LEVELS OF CLINICAL COMPETENCE [Cox, 1982] Raja C. Bandaranayake

Clinical skills are complex, consisting of: Clinical skills are complex, consisting of:  cognitive  psychomotor  perceptual  affective  communication skills

LEVELS OF CLINICAL COMPETENCE  PREREQUISITES on which clinical ability will be based  COMPONENT CLINICAL ABILITIES form parts of the clinical task  COMPOSITE CLINICAL PERFORMANCE focuses on management of whole patient  COMPETENT PRACTICE focuses on management of a series of patients

PREREQUISITES  Knowledge structure, function, Abnormality  Skills communication, observation, percussion  Attitudes respect, honesty, persistence Pen-and-paper, Oral Observation Progressive assessment during clerkship

COMPONENT CLINICAL ABILITIES  Taking a history  Examining the abdomen  Generating diagnostic explanations  Establishing rapport  Explaining implications of illness Direct observation OSCE OSCE Checklists and rating scales Real or simulated patients Video review

COMPOSITE CLINICAL PERFORMANCE  Processes of:  perceiving  questioning  reasoning  selecting  interpreting  Outcomes:  diagnosis  management “ Long case” during clerkships and in examinations “ Long case” during clerkships and in examinations Real or simulated patients Video review

COMPETENT PRACTICE Management of ward, clinic or practice over a period, which includes:  setting priorities  management of health care team  investigations  referral  consultation  Progressive assessment during clerkship  Simulated patients  Self- and peer-review  Outcome measures:  recovery rates  morbidity rates

KnowledgeSkillsAttitudes PREREQUI- SITES COMPONENT ABILITIES COMPOSITE PERFORMANCE COMPETENT PRACTICE

EXPECTED PERFORMANCE LEVEL AT GRADUATION 1. Diagnosis + Total Management 2. Diagnosis + Initial Management + Referral 3. Diagnosis + Emergency Management 4. Diagnosis + Referral 5. Prevention

PERFORMANCE INDICATOR A variable which tells us the extent to which a particular ability exists. May be a: process indicator product indicator PERFORMANCE CRITERION The level to which the indicator should exist if we are to judge anyone as competent. Hence: CRITERION-REFERENCED ASSESSMENT

COMMUNICATION SKILLS Self-assessment Self-assessment –How am I progressing? Formative assessment Formative assessment –Observation using audio- or video-tapes –Real or simulated situations Summative assessment Summative assessment –Built into other test situations, e.g. OSCE –May use standardised instruments