Assessment in System-based Curriculum Dr Usman Mahboob Assistant Professor in Medical Education

First Year Modules Foundation Module Blood & Immunology Musculo-skeletal and Locomotion Cardiovascular Respiratory First Year Modules Consider talking about: Writing to learn Writing in the disciplines

System-based Curriculum: How?

Year-1 Academic Colander Academic Calendar Year 1, (Session 2018-2019) Activity (Exams, holidays, vacations) Date Week No. Year 1 Modules   Dec 31- Jan 5 1 Foundation-I Jan 07- Jan 12 2 Jan 14- Jan 19 3 Jan 21- Jan 26 4 Jan 28- Feb 02 5 End of Module Exam 5th Feb Public Holiday Feb 04- Feb 09 6 End of Module Exam Feb 11- Feb 16 7 Blood & Immunology Feb 18- Feb 23 8 Feb 25- Mar 02 9 Mar 04- Mar 09 10 Block-I Exam Mar 11- Mar 16 11 23rd March Public Holiday Mar 18- Mar 23 12 MSK Mar 25- Mar 30 13 Spring Break April 01- April 06 14 April 08- April 13 15 April 15- April 20 16 April 22- April 27 17 1st May Public Holiday April 29- May 04 18 May 06- May 11 19 Block-II Exam May 13- May 18 20 May 20- May 25 21 CVS-I May 27- June 01 22 Eid Holidays June 03- June 08 23 June 10- June 15 24 June 17- June 22 25 June 24- June 29 26 Respiratory-I July 01- July 06 27 July 08- July 13 28 Block-III Exam July 15- July 20 29 4-weeks Preperatory Leaves for Professional Exam July 22- Aug 22 30-33 4=weeks Preperatory Leaves for Professional Exam Year 1 Professional Exam Aug 23- Sept 14 34-36 Tentative dates for Exam Start of Year 2 Academic Session 30-Sep Tentative Start of Year 2 Academic Session

01 - Foundation Module (6-weeks) SNO Theme Duration 1 Orientation 1 week 2 Cell 3 Growth & Development of Human Body 2 weeks 4 Human Body tissues, bones & joints

02 – Blood & Immunology (5-weeks) S No Theme Duration 1 Pallor and swelling 2 weeks 2 Fever (Infection and Immunity) 3 Excessive bleeding & Transfusion Reaction 1 week

03 – MSK & Locomotion (8-weeks) S No Theme Duration 1 Orientation and shoulder pain 2 weeks 2 Weak grip and painful hand 1 week 3 Pain lower limb/limping 4 Bony arches and fracture of foot 5 Backache 6 Muscle weakness and fatigue

Breathlessness and ankle swelling 04 – CVS (5-weeks) SNO Theme Duration 1 Chest pain 1 week 2 Breathlessness and ankle swelling 2 weeks 3 Blood Pressure 1 weeks 4 Palpitations

05 – Respiratory (4-weeks) S No Theme Duration 1 Chest wall injury 1 week 2 Cough and Hemoptysis 3 Breathlessness 2 weeks

Integrating Teaching of Behavious in Curriculum

Outcomes required by the PMDC Year Medical Knowledge Clinical Practice & patient care Community Health Promoter Communication Skills Doctor as Leader and Manager Doctor as Scholar/ Researcher Doctor as Professional/ Professionalism Year 5 Year 4 Year 3 Year 2 Year 1

How to learn these skills? P – Professionalism, Patient safety & Communication Skills R – Research I – Identity formation M – Management & Leadership E – Ethics & Legal issues

Assessment in system-based curriculum

Assessment in System-based Curriculum FM End of Module Exam Block 1 exam (FM+ Blood) Block 2 exam (MSK) CVS End of Module Exam Block 3 exam (CVS+ Resp.) Pre-prof exam (Paper I, II, III) Prof exam (University) Assessment in System-based Curriculum

How to assess in System-based curriculum? Assessment is based on blueprints Students would pass the module/block University theory paper – MCQ only University Skills assessment – OSPE/OSCE only

Year 1 Professional Exam in System-based Curriculum Theory paper Modules Theory Marks Internal Assessment Theory (10%) OSPE/ OSCE Internal Assessment OSPE/ OSCE (10%) TOTAL MARKS Paper A FM 120 14 90 10 234 Blood Paper B MSK 13 233 Paper C CVS Respiratory   360 40 270 30 700

Sample Blueprint: Paper A (FM+ Blood) Subject No. of MCQs in Foundation (total 158 hours) No. of MCQs in Blood (total 93 hours) Total * Gross Anatomy 12 1 13 Histology 10 4 14 Embryology 15 Physiology 22 32 Biochemistry 26 Pathology 2 6 Pharmacology Community medicine 3 Forensic medicine PRIME 5 8 Total 70 50 120 * Distribution of MCQs are based on a ratio of 1.7:1 (158:93) between 2 modules

Sample Blueprint: Paper B (MSK) Subject No. of hours allocated in TT Percent distribution (No. of hours allocated in TT for specific subject/total hours x 100) Percentage distribution of hours (subject-wise) Total subject-wise MCQs out of 120 Gross Anatomy 121   59 69 71 Histology 14 7 8 Embryology 3 4 Physiology 26 13 16 Biochemistry Pathology 2 Pharmacology 1 Community medicine PRIME Total 207 100 120

Sample Blueprint: Paper C (CVS+ Resp.) Subject CVS module MCQs Respiratory Total MCQs* Gross Anatomy 9 12 21 Histology 4 8 Embryology 5 3 Physiology 34 20 54 Biochemistry 14 22 Pathology 1 2 Pharmacology Forensic medicine Community medicine 70 50 120 CVS module (total 109 hours) Respiratory module total 65 hours) *total MCQs are distributed with a ratio of 1.7:1 (109:65) ! example=(30/120) x 50 (where 30 is the total no. of MCQ for gross anatomy in individual Respiratory module out of 120 MCQs and 50 is the total MCQs required for block assessment according to the ratio of 1.7:1)

OSPE Minimum 18 stations (excluding pilot and rest stations) for each batch. Mix of static and interactive stations. Time: Minimum 3-6 minutes, including 1 minute for movement between the stations and reading the instructions. Faculty up to demonstrator/ SR level to be involved. For every block exam, there should be at least three external examiners for the major subjects One of the external examiner - Nominated as coordinator

Example: OSPE Circuit MSK & Locomotion Static Shoulder Joint model Ana Internal Viva Static Histology slide Enter Phy Internal Viva Static Walking mechanism Ana External Viva Static Action potential Phy External Viva Static ATP production Bio External Viva Static G6PD deficiency Bio Internal Viva Exit

OSPE Circuit Dr Usman Mahboob This Photo by Unknown Author is licensed under CC BY-SA

Example of Paper A

Paper A (FM+ Blood & Immunology) 3 5 7 1 9 Operating The Microscope Anatomical terms Histology of Simple Epithelia Rest 1 Ana Viva 1 Histology of Glands/ Lymph nodes Rest 2 Ana Viva 2 Sterilization Lab Equipment’s Rest 3 Phy Viva 1 Oral temperature Bio Viva 2 Rest 7 Detection of Monosaccharide’s 25 OSPE Circuit Paper A (FM+ Blood & Immunology) 11 23 13 Bio Viva 1 Rest 6 PH and buffer solutions Blood count Rest 5 Hb determination Phy Viva 2 Rest 4 Blood grouping 21 19 17 15

Plan 1 (Single Circuit – 25 students) Total Circuit Time: 25 * 5 = 125 minutes (2 hours and 5 minutes) Circuit 1 (9 – 11:05 AM) Break 1 (11:05 – 11:30 AM) Circuit 2 (11:30 AM – 1:35 PM) Break 2 (1:35 – 2:00 PM) Circuit 3 (2:00 – 4:05 PM) Break 3 (4:05 – 4:30 PM) Circuit 4 (4:30 – 6:35 PM)

Plan 2 (Parallel Circuits – 50 students) Boys Common Room Girls Common Room Circuit 1 (Group A) Circuit 1 (Group B) Circuit 2 (Group c) Circuit 2 (Group D) Circuit 1 (9 – 11:05 AM) Group A & B Break 1 (11:05 – 12:00 PM) Circuit 2 (12:00 – 2:05 PM) Group C & B

Works cited

Thank you Dr Usman Mahboob MBBS, MPH, FHEA (UK), PhD (UK), Fellow FAIMER (USA) Director Medical Education Khyber Medical University usman.mahboob@kmu.edu.pk