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Assessment of Clinical Competence in Health Professionals 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

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Assessment of Clinical Competence in Health Professionals Education

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  1. Assessment of Clinical Competence in Health Professionals Education Professor Hossam Hamdy University of Sharjah

  2. 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

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

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

  5. 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

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

  7. 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

  8. Workplace-Based Training and Assessment

  9. 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

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

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

  12. Unobserved 30 – 45 minute interview and examination on a selected patient Candidates present only their findings to the examiner The Traditional Long Case Examinations (LCE) 12

  13. 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” (LCE) Validity 13

  14. 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 (LCE) Reliability 14

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

  16. Four real patients The whole encounter is observed Focused history & examination Clinical reasoning & decision-making Communication skills 20-30 minutes Summative / formatives Direct Observation Clinical Encounter Examination “DOCE” (Hamdy et al, MedEduc, 2003)

  17. Case Based Discussion • Trainees select two case records for discussion with assessment • Focus on evaluating clinical reasoning and decision making

  18. Clinical Work Sampling (CWS) • Sample performance in the workplace • Collection of information concerning specific patient encounters, admission, discharge, ward follow up • Portfolios

  19. Whole procedure observed from start to finish Simulators Or Real Patient Direct Observation Practical Procedure Skills “DOPS”

  20. Multi-source Feedback (MSF) 360 Degree Assessment • Peers • Supervisors • Nurses • Secretary • Lab Technicians • Patients

  21. 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 " .

  22. 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

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