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

introduction

ارزیابی : Assessment ارزشیابی : evaluation

Important points in any assessment: Importance Sample Validity Reliability

Important points in any assessment: Objectivity feasibility Acceptability Limitations

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

Miller’s pyramid

Miller’s pyramid

Bloom’s taxonomy :

performance-based assessments: OSCE Mini CEX DOPS PBA MSF

OSCE Objective Structured Clinical Exam

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

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

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

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

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

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

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

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

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

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

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)

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

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

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

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

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

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

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

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

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

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

Mini CEX Mini Clinical Evaluation Exercise

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

Mini CEX: Assessor rates along several dimensions on a form Feedback Multiple encounters expected Intended to be short & routine Takes 15-20 minutes, feedback 5-7 min.

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

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)

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

DOPS Direct Observation of Procedural Skills