Assessment of clinical skills Joseph Cacciottolo Josanne Vassallo UNIVERSITY OF MALTA ANNUAL CONFERENCE - OSLO - MAY 2007

Assessing clinical skills 1.WHY do we need to assess ? 2.WHAT do we want to measure ?

WHY do we assess ? To ensure safety of patients our responsibility to the public Achievement of a minimum standard responsibility to the candidate and University In principle…

WHY do we assess ? To ensure competence Often as a means of academic competition In practice: the scope

WHY do we assess ? Formative: to give feedback and advice Summative: to grade Qualificative or licensing In practice: the purpose

WHAT do we measure ? To test not only presence of knowledge …but also the application of knowledge In principle…

Several types of clinical assessment One model presented in some detail to provide a framework for later discussion

One model of clinical assessment Certification of competence - pass / fail a state (and legal) requirement Grading in rank order for employment / placement purposes A competition for the award of a prize In principle…a three-fold aim

One model of clinical assessment Measurement of: adequacy of basic clinical skills ability to interpret clinical findings facility of communication in practical settings ability to think analytically about diagnosis ability to discuss management logically In practice…

Practical steps for assessment 6 encounters with different clinical situations Two examiners at every encounter, each examiner giving an individual assessment Highly structured examination and detailed assessment of skills Examiners from other Universities for process evaluation and quality control

Practical steps for assessment Encounters with at least six real patients Ability to interpret and discuss clinical data Management of an emergency scenario Appraisal of communication skills and attitude

Set-points for testing Attitude to patient Actual examination skills Presentation of findings Clinical judgment Clinical examination of patients

Set-points for testing Evaluation of data Significance of data Clinical reasoning Interpretation of clinical data

Set-points for testing Ability to solve problems Ability to discuss logically Clinical judgment and prioritization General medical knowledge Management of emergency situations

Set-points for testing Attitude to ‘patient’ Ability to communicate well Clinical judgment General medical knowledge Communication skills

Evaluation Subjective evaluation: looking in the mirror Objective evaluation of outcome

Evaluating ourselves “Examinations are formidable even to the best prepared… …for the greatest fool may ask more than the wisest man can answer” Charles Caleb Colton

Evaluating outcome Pattern of results Consistency of results Patterns of marking Process shortcomings Basis for improvement Analysis of data to assess effectiveness

What happens to candidates who fail ? Review of performance – a formative exercise Counselling at a personal level Specific attention and individual training Repeat assessment after a period of time

Points for discussion Competence versus performance Exam based versus continuous assessment Methodology related issues Organisational issues

Competence versus Performance In relation to methods used Use of core curriculum with additional modules as required Eventual medical practice in different environment Impact on mobility

Competence versus Performance In relation to methods used Use of core curriculum with additional modules as required Eventual medical practice in different environment Impact on mobility

Competence versus Performance In relation to methods used Use of core curriculum with additional modules as required Eventual medical practice in different environment Impact on mobility

Competence versus Performance In relation to methods used Use of core curriculum with additional modules as required Eventual medical practice in different environment Impact on mobility

Exam based vs continuous assessment Assessment of a modular curriculum Written exams: MCQs, SAQ, Essays Real-time exams Orals: clinical / table viva, OSCEs Clinical assessment on site: mini-CEX, DOPS, multi-source feedback Log books, portofolios, CATs

Exam based vs continuous assessment Assessment of a modular curriculum Written exams: MCQs, SAQ, Essays Real-time exams Orals: clinical / table viva, OSCEs Clinical assessment on site: mini-CEX, DOPS, multi-source feedback Log-books, portfolios, CATs

Methodology-related issues Reliability Validity Practicality Transparency

Organisational issues Resources available Student numbers Patient availability Invasive procedures Scheduling

Role of grading Is there need for grading ? Selection process for employment Selection for postgraduate training Quality of assessment method and performance of candidates

Conclusions There is wide diversity among European medical schools regarding methods of assessment of clinical skills: some schools aim at pass/fail outcomes, others use systems that lead to grading several quality assurance mechanisms are used to varying degrees There is place for widespread application of agreed standard methods to: assess clinical competences in core curricula assess additional competences essential to individual practice

UNIVERSITY OF MALTA MEDICAL SCHOOL EU UNIVERSITY PARTNER ● ●

Thank you ANNUAL CONFERENCE - OSLO - MAY 2007