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Clinical Assessment Dr. H. Javdani Assistant professor of Psychiatry QUMS

Clinical Assessment Dr. H. Javdani Assistant professor of Psychiatry QUMS. introduction. ارزیابی : Assessment ارزشیابی : evaluation. Important points in any assessment: Importance Sample Validity Reliability. Important points in any assessment: Objectivity feasibility

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Clinical Assessment Dr. H. Javdani Assistant professor of Psychiatry QUMS

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  1. Clinical AssessmentDr. H. JavdaniAssistant professor of PsychiatryQUMS

  2. introduction

  3. ارزیابی : • Assessment • ارزشیابی : • evaluation

  4. Important points in any assessment: • Importance • Sample • Validity • Reliability

  5. Important points in any assessment: • Objectivity • feasibility • Acceptability • Limitations

  6. Domains of learning : • Cognitive : knowledge , comprehension , application , analysis , synthesis , evaluation (judging) • Psychomotor • Affective

  7. Miller’s pyramid

  8. Miller’s pyramid

  9. Bloom’s taxonomy :

  10. performance-based assessments: • OSCE • Mini CEX • DOPS • PBA • MSF

  11. OSCEObjective Structured Clinical Exam

  12. OSCE : • Performance based test which allows for standardized assessment of clinical skills • Assess the same skills in the same area

  13. OSCE : • Increasing the number of skills to be evaluate • Increasing the number of raters • Scoring with clear & objective criteria

  14. OSCE : • Fun ! • Need to practice ! • Not going to pass by reading books ! • More students failed than MCQ !

  15. Structure of OSCE : • Candidates rotate through the stations & performing a series of clinical tasks • Use SPs, mannequins or simulations • Raters assess performance using checklists

  16. Structure of OSCE : • Stations built upon a blueprint to ensure adequate sampling of the content domain & process skills • Evaluate both clinical knowledge & communication or psychomotor skills

  17. Advantages of OSCE : • Assess at “shows how” level • Testing of complex skills without any supervision • Standardized • Objective

  18. Limitations of OSCE : • Small sample of content • Time-consuming • Need trained item writers & raters • Need trained SPs • Need practice

  19. Why OSCE ? • Measurement of communication skills • Integration of communication skills with clinical knowledge • Safety of patients • Standard assessment • Uniquely capable of evaluation of clinical skills on simulated real-world environment

  20. Why not OSCE ? • Not efficient for assessment of knowledge alone • Expense issues • Time-consuming • feasibility

  21. OSCE with: • High : objectivity , acceptability • Moderate to high : validity , reliability • low: : feasibility

  22. What dose OSCE assess? • History taking skills • Performance of physical exam • Interpretation of data & complementary exams • Counseling • Dealing with particular situations (e.g: giving bad news, dealing with anger , etc)

  23. validity-response process: • Training of SPs • Rater training • Practicing SP & rater before the exam • Increasing objectivity (only y/n checklist)

  24. principles for use of OSCE : • Performance based assessment must be matched with performance based teaching • “Format anxiety” must be addressed • Standardization of simulations must be achieved

  25. development of OSCE: • Blueprinting • Station development • Case writing • Case review & validation • Standard setting • Piloting • Assembly of OSCE

  26. Blueprinting: • Defining content domain & process skills to be assessed • Based upon outcomes, expectations or standards • Level & Range: complexity of problem & performance

  27. SP ?! • Standardized patient • A person who is trained to show a specific clinical problem • Participates in evaluation the candidate’s communications skills

  28. How to develop OSCE? • Consider the relevant objectives • Write them down • Is the OSCE a suitable format to evaluate the objectives? • Consider each station for only one objective

  29. How to develop OSCE? • Write a scenario for each station • Develop a suitable rating tool for each station • Write an instruction for examinee • Write an instruction for standardized patient

  30. How to develop OSCE? • Try to simulate nearer to the real situation • Have several practices • Have a pilot study

  31. How to develop OSCE? • Run “OSCE” • have a suitable feedback

  32. Checklists : • Number of items : 8-25 • Items must be clear & dichotomous • Weighting of items • Killer items

  33. Mini CEXMini Clinical Evaluation Exercise

  34. Mini CEX: • Assessor observes a trainee with a patient in any settings: • Out-patient clinic • In-patient service • Emergency department • Trainer performs a focused task

  35. Mini CEX: • Assessor rates along several dimensions on a form • Feedback • Multiple encounters expected • Intended to be short & routine • Takes 15-20 minutes, feedback 5-7 min.

  36. Clinical skills evaluated: • Medical interview • Physical examination • Informed decision-making or counseling • Clinical judgment or reasoning

  37. Mini CEX forms: • Medical interviewing & history taking • Physical examination skills • Humanistic qualities / professionalism: (shows respect, compassion, empathy, establishes trust, attends to patient’s needs of comfort, modesty, confidentiality, information)

  38. Mini CEX forms: • Clinical judgment : (selectively order & considers risks/benefits) • Counseling skills • Overall clinical competence

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