Designing an Assessment System: An Assessment System for Clinical Principles, Practices and Skills Course; A Longitudinal Course for Years 1 and 2 Audrey Okun-Langlais, D.O. Elisabeth DelPrete, D.O. Department of Family Medicine University of New England College of Osteopathic Medicine

Course Context Longitudinal course for first and second year medical students at the University of New England College of Osteopathic Medicine Beginner program for developing physicians to develop, apply and integrate emerging clinical skills

Content and Skills History Taking Physical Exam Differential Diagnosis Treatment Plans Interviewing/ Communication Professionalism Cultural Sensitivity Medical Documentation

Teaching Methods Didactic large group presentations Small groups with facilitated supervision Standardized patient encounters at Clinical Performance Center Community Preceptor Experiences Clinical Experience with facilitator supervision

Assessments Should Arise From Specified Goals and Clearly Articulated Achievement Targets

Learning Outcomes Conduct medically thorough history taking skills and record results in a professionally acceptable manner Conduct a gentle but thorough physical exam and record results in a professionally acceptable manner Demonstrate respect and empathy for patient privacy and confidentiality

Learning Outcomes Formulate a concise yet accurate differential diagnosis based on historical and physical exam information Formulate an appropriate, cost effective treatment plan, based on their differential diagnosis Analyze patient preferences, needs, and beliefs when formulating a treatment plan. Students will also consider societal and socioeconomic needs that may constitute barriers to effective patient care

Learning Outcomes Communicate effectively with all patients and colleagues, across all cultural and socioeconomic divides, using appropriate body language and empathetic listening skills Demonstrate culturally sensitive care to all patients

Performance Indicators for Medical History Taking: Elicit a complete history of present illness, utilizing the OPQRST format Identify and elicit the appropriate review of systems for the chief complaint, including pertinent positives and negatives Record a complete past medical and surgical history, as well as family history including at least three generations utilizing a genogram Elicit a list of allergies to food, medicine, and environment, including type of reaction

Performance Indicators for Medical History Taking: Obtain a list of both prescribed and over the counter medications, vitamins, and supplements, including dose and frequency Elicit a complete psychosocial history, that will include tobacco use, alcohol use, drug use, occupation, partner status, members of household, and living arrangements, and any particular cultural needs or beliefs that may affect medical care and treatment Record all elicited historical information, in a medically acceptable format, using standardized medical terminology, in a clear, concise fashion

Assessment Instruments Systems ROS and Exam Rubric SOAP Note Rubric History and Physical Rubric Differential Diagnosis Grading Rubric Direct Observation Rater form Standardized Patient Checklist Self -Assessment Form COM Professional Behavior Checklist Reflective Essay (with Guide)

Grading Rubric for Respiratory System

Assessment Methods Must Align With Desired Learning Outcomes

Assessment Methodology

Balance of Assessment Purposes Formative Patient, peer and faciltator feedback Reflective exercises Formative and Summative Rubrics Summative – “Grades” Developmental scale of competency

Summarizing Assessment Information Learners must show appropriate progression for their level of training throughout the course, for each year of instruction. Non-achievement factors such as timeliness and professionalism are included in the assessment tools

Standards for Assessment Quality Measurement of assessment tool quality Metarubrics such as the “Rubric for Rubrics” Validity and reliability Inter-rater reliability

Student or Other Key User Involvement in the Assessment Process “Who are the key users?” (Stiggins) Learners Facilitators Clinical Performance Center Staff Standardized patients Focus groups Facilitator Meetings Institutional Level Committee on Educational Programs

Summary Assessment methods align with desired learning outcomes Both formative and summative assessments are utilized to enhance the learning process and empower the learner Formative assessment provides information for learner improvement, as well as facilitator and course adjustments to better meet learning objectives. Summative information allows for improved, conjunctive evaluation of competency, and also provides evidence to support allocation of educational resources The assessment plan is developmental, encouraging a model for life long androgogy

References American Osteopathic Association. (2006) Competency –Based Evaluation For Residency Training Programs in Osteopathic Family Practice and Manipulative Treatment. American College of Osteopathic Family Physicians. Retrieved February 28, Andrade, H. (2005 ). Teaching with Rubrics; The Good, the Bad and the Ugly. College Teaching. 53 (1), pp Arter, J. & McTighe, J (2001) Scoring Rubrics in the Classroom Bickley,L (2007) Thorax and Lungs, in Bickley, L.,&Szilagyi,P. Bates’Guide to Physical Examination and History Taking - ninth edition, Philadelphia. : Lippincott, Williams & Wilkins Licari, F, Knight, G., Guenzel, P. (2008) Designing Evaluation Forms to Facilitate Student Learning. Journal of Dental Education. 72 (1), pp McTighe, J. & O’Connor, K. (2005). Seven Practices for Effective Learning. Educational Leadership. 63 (3), pp10-17 Overbaugh, R, & Schultz, Lynn.(2008) Bloom’s Revised Taxonomy Comparison. Stiggins, Rick, Assessment FOR Learning: A Key to Motivation and Achievement, Edge, PDK International, Vol2(2), Nov/Dec Taleghani,M., Solomon, E., & Wathen, W. (2006). Grading Dental Students in a “Nongraded” Clinical Assessment Program. Journal of Dental Education. 70 (5), pp