1 Tools of clinical assessment

2 Presentation outline Introduction Introduction Our daily practice Our daily practice Types of assessment tools Types of assessment tools Pros and cons Pros and cons Emphasis Emphasis Summary Summary Q&A Q&A

3 Introduction It is part of our daily practices It is part of our daily practices Undergraduate as well as postgraduate Undergraduate as well as postgraduate Most of them are difficult to organize Most of them are difficult to organize Lack of information Lack of information The students The students Formative Vs summative Formative Vs summative Wedded to tradition Wedded to tradition

4 Our daily practice Done at the corridor Done at the corridor Most the times it is ORAL Most the times it is ORAL Observe while doing it Observe while doing it We chose the easy one/s to conduct We chose the easy one/s to conduct Rigidity Rigidity Restricted with venues!!! Restricted with venues!!! Feedback is almost always ZERO Feedback is almost always ZERO

5 OSCE The candidates rotate through a series of stations at which they are asked to carry out a (usually clinical) task

6 Advantages of the OSCE Valid examination Valid examination Controlled complexities Controlled complexities Summative as well formative Summative as well formative Larger number of students Larger number of students Reproducible Reproducible Less biased Less biased Fun activity Fun activity

7 Disadvantages of the OSCE Knowledge and skills are tested in compartments Knowledge and skills are tested in compartments The OSCE may be demanding for both examiners and patients The OSCE may be demanding for both examiners and patients More time in setting it up More time in setting it up Shortage of examiners Shortage of examiners Might be quite distressing to the student Might be quite distressing to the student

8 Long case exam Candidates spend min with patient Candidates spend min with patient No examiner (s) is present No examiner (s) is present Students are then examined by examiner for min Students are then examined by examiner for min Time is fixed by the institute where the examination is run Time is fixed by the institute where the examination is run Usually ran over 4-5 days Usually ran over 4-5 days

9 Advantages of long case exam Holistic approach to patients’ problem (s) Holistic approach to patients’ problem (s) Realistic Realistic Interactive Interactive Time Time More related to daily practice of student More related to daily practice of student Student is used to such encounters Student is used to such encounters

10 Disadvant.of long case exam Time consuming Time consuming Not observed Not observed Physical signs Physical signs Different emphasis by examiners Different emphasis by examiners Biased Biased Fixed Fixed Not structured Not structured Not standardized Not standardized

11 OSLER (1/2) The following are the key features of OSLER: Ten item structured record. Ten item structured record. Objective approach – there is prior agreement Objective approach – there is prior agreement on what is to be examined. Examiner reliable – all candidates are assessed Examiner reliable – all candidates are assessed on identical items. Construct validity is recognized and assessed Construct validity is recognized and assessed

12 OSLER (2/2) History process and product are assessed. History process and product are assessed. Communication skill assessment is emphasised. Communication skill assessment is emphasised. Case difficulty is identified by the examiner. Case difficulty is identified by the examiner. Can be used for both criterion and norm Can be used for both criterion and norm referenced assessment. A descriptive mark profile is available where A descriptive mark profile is available where marks are used. No extra assessment time is required. No extra assessment time is required.

14 Oral examination Face to face discussion Face to face discussion No. of examiners vary, usually 2-3 No. of examiners vary, usually 2-3 Mainly related to emergencies or important topics but in reality………. Once the question is asked: Mainly related to emergencies or important topics but in reality………. Once the question is asked:

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16 Advantages of oral exam Allows assessment of personal characteristics Allows assessment of personal characteristics Assess language related issues Assess language related issues Discussion Vs argument Discussion Vs argument Flexible Flexible Easy to conduct Easy to conduct

17 Disadvantages of oral exam Prejudice Prejudice Threatening Threatening Not standardized Not standardized Personal preference Personal preference Factual knowledge and recall Factual knowledge and recall No. of students No. of students No criteria No criteria

18 Short cases exam Each student will be assessed using 3-4 cases of different clinical findings Each student will be assessed using 3-4 cases of different clinical findings Usually observed by 2 examiners Usually observed by 2 examiners Cases should be prepared before hand Cases should be prepared before hand Examiners must have a look at the cases before taking the student to them Examiners must have a look at the cases before taking the student to them

19 Advantages of short exam Identify real clinical signs Identify real clinical signs Assess clinical examination skills Assess clinical examination skills Time Time Reproducible Reproducible Setting up Setting up No of examiners No of examiners

20 Disadvantages of short case exam Compartmental Compartmental Not objective Not objective Not standardized Not standardized Hectic to both patients and students Hectic to both patients and students Not valid Not valid Low reliability Low reliability biased biased

21 WORKPLACE –BASED ASSESSMENT Contextualisation, real life, formative and summative, objective

22 Case-based Discussion (CbD) Consultation Observation Tool Clinical encounter cards Clinical work sampling Blinded patient encounters Multi-Source Feedback ( 360 degree assessment) Patient Satisfaction Questionnaire (PSQ) Direct Observation of Procedural Skills (DOPS) Clinical Evaluation Exercise ( Mini CEX) Clinical Supervisors Report

23 PORTFOLIOS Clinical log-books Procedural log-books Clinical diaries Reflective portfolios Portfolios of learning Formative Summative

24 Finally…… There is no clinical assessment tool that is better than the other There is no clinical assessment tool that is better than the other Tools should correlate with objectives and learning process Tools should correlate with objectives and learning process Faculty need to be aware Faculty need to be aware Students need to know how are they going to be assessed Students need to know how are they going to be assessed Use the tool properly Use the tool properly Then inshalla…………….