Assessment of Clinical Competence in Health Professionals Education Assessment of Studnets Competence in Health Professional Education Assessment of Clinical Competence in Health Professionals Education Professor Hossam Hamdy University of Sharjah

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

WHAT Should Be Assessed? ACGME Competencies Patient care Knowledge Practice-based learning and improvement Interpersonal and communication skills Ethics & Professionalism System-based practice

Blueprinting Test content matches objectives Assessment matches competencies learnt Assessment matches format of learning, “PBL”

A Simple Model of Competence Assessment of Studnets Competence in Health Professional Education A Simple Model of Competence Professional authenticity Performance or hands on assessment Does Shows how Written, Oral or Computer based assessment Knows how Knows Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S7. 5 5

Validity Climbing the Pyramid . . . Does Performance assessment in vivo: Masked SPs, Video, Audits….. Does Shows how Performance assessment in vitro: OSCE, SP-based test….. Shows how Knows how (Clinical) Context based tests: MCQ, essay type, oral….. Knows how Knows Factual tests: MCQ, essay type, oral….. Knows 6

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. 7

Workplace-Based Training and Assessment

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

Problems of Workplace –based Training Not observed No assessment of Competencies No feed-back

Effective Workplace-Based Assessment “sampling collection of data concerning specific patient encounters for a number of different domains” Reflects routine performance

The Traditional Long Case Examinations (LCE) Assessment of Studnets Competence in Health Professional Education The Traditional Long Case Examinations (LCE) Unobserved 30 – 45 minute interview and examination on a selected patient Candidates present only their findings to the examiner 12 12

Assessment of Studnets Competence in Health Professional Education (LCE) Validity 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” 13 13

(LCE) Reliability Poor intercase reliability Assessment of Studnets Competence in Health Professional Education (LCE) Reliability 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 14 14

Mini-CEX Real patients 12 - 14 ~ 6 / years Only components of the encounter observed 15-20 minites (Norcini 2003) Formative

Direct Observation Clinical Encounter Examination “DOCE” Four real patients The whole encounter is observed Focused history & examination Clinical reasoning & decision-making Communication skills 20-30 minutes Summative / formatives (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 " .

Problems of Workplace Based Assessment of Performance Sampling: variability in the complexity of patients problem Judges errors: Time: Requires adequate allocation of time and resources. Management of Data: not easy Validity and Reliability: variable 22