée 0,5– prise de médicaments 0,5

Example (evaluation grid)b

• Symptomatologie dépressive– humeur triste 2– inhibition psycho-motrice 2– dévalorisation 2– troubles de l’appétit 0,5– troubles du sommeil 0,5

• Soutien de l’entourage 1• Idées suicidaires 2

Example (evaluation grid)

• Prise en charge– énoncé du diagnostic 1– traitement médicamenteux ou psychothérapie 1– suivi rapproché dans les 8 jours 1– arrêt maladie 1

• Empathie écoute, reformulation 0 – 1 – 2 – 3• TOTAL :

The path

Station 1

Station 1

Station 7

Station 7

Station 6

Station 6

Station 5

Station 5

Station 2

Station 2

Station 4

Station 4

Station 3

Station 3

ECOS

timing

• Each station: 7 minutes

• Clock: 1 minute for change

• Clock : start the station

To learn more about OSCE

• http://w3.fmed.ulaval.ca/cessul/index.php?id=792

• http://w3.fmed.ulaval.ca/cessul/fileadmin/template/main/cessul/documents/document/PPTECOSFaculte.mov

Centre d’Evaluation des Sciences de la Santé Université de Laval

Step 4 scientific validation

Kamtchatka, Ru