LEVELS OF CLINICAL COMPETENCE [Cox, 1982]

1. LEVELS OF CLINICAL COMPETENCE [Cox, 1982] Raja C. Bandaranayake

2. Clinical skills are complex, consisting of: • cognitive • psychomotor • perceptual • affective • communication skills

3. LEVELS OF CLINICAL COMPETENCE • PREREQUISITES on which clinical ability will be based • COMPONENT CLINICAL ABILITIES form parts of the clinical task • COMPOSITE CLINICAL PERFORMANCE focuses on management of whole patient • COMPETENT PRACTICE focuses on management of a series of patients

4. Knowledge structure, function, Abnormality Skills communication, observation, percussion Attitudes respect, honesty, persistence Pen-and-paper, Oral Observation Progressive assessment during clerkship PREREQUISITES

5. Taking a history Examining the abdomen Generating diagnostic explanations Establishing rapport Explaining implications of illness Direct observation OSCE Checklists and rating scales Real or simulated patients Video review COMPONENT CLINICAL ABILITIES

6. Processesof: perceiving questioning reasoning selecting interpreting Outcomes: diagnosis management “ Long case” during clerkships and in examinations Real or simulated patients Video review COMPOSITE CLINICAL PERFORMANCE

7. COMPETENT PRACTICE Management of ward, clinic or practice over a period, which includes: setting priorities management of health care team investigations referral consultation Progressive assessment during clerkship Simulated patients Self- and peer-review Outcome measures: recovery rates morbidity rates

8. Knowledge Skills Attitudes PREREQUI-SITES COMPONENT ABILITIES COMPOSITE PERFORMANCE COMPETENT PRACTICE

9. EXPECTED PERFORMANCE LEVEL AT GRADUATION 1. Diagnosis + Total Management 2. Diagnosis + Initial Management + Referral 3. Diagnosis + Emergency Management 4. Diagnosis + Referral 5. Prevention

10. PERFORMANCE INDICATORA variable which tells us the extent to which a particular ability exists.May be a:process indicator productindicatorPERFORMANCE CRITERIONThe levelto which the indicator should exist if we are to judge anyone as competent.Hence:CRITERION-REFERENCED ASSESSMENT

11. COMMUNICATION SKILLS • Self-assessment • How am I progressing? • Formative assessment • Observation using audio- or video-tapes • Real or simulated situations • Summative assessment • Built into other test situations, e.g. OSCE • May use standardised instruments