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Strasbourg 10 novembre 2011

ECOS. Strasbourg 10 novembre 2011. Michel LEVEQUE. ECOS (french) OSCE (english). O bjective S tructured C linical E xamination. Levels for evaluation. PERFORMANCE. SKILLS. KNOWLEDGE. For what?. Explore the competencies or performance in : diagnostic interview examination

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Strasbourg 10 novembre 2011

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  1. ECOS Strasbourg 10 novembre 2011 Michel LEVEQUE

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

  3. Levels for evaluation PERFORMANCE SKILLS KNOWLEDGE

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

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

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

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

  8. 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

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

  10. 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… »

  11. Contents of stations Commons situations in primary care

  12. 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

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

  14. Method Team (professors, lecturers) only GP : n=15 • Step 1 : choice of situations • Step 2: writing the clinical case • Step 3: selectioncriteria • Step 4: scientific validation • Step 5: writingevaluationgrid • Step 6: test stations with GP • Step 7: plan the examination • Step 8: examination

  15. Example (instruction for the student) • Ms. Richard, 45, teacher, comes to youat the request of others to a "loss of form": itsleepsbadly, cryingoften, feeling irritable and does not know whatis happening.Sheismarriedwithtwochildren (16 and 20 years). • Yourtaskis to conduct the examination to clarify the diagnosis and propose a course of action.

  16. 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)…

  17. Example (evaluation grid)a NOM et PRENOM : Grille de correction : Note/20 • Antécédents personnel • dépression 1 • tentative de suicide 0,5 • épisode maniaque 0,5 • consommation alcoolisée 0,5 • prise de médicaments 0,5

  18. Example (evaluation grid)b • Symptomatologie dépressive • humeur triste 2 • inhibition psycho-motrice 2 • dévalorisation 2 • troubles de l’appétit 0,5 • troubles du sommeil 0,5 •  Soutien de l’entourage 1 • Idées suicidaires 2

  19. Example (evaluation grid) • Prise en charge • énoncé du diagnostic 1 • traitement médicamenteux ou psychothérapie 1 • suivi rapproché dans les 8 jours 1 • arrêt maladie 1 • Empathie écoute, reformulation 0 – 1 – 2 – 3 • TOTAL :

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

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

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

  23. Step 4 scientific validation

  24. Kamtchatka, Ru

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