1. Assessment of Clinical Competence in Health Professionals Education
Assessment of Studnets Competence in Health Professional Education
Assessment of Clinical Competence in Health Professionals Education
Professor Hossam Hamdy
University of Sharjah

2. Professional Competence
The Habitual and Judicious use of:
Communication
Knowledge
Technical Skills
Evidence-based decision-making
Emotions
Values and reflection to improve the health of the individual patient and the community

3. WHAT Should Be Assessed?
ACGME Competencies
Patient care
Knowledge
Practice-based learning and improvement
Interpersonal and communication skills
Ethics & Professionalism
System-based practice

4. Blueprinting Test content matches objectives
Assessment matches competencies learnt
Assessment matches format of learning, “PBL”

5. A Simple Model of Competence
Assessment of Studnets Competence in Health Professional Education
A Simple Model of Competence
Professional authenticity
Performance or hands on assessment
Does
Shows how
Written, Oral or
Computer based assessment
Knows how
Knows
Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S7. 5 5

6. Validity Climbing the Pyramid . . .
Does
Performance assessment in vivo:
Masked SPs, Video, Audits…..
Does
Shows how
Performance assessment in vitro:
OSCE, SP-based test…..
Shows how
Knows how
(Clinical) Context based tests:
MCQ, essay type, oral…..
Knows how
Knows
Factual tests:
MCQ, essay type, oral…..
Knows 6

7. Assessment of Clinical Performance
Fundamental to “Good Medical Practice”
“What doctors do in controlled representations” of practice e.g. “OSCE”
“What doctors do in real life”
Rethans et al, Med Ed 2002. 7

8. Workplace-Based Training and Assessment

9. Effective Workplace Training
“The ability of faculty to accurately
observe trainees performing these (history-taking and physical examination) tasks and provide
effective feedback is thus one of the most important aspects of medical training.”
Learning

10. Problems of Workplace –based Training
Not observed
No assessment of Competencies
No feed-back

11. Effective Workplace-Based Assessment
“sampling collection of data concerning specific patient encounters for a number of different domains”
Reflects routine performance

12. The Traditional Long Case Examinations (LCE)
Assessment of Studnets Competence in Health Professional Education
The Traditional Long Case Examinations (LCE)
Unobserved 30 – 45 minute interview and examination on a selected patient
Candidates present only their findings to the examiner 12 12

13. Assessment of Studnets Competence in Health Professional Education
(LCE) Validity
It assesses the integrated interaction between the student/doctor and the real patient
Authenticity high
More valid than the task given in an OSCE
Little is known about the construct validity and consequential validity “Educational Impact” 13 13

14. (LCE) Reliability Poor intercase reliability
Assessment of Studnets Competence in Health Professional Education
(LCE) Reliability
Poor intercase reliability
Content specificity is the most crucial issue in the assessment of clinical competence
Broad sampling across cases is essential “Multiple Biopsies”
Logistics will be difficult 14 14

15. Mini-CEX Real patients 12 - 14 ~ 6 / years
Only components of the encounter observed
15-20 minites (Norcini 2003)
Formative

16. Direct Observation Clinical Encounter Examination “DOCE”
Four real patients
The whole encounter is observed
Focused history & examination
Clinical reasoning & decision-making
Communication skills
20-30 minutes
Summative / formatives
(Hamdy et al, Med Educ, 2003)

17. Case Based Discussion
Trainees select two case records for discussion with assessment
Focus on evaluating clinical reasoning and decision making

18. Clinical Work Sampling (CWS)
Sample performance in the workplace
Collection of information concerning specific patient encounters, admission, discharge, ward follow up
Portfolios

19. Direct Observation Practical Procedure Skills “DOPS”
Whole procedure observed from start to finish
Simulators Or
Real Patient

20. Multi-source Feedback (MSF) 360 Degree Assessment
Peers
Supervisors
Nurses
Secretary
Lab Technicians
Patients

21. Feedback
"The most basic focus of feedback addresses the quality of the task performed. Using well defined criteria, trainees are given specific information about whether they achieved the required level of performance " .

22. Problems of Workplace Based Assessment of Performance
Sampling: variability in the complexity of patients problem
Judges errors:
Time: Requires adequate allocation of time and resources.
Management of Data: not easy
Validity and Reliability: variable 22