work based assessment [email protected]
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Work based assessment [email protected]. Challenges and opportunities. Choosing assessments?. What do you want to assess - e.g. Professionalism Clinical reasoning Technical skills Clinical evaluation Who do you want to assess Med student Resident Practising physician. - PowerPoint PPT PresentationTRANSCRIPT
Work based [email protected]
Challenges and opportunities
Choosing assessments?
What do you want to assess - e.g. Professionalism Clinical reasoning Technical skills Clinical evaluation
Who do you want to assess Med student Resident Practising physician
Choosing assessments
Patient outcome gold standard but attribution a problem
Judgements largely based on process measures
Case mix and reliability an issue
Assessors
If sufficient subjective judgements are combined the
collated judgement about performance can be reliable
i.e objectivity and reliability are not the same thing
Assumes that assessor has both observed competence
in question and can make a judgement about its
quality
How many assessors is enough?
MSF in healthcare settings
Feedback about observable behaviors is provided by some or all of Physician colleagues (peers, referring MDs, referral MDs) Co-workers (e.g., nurses, pharmacists, dieticians) Patients Self
If trainee borderline or in difficulty sample more
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6
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Assessors Self
Insight
MSF
One to one feedback Problems may need further diagnostic work Need support mechanisms in place
Bias
Consider sources of bias such as Gender Working relationship Working environment Ethnic group University of graduation
Cons SASG
F1/F2
SHO
SpR
Nurse
F=524.1
p= <0.001
GP
AHP
Mini-CEX case complexity
Validity
Extent to which a test assesses what it purports to Content validity
Criterion validity
Construct validity
Face validity
Consequential validity
Recognised need for further validity data in relation to
MSF and other work based assessments1
Evans, R., G. Elwyn, and A. Edwards, Review of instruments for peer assessment of physicians. BMJ, 2004. 328(7450): p. 1240.
Validity
Content validity Blueprint assessments to the curriculum
Evidence from a range of sources supporting the hypothesis that the score really measures what it is meant to
Relationship with patient ratings
SHEFFPAT vs SPRAT r=0.12 NS
SHEFFPAT vs PATSCOREr=0.45 p<0.01
Predictive and consequential validity
Centralisation
Facilitates standardisation and robust QA Facilitates movement between locations Economies of scale Strategies to enhance local ownership
important
Practicalities
Is it feasible? Electronic vs paper Centralised vs localised Who assesses? How is training organised? Who will do the QA?
Acknowledge legitimate concerns
Healthy scepticism Resources - especially time Conflicting demands espy CLINICAL Need for sampling Lack of standardisation Training needs Loss of local ownership
Support doctors in difficulty
Be patient
Op-ti-mist n Somebody who tends to feel hopeful and positive
about future outcomes Recognise extent of cultural change Ensure work based assessment is done as
well as possible
“ Every problem is just an opportunity waiting to be made use of ”
Who assesses?
57.6%
14.8% 19.4%
7.1%
Consultant 1SASG 2SpR 3GP 4
The programme should be quality assured
RR VV EE CC AA
importanceimportance
100 %100 %
0 %0 %
aspectaspectFF
van der Vleuten C. The assessment of professional competence: developments, research and practical implications. Advances in Health Sciences Education. 1996;1:41-67.
Sampling
Content specificity Being good at one thing doesn’t mean you are
good at everything Must sample clinical content widely Map to curriculum - blueprint
Sources of variance Assessors significant source of variance Use lots of assessors
Classification Scheme for Work-Based Assessment
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
Norcini BMJ 2003
Quality assurance
Quality assure assessment system
Modify assessment system in response to QA
Effective (work based) assessment
RESOURCES and CO-ORDINATION
TIME
FUNDING
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RB SELF PRACT
Key messages
Sampling is crucialConsider sources of biasHave as many different clinical
problems and as many assessors as possible
Subjectivity ≠ unreliabilityTrain the raters
Holmboe, E. S., R. E. Hawkins, et al. (2004). "Effecs of training in direct observation of medical residents' clinical competence; a randomized trial." Ann Intern Med 140: 874-881.
PERFORMANCEOF
PHYSICIAN
Personal pressures: •Home•Health
Attributes of training:
•Post •Programme•Supervisor
Context of training:•Workload
•Colleagues•Patients
Attributes of physician: •Personality
•Background •Aptitude for specialty
MSF