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Tools of clinical Tools of clinical assessmentassessment

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Presentation outlinePresentation outline

IntroductionIntroduction Our daily practiceOur daily practice Types of assessment toolsTypes of assessment tools Pros and consPros and cons EmphasisEmphasis SummarySummary Q&AQ&A

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Introduction Introduction

It is part of our daily practicesIt is part of our daily practices Undergraduate as well as postgraduateUndergraduate as well as postgraduate Most of them are difficult to organizeMost of them are difficult to organize Lack of informationLack of information The studentsThe students Formative Vs summativeFormative Vs summative Wedded to traditionWedded to tradition

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Our daily practiceOur daily practice

Done at the corridorDone at the corridor Most the times it is ORALMost the times it is ORAL Observe while doing itObserve while doing it We chose the easy one/s to conductWe chose the easy one/s to conduct Rigidity Rigidity Restricted with venues!!!Restricted with venues!!! Feedback is almost always ZEROFeedback is almost always ZERO

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OSCEOSCE

The candidates rotate through a series of The candidates rotate through a series of stations at which they are asked to carry stations at which they are asked to carry out a (usually clinical) taskout a (usually clinical) task

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AdvantagesAdvantages of the OSCE of the OSCE Valid examinationValid examination Controlled complexitiesControlled complexities Summative as well formativeSummative as well formative Larger number of studentsLarger number of students ReproducibleReproducible Less biasedLess biased Fun activityFun activity

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Disadvantages of the OSCEDisadvantages of the OSCE

Knowledge and skills are tested in Knowledge and skills are tested in compartments compartments

The OSCE may be demanding for The OSCE may be demanding for both examiners and patientsboth examiners and patients

More time in setting it upMore time in setting it up Shortage of examinersShortage of examiners Might be quite distressing to the Might be quite distressing to the

studentstudent

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Long case examLong case exam

Candidates spend 45-60 min with Candidates spend 45-60 min with patientpatient

No examiner (s) is presentNo examiner (s) is present Students are then examined by Students are then examined by

examiner for 20-30 min examiner for 20-30 min Time is fixed by the institute where Time is fixed by the institute where

the examination is runthe examination is run Usually ran over 4-5 daysUsually ran over 4-5 days

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Advantages of long case Advantages of long case examexam

Holistic approach to patients’ Holistic approach to patients’ problem (s)problem (s)

RealisticRealistic InteractiveInteractive Time Time More related to daily practice of More related to daily practice of

student student Student is used to such encountersStudent is used to such encounters

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Disadvant.of long case Disadvant.of long case examexam

Time consumingTime consuming Not observedNot observed Physical signsPhysical signs Different emphasis by examinersDifferent emphasis by examiners BiasedBiased Fixed Fixed Not structured Not structured Not standardizedNot standardized

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OSLER (1/2)OSLER (1/2)

The following are the key features of OSLER:The following are the key features of OSLER: Ten item structured record.Ten item structured record. Objective approach – there is prior Objective approach – there is prior

agreementagreement

on what is to be examined.on what is to be examined. Examiner reliable – all candidates are Examiner reliable – all candidates are

assessedassessed

on identical items.on identical items. Construct validity is recognized and Construct validity is recognized and

assessed assessed

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OSLER (2/2)OSLER (2/2) History process and product are assessed.History process and product are assessed. Communication skill assessment is Communication skill assessment is

emphasised.emphasised. Case difficulty is identified by the examiner.Case difficulty is identified by the examiner. Can be used for both criterion and normCan be used for both criterion and normreferenced assessment.referenced assessment. A descriptive mark profile is available whereA descriptive mark profile is available wheremarks are used.marks are used. No extra assessment time is required.No extra assessment time is required.

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Oral examinationOral examination

Face to face discussionFace to face discussion No. of examiners vary, usually 2-3No. of examiners vary, usually 2-3 Mainly related to emergencies or Mainly related to emergencies or

important topics but in reality………. important topics but in reality………. Once the question is asked:Once the question is asked:

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Advantages of oral examAdvantages of oral exam

Allows assessment of personal Allows assessment of personal characteristics characteristics

Assess language related issuesAssess language related issues Discussion Vs argumentDiscussion Vs argument FlexibleFlexible Easy to conductEasy to conduct

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Disadvantages of oral Disadvantages of oral examexam

PrejudicePrejudice ThreateningThreatening Not standardizedNot standardized Personal preferencePersonal preference Factual knowledge and recallFactual knowledge and recall No. of studentsNo. of students No criteria No criteria

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Short cases examShort cases exam

Each student will be assessed using 3-Each student will be assessed using 3-4 cases of different clinical findings 4 cases of different clinical findings

Usually observed by 2 examinersUsually observed by 2 examiners Cases should be prepared before Cases should be prepared before

handhand Examiners must have a look at the Examiners must have a look at the

cases before taking the student to cases before taking the student to themthem

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Advantages of short Advantages of short examexam

Identify real clinical signsIdentify real clinical signs Assess clinical examination skillsAssess clinical examination skills Time Time ReproducibleReproducible Setting upSetting up No of examinersNo of examiners

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Disadvantages of short case Disadvantages of short case examexam

CompartmentalCompartmental Not objectiveNot objective Not standardizedNot standardized Hectic to both patients and studentsHectic to both patients and students Not validNot valid Low reliabilityLow reliability biasedbiased

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WORKPLACE –BASED ASSESSMENT

Contextualisation, real life, formative and

summative, objective

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• Case-based Discussion (CbD)

• Consultation Observation Tool

Clinical

encounter cards

Clinical work

sampling

Blinded patient

encounters

• Multi-Source Feedback ( 360 degree assessment)

• Patient Satisfaction Questionnaire (PSQ)

• Direct Observation of Procedural Skills (DOPS)

• Clinical Evaluation Exercise ( Mini CEX)

• Clinical Supervisors Report

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PORTFOLIOS

• Clinical log-books

• Procedural log-books

• Clinical diaries

• Reflective portfolios

• Portfolios of learning

• Formative

• Summative

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Finally……Finally……

There is no clinical assessment tool There is no clinical assessment tool that is better than the other that is better than the other

Tools should correlate with Tools should correlate with objectives and learning process objectives and learning process

Faculty need to be aware Faculty need to be aware Students need to know how are they Students need to know how are they

going to be assessedgoing to be assessed Use the tool properlyUse the tool properlyThen inshalla…………….Then inshalla…………….