1. ECOS Michel LEVEQUE Arkangelsk 02/02/2012

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

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

4. Levels for evaluation KNOWLEDGE SKILLS PERFORMANCE Adapted from Miller’s triangle 1990

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

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

7. WHEN ? Formative evaluation – During the professionnal training Final evaluation – Performance for professionnal certification Strasbourg: – First expérience for training ( 2000) – Today only final evaluation (efficiency)

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

9. 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

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

11. Recommandation to the students need clear and 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… »

12. Contents of stations Commons situations in primary care

13. 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

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

15. 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 -Step 9: assesment of teaching…

16. 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.

17. 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 cannot 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)…

18. Example (evaluation grid) Name surname: Note/20 Personnal history – dépression1 – SuicidE attempt0,5 – Mania episode 0,5 – Alcohol consimption0,5 – Médication0,5

19. Example (evaluation grid)b Dépressive symptomatology – Sad mood2 – Inhibition2 – dévalorisation 2 – Eating disorder0,5 – Sleeping disorder0,5 Support at home?1 Sucidal ? 2

20. Example (evaluation grid) Support – Statement of the diagnostic1 – Treatement proposal1 – Close monitoring1 – Sick leave1 Empathy, listening, reformulation 0 – 1 – 2 – 3 TOTAL :

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

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

23. To learn more about OSCE http://w3.fmed.ulaval.ca/cessul/index.php?id =792 http://w3.fmed.ulaval.ca/cessul/index.php?id =792 http://w3.fmed.ulaval.ca/cessul/fileadmin/te mplate/main/cessul/documents/document/P PTECOSFaculte.mov http://w3.fmed.ulaval.ca/cessul/fileadmin/te mplate/main/cessul/documents/document/P PTECOSFaculte.mov Centre d’Evaluation des Sciences de la Santé Université de Laval

25. STUDENT EXAMINATOR ACTOR

26. Kamtchatka, Ru