ارزشيابي صلاحيت باليني

2. ارزشيابي صلاحيت باليني دكتر محمدرضايوسفي MD-MPH- MS.c Medical education عضوهیئت علمی مرکز مطالعات و توسعه آموزش پزشکی دانشگاه دفترتوسعه آموزش باليني Workshop for assessing clinical competence

4. Evaluation is for Improvement Not Provement

5. 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. “به کارگیری عادت‌گونه و مدبرانه‌ دانش، مهارتهای ارتباطاتی، مهارتهاي عملي، استدلال باليني، عواطف، ارزشها و بازانديشيدر فعاليت حرفه‌اي روزمره، در جهت خدمت به فرد و جامعه" Epstein and Hundert, Designing and assessing professional competence. JAMA 287:226, 2002

6. What is Clinical Competency? The ability to handle a complex professional task by integrating knowledge, skills and attitudes. نگرش تلفیق دانش، مهارت عملی و نگرش های حرفه ای در ضمن انجام یک وظیفه بالینی پیچیده مهارت شناخت (دانش) عملی Reference Van der Vleuten, C. The assessment of professional competence: developments,research and practical implications Advances in Health Science Education 1996, Vol 1: 41-67 Rice et al., Competency-based objectives for clinical training. Can. J. Med. Technol. 57:136, 1995

7. What is the best way to evaluate Clinical Competency? Performance assessment: MaskedSP Behavior Skills & attitudes Competency assessment: OSCE Clinical based tests: MCQ Knowledge Knowledge tests:MCQs Miller’s Pyramid of Competenc Miller GE. The assessment of clinical skills, competence, performance Acad Med, 1990; 65(Suppl.):S63-S67.

8. Professional authenticity A simple model of competence 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.

9. Model of competence Cognition~ knowledge Behaviour~ skills/attitudes Professional authenticity Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S67.

10. Performance assessment in vivo: Masked SPs, Video, Portfolio….. Does Competence assessment in vitro: OSCE, ….. Knows how (Clinical) Context based tests: MCQ, essay type, oral….. Knows Factual tests: MCQ, essay type, oral….. Shows how climbing the pyramid Does Shows how Knows how Knows

11. Validity of testing formats Professional practice assessment Performance assessment: OSCEs, long/short cases, etc Problem-solving assessment: PMP، MCQs,.. Knowledge assessment: MCQs...

12. Does Shows How Knows How Knows Miller’s Pyramid for Assessing Clinical Competence Work Action OSCE Performance PMPs Competence Knowledge MCQs

13. Established technology of efficient written or computer-based high fidelity simulations (MCQ, Key Feature, Script Concordance Test, MEQs….) Knows how Knows Expanding our toolbox….. Does Shows how Knows how Knows

14. Established technology of structured high fidelity in vitro simulations requiring behavioural performance (OSCE, SP-based testing, OSPE….) Knows how Shows how Expanding our toolbox….. Does Knows how Knows

15. Emerging technology of appraising in vivo performance (Work-based assessment: Clinical work-sampling, Mini-CEX, Portfolio, practice visits, case orals….) Does Shows how Expanding our toolbox….. Does Shows how Knows how Knows

16. Emerging technology of appraising in vivo performance (self-, peer, co-assessment, portfolio, multisource feedback, learning process evaluations……) “Domain independent” skills Expanding our toolbox….. Does Shows how Knows how Knows “Domain specific” skills

17. ACGME Core Competencies(The 6 Competencies) • Patient Care • Medical Knowledge • Professionalism • Interpersonal & Communication Skills • Practice-Based Learning and Improvement • Systems-Based Practice

18. انواع آزمونها 1- آزمونهای تکوینی (Formative): • ارزيابي هاي محل خدمت (Workplace) با پس خوراند (feedback) مناسب درطول دوره آموزشی • پيشرفت تحصیلی وتجربیات یادگیری دانشجو • تمام عملكرد و رفتار يك دانشجو مورد ارزيابي قرار مي گيرد. 2- آزمونهاي تجمعی : (Summative) • نشانگر قبولي يا ردي از امتحان آخر ترم يا ارتقائ سالانه دستياري مي باشد . • ارزيابي فقط در حيطه دانش مي باشد.

19. محدود پاسخ restricted تشريحي باز گسترده پاسخ extended كوتاه پاسخ كتبي صحيح-غلط بسته جور كردني چندگزينه‌اي What are assessment tools? Uncued questions Cued questions انجام تكاليفAssignments

20. آزمونهای کتبی • کاربرد: آزمونهای کتبی

21. Lab-based practical DOPS What are assessment tools? آزمون‌هاي عملي Practical PBA(Procedure – based Assessment) 

22. CBDیا CSR(Chart Stimulated Recall ) GRF OSCEs Mini-CEX What are assessment tools? آزمون‌هاي باليني ‍Clinical

23. Structured Unstructured What are assessment tools? شفاهي

24. ارزيابي هاي در محل خدمتWorkplace Based Assessment)) • Mini-CEX) Clinical Evaluation Exercise) • CBD یا CSR(Chart Stimulated Recall) • DOPS )Direct Observation Of procedural Skills) • PBA(Procedure – based Assessment)  • )ارزیابی °360Mini-PAT ( • OSCE(objective structured clinical examination) • GRF(Global Rating Form )

25. Performance Assessment : Video, Real patient( Mini-CEX – DOPS-…) Does Competence Assessment :OSCE Knows how (Clinical) Context Based Tests: essay type, oral Knows Knowledge Tests: Shows how Climbing the Pyramid Does Shows how Knows how MCQ Knows

26. ارزشیابی صلاحیت بالینی به وسیله آزمون بالینی ساختارمند عینی (OSCE) (Objective Structured Clinical Examination)

27. OSCE What’s in a name? Objective Structured Clinical Examination

28. OSCE Objective Structured Clinical Examination عینی ساختاردار بالینی آزمون

29. آزمون آسکی يک آزمون ارزيابی صلاحيت بالينی است که بصورت عينی در ايستگاههای مختلف سازماندهی شده و تقريبا هر چهار ضابطه يک آزمون عادلانه را داراست.

30. همه داوطلبين با يك مقياس یکسان مورد سنجش قرار مي گيرند. • همه دانشجویان با یک معیار ارزشیابی می شوند.

31. OSCEs - Structured تدابير و برنامه هر ايستگاه نظام دار است. • ابزاراندازه گیریدرهرایستگاه،ویژه همانایستگاه تنظیم شده است. • درهرایستگاه یک مهارت بالینی ویژه موردارزشیابی قرارمی گیرد. • مهارت هاي ويژه اي كه در هر ايستگاه مورد آزمون قرار ميگيرند شامل موارد زير است: • History taking • Interpersonal communication • Clinical examination • Procedures

32. OSCEآزمون توانایی انجام مهارتهای بالینی است. • Students have to demonstrate their skills, not just describe the theory

33. Clinical Examination ارزشیابی رفتار حرفه ای و مهارتهای ارتباطی ایستگاه هایی با حضور بیمارنما فرایند را ارزشیابی کنید، نه محتوا را مثلا دانشجو چگونه صحبت کرد نه اینکه چه گفت. ارزشیابی مهارتهای بالینی توانمندی دانشجو و فرایند انجام مهارت را ارزیابی کنید،نه نتیجه کار را.

34. Competencies: The SIX Domains

35. Objective Structured Clinical Examination Medical authorities & faculties started to implement the OSCE exams for clinical and communication skills assessment of medical students, clerks, interns, residents, and graduates since the 1980s. It is a standardized method of clinical evaluation that eliminates bias. www.OSCEhome.com

36. Objective Structured Clinical Examination OSCE is a form of performance-based testing used to measure candidates’ clinical competency.  During an OSCE, candidates are observed and evaluated as they go through a series of stations in which they interview, examine and treat standardized patients (SP) who present with some type of a medical problem. www.OSCEhome.com

37. Objective Structured Clinical Examination “The OSCE is an approach to the assessment of clinical competence in which the components of competence are assessed in a planned or structured way with attention being paid to the objectivity of the examination”. Harden, 1988 www.OSCEhome.com

38. Objective Structured Clinical Examination The curriculum tells the staff what to teach... The OSCEs tells the students what to learn ! And that is the point…. What OSCE candidates should learn? What candidates can do rather than what they know. www.OSCEhome.com

39. Objective Structured Clinical Examination The application of their knowledge rather than the recall of knowledge. The ‘WHAT’ to ask and do. The ‘HOW’ they ask and do. The ‘WHEN’ they ask and do. How do they organize themselves. How do they communicate with patients. www.OSCEhome.com

40. Objective Structured Clinical Examination • The OSCE has offered a strikingly new and exiting way of making valid assessment of clinical performance of medical student ,resident, and fellows .

42. What is the purpose of the OSCE? • Provide feedback on performance • Evaluate basic clinical skill • Measure minimal competency

43. What is OSCE? • It is some sort of student evaluation that examinee will go through several stations to be evaluated in clinical fields by special rating scales and checklists.

44. OSCE is Useful to Evaluate: • Clinical skill • Practical attitudes • Practical knowledge

45. OSCE =Performance-Base assessment (Skill Based Assessment) : Actual Performance of clinical skills is observed in order to adjudicate the competence of Health professionals

46. What is the format of OSCE?

47. What is the format of OSCE? • It consists of several Stations • (12-20 each lasting 5 to 15 minutes not more than 30 seconds rest between each).

48. OSCE • نکاتی که باید هنگام طراحی این آزمون رعایت نمود: • تهیه blueprint: • تعیین اهداف آموزشی مهمی که باید مورد ارزیابی قرار گیرند. • تعداد کافی ایستگاه: • تعداد ایستگاه بیشتر از زمان هر ایستگاه اهمیت دارد. • برنامه ریزی دقیق و منظم • پیش بینی وقایع احتمالی

49. OSCE • نحوه برگزاری آزمون: • ایستگاههای پشت سر هم و در هر ایستگاه یک task مشخص • 12تا 20 ایستگاه و هر ایستگاه 5 تا 15 دقیقه

50. نقشه طرحريزي شده از 9 ايستگاه OSCE Start 1 2 3 4 5 End 9 8 7 6