2. Clinical Assessment Dr. H
Clinical Assessment Dr. H. Javdani Assistant professor of Psychiatry QUMS

3. introduction

4. ارزیابی :
Assessment
ارزشیابی :
evaluation

5. Important points in any assessment:
Importance
Sample
Validity
Reliability

6. Important points in any assessment:
Objectivity
feasibility
Acceptability
Limitations

7. Domains of learning : Cognitive : Psychomotor Affective
knowledge , comprehension , application , analysis , synthesis , evaluation (judging)
Psychomotor
Affective

8. Miller’s pyramid

9. Miller’s pyramid

10. Bloom’s taxonomy :

12. performance-based assessments:
OSCE
Mini CEX
DOPS
PBA
MSF

13. OSCE Objective Structured Clinical Exam

14. OSCE :
Performance based test which allows for standardized assessment of clinical skills
Assess the same skills in the same area

15. OSCE : Increasing the number of skills to be evaluate
Increasing the number of raters
Scoring with clear & objective criteria

16. OSCE : Fun ! Need to practice ! Not going to pass by reading books !
More students failed than MCQ !

17. Structure of OSCE :
Candidates rotate through the stations & performing a series of clinical tasks
Use SPs, mannequins or simulations
Raters assess performance using checklists

18. Structure of OSCE :
Stations built upon a blueprint to ensure adequate sampling of the content domain & process skills
Evaluate both clinical knowledge & communication or psychomotor skills

21. Advantages of OSCE : Assess at “shows how” level
Testing of complex skills without any supervision
Standardized
Objective

22. Limitations of OSCE : Small sample of content Time-consuming
Need trained item writers & raters
Need trained SPs
Need practice

23. Why OSCE ? Measurement of communication skills
Integration of communication skills with clinical knowledge
Safety of patients
Standard assessment
Uniquely capable of evaluation of clinical skills on simulated real-world environment

24. Why not OSCE ? Not efficient for assessment of knowledge alone
Expense issues
Time-consuming
feasibility

25. OSCE with: High : objectivity , acceptability
Moderate to high : validity , reliability
low: : feasibility

26. What dose OSCE assess? History taking skills
Performance of physical exam
Interpretation of data & complementary exams
Counseling
Dealing with particular situations (e.g: giving bad news, dealing with anger , etc)

27. validity-response process:
Training of SPs
Rater training
Practicing SP & rater before the exam
Increasing objectivity (only y/n checklist)

28. principles for use of OSCE :
Performance based assessment must be matched with performance based teaching
“Format anxiety” must be addressed
Standardization of simulations must be achieved

29. development of OSCE: Blueprinting Station development Case writing
Case review & validation
Standard setting
Piloting
Assembly of OSCE

30. Blueprinting: Defining content domain & process skills to be assessed
Based upon outcomes, expectations or standards
Level & Range: complexity of problem & performance

32. SP ?! Standardized patient
A person who is trained to show a specific clinical problem
Participates in evaluation the candidate’s communications skills

33. How to develop OSCE? Consider the relevant objectives Write them down
Is the OSCE a suitable format to evaluate the objectives?
Consider each station for only one objective

34. How to develop OSCE? Write a scenario for each station
Develop a suitable rating tool for each station
Write an instruction for examinee
Write an instruction for standardized patient

35. How to develop OSCE? Try to simulate nearer to the real situation
Have several practices
Have a pilot study

36. How to develop OSCE?
Run “OSCE”
have a suitable feedback

37. Checklists : Items must be clear & dichotomous Number of items : 8-25
Weighting of items
Killer items

44. Mini CEX Mini Clinical Evaluation Exercise

45. Mini CEX: Assessor observes a trainee with a patient in any settings:
Out-patient clinic
In-patient service
Emergency department
Trainer performs a focused task

46. Mini CEX: Assessor rates along several dimensions on a form Feedback
Multiple encounters expected
Intended to be short & routine
Takes minutes, feedback 5-7 min.

48. Clinical skills evaluated:
Medical interview
Physical examination
Informed decision-making or counseling
Clinical judgment or reasoning

49. Mini CEX forms: Medical interviewing & history taking
Physical examination skills
Humanistic qualities / professionalism:
(shows respect, compassion, empathy, establishes trust, attends to patient’s needs of comfort, modesty, confidentiality, information)

50. Mini CEX forms:
Clinical judgment : (selectively order & considers risks/benefits)
Counseling skills
Overall clinical competence

55. DOPS Direct Observation of Procedural Skills