ECOS Michel LEVEQUE Strasbourg 10 novembre 2011

ECOS (french) OSCE (english) Objective Structured Clinical Examination

OSCEObjective Observable, measurable Structured Tasks, to solve problems Clinical Clinical context, real or simulated Examination Evaluation the skills

Levels for evaluation KNOWLEDGE SKILLS PERFORMANCE

For what? Explore the competencies or performance in : – diagnostic – interview – examination – assessment – medical reasoning – sharing médical decision – treatment plan – doctor patient relationship

WHO ? Post graduate students – Prerequisite for ECOS: Training in clinical Have skills….

WHEN ? Formative evaluation – During the professionnal training Final evaluation – Performance for professionnal certification Strasbourg: – First expérience for training – Today only final evaluation (efficiency)

HOW ? Path between stations: – 19 stations ( U Laval) – 7 stations (Strasbourg) On each station – simulated patient – Physician observer – document specifying the task

HOW ? Path between stations: – 19 station ( U Laval) Clinical stations Questionnaire station related with clinical station Questionnaire station not related with clinical station Rest station… – 7 station (Strasbourg) Only clinical stations

Clinical station Patient (simulated) Task, problèms Observer rating Questionnaire station Questionnaire Open-ended questions and short

Recommandation to the students need clear, précise candidate instructions « Red them carefully before starting !! before any question if you are unclear as to what you are being ask to do clarify the task with the examinator… »

Contents of stations Commons situations in primary care

Examples … The diabetic foot – Examination Announcement of a diabetes – Explanations Contraception (teenager) – Explanations and prescription Infant immunization – plan Announcement of a AD – Explanations Visual disorder (elderly) – Diagnostic and plan

Examples … Skin redness (Lyme) – Diagnostic and plan Chronic complaint – Relationship Insomnia – assement and prescription Sadness – Diagnostic, assement,suicidal risk Fatigue – Diagnostic and plan

Method Team (professors, lecturers) only GP : n=15 -Step 1 : choice of situations -Step 2: writing the clinical case -Step 3: selection criteria -Step 4: scientific validation -Step 5: writing evaluation grid -Step 6: test stations with GP -Step 7: plan the examination -Step 8: examination

Example (instruction for the student) Ms. Richard, 45, teacher, comes to you at the request of others to a "loss of form": it sleeps badly, crying often, feeling irritable and does not know what is happening. She is married with two children (16 and 20 years). Your task is to conduct the examination to clarify the diagnosis and propose a course of action.

Example (instructions for the actor) You are Ms. Richard, 45, teacher. You tell the doctor that you have at the request of your family, because you have a loss of form. Your husband has supported and is in the waiting room. In response to questions from the doctor: You can not stand your students You are no longer the household (too tired) Grocery shopping is a charge unrest begins one to two months No more appetite (loss of six pounds in 6 weeks)…

Example (evaluation grid)a NOM et PRENOM : Grille de correction : Note/20 Antécédents personnel – dépression1 – tentative de suicide0,5 – épisode maniaque0,5 – consommation alcoolisée0,5 – prise de médicaments0,5

Example (evaluation grid)b Symptomatologie dépressive – humeur triste2 – inhibition psycho-motrice2 – dévalorisation 2 – troubles de l’appétit0,5 – troubles du sommeil0,5 Soutien de l’entourage1 Idées suicidaires2

Example (evaluation grid) Prise en charge – énoncé du diagnostic1 – traitement médicamenteux ou psychothérapie1 – suivi rapproché dans les 8 jours1 – arrêt maladie1 Empathie écoute, reformulation 0 – 1 – 2 – 3 TOTAL :

The path Station 1 Station 7 Station 6 Station 5 Station 2 Station 4 Station 3 ECOS

timing Each station: 7 minutes Clock: 1 minute for change Clock : start the station

To learn more about OSCE =792 =792 mplate/main/cessul/documents/document/P PTECOSFaculte.mov mplate/main/cessul/documents/document/P PTECOSFaculte.mov Centre d’Evaluation des Sciences de la Santé Université de Laval

Step 4 scientific validation

Kamtchatka, Ru