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Clinical Programs and Competence

Clinical Programs and Competence. Evaluation and Outcomes Keith Watson, D.O. Associate Dean for Graduate Medical Education Centers for Osteopathic Research and Education. Osteopathic Continuum Curriculum. O. O. O. Residency. Medical School. Basic Science. Clinical Science.

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Clinical Programs and Competence

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  1. Clinical Programs and Competence Evaluation and Outcomes Keith Watson, D.O. Associate Dean for Graduate Medical Education Centers for Osteopathic Research and Education

  2. Osteopathic Continuum Curriculum O O O Residency Medical School Basic Science Clinical Science Osteopathic Principles and Practice B.E. D.O. PGY2 O Outcomes Measures

  3. Osteopathic Continuum Curriculum O O O FM Residency Medical School B.E. D.O. PGY2 Basic Science Clinical Science Osteopathic Principles and Practice Cert. Exam In-service In-service COMLEX I II III ? OSCE? OSCE OSCE OSCE

  4. Resident Evaluation • External validation (examples) • In-service examinations • Certification pass rates for graduates (first time takers) • Internal validation (examples) • Continuous Progress Indicator exam (CPI) • Objective Structured Clinical Examination (OSCE) • [Objective Structured Assessment of Technical Skill (OSATS)] • Performance Assessments of rotations.

  5. General Principles –Evaluation Standards • Language must reflect evaluations required for minimal approval • Generalized statements are often not helpful • Regular Self Study Review and updated Goals Statements should be required for at least: • Growth • Improvement • Outcomes • Consortium Goals for OPTI Sponsor must be integrated into Program Self Study and Objectives

  6. Program Evaluation • External validation (examples) • Group scores on In Service Examination • Collective pass rates on Board Examinations • Peer reviewed assessments every five years • Internal validation (examples) • Self Study Involving PD, faculty, and Institution • Identification of problems • Identification of “Markers of Excellence” • Goal Setting • Ongoing regular review of every stated goal and present outcome • Etc.

  7. Program Evaluation-How well does the program meet it’s stated goals? • Basic Standards = minimums • Self Study and Declared Plans (Targets) for: • Growth goals (examples) • “increase recruitment/retention by _% by ___.” • “add ___ number of compensated faculty by ____.” • Improvement goals (examples) • “institute quality assurance thresholds for clinic charts by ___” • “adjust curricular emphasis to improve resident performance on In Service Examination by ___%” • Outcome goals (examples) • “Achieve 100% graduate pass rate (first attempt) on Board Certification Exam” • “All residents will demonstrate a high proficiency rating in each of the seven competencies prior to graduation”

  8. Program Evaluation – OPTI Considerations • Standards should address: • Adherence to OPTI sponsor policies and procedures regarding evaluation expectations and outcomes • Coordination of program outcomes with general OPTI sponsor goals and outcomes • Shared data resources with OPTI sponsor and the restrictions/conditions of use

  9. Information Silos Create Barriers • Programs and OPTIs must access and share data: • NBOME • Specialty Colleges • Certification Boards • COPT • Etc

  10. Resident Evaluation • External validation (examples) • In-service examinations • Certification pass rates for graduates (first time takers) • Internal validation (examples) • Continuous Progress Indicator exam (CPI) • Objective Structured Clinical Examination (OSCE) • [Objective Structured Assessment of Technical Skill (OSATS)] • Performance Assessments of rotations.

  11. Evaluation Goals • Measure objectives in more than one domain: • Affective (attitudinal) • Psychomotor (skills) • Cognitive (knowledge) • Choose evaluation tool which best fits the domain and performance area: • No one tool is the best fit for all parameters

  12. Does Shows How Knows How Knows Assessment Model

  13. Guide for Selecting a Testing Method(A=Most efficient/B=Secondary utility)

  14. Conclusions • More than one type of evaluation should be used for overall assessment of a resident. • PA may be summative; a formative PA should be used for interval progress discussion. • SP experience essential • For experience toward licensure/certification • Best method for demonstrating skills learned • Testing domains should be linked to articulated learning objective domains. • Entire process should be congruent with declared outcome objectives for the residency (evidence based).

  15. Osteopathic General Competencies for Residents • Osteopathic Manipulative Therapy • Patient care • Medical knowledge • Practice-based learning and improvement • Interpersonal and communication skills • Professionalism • Systems-based practice

  16. Testing the General Competencies ?

  17. Writing and Testing Objectives

  18. Osteopathic Continuum Curriculum O O O FM Residency Medical School B.E. D.O. PGY2 Basic Science Clinical Science Osteopathic Principles and Practice Cert. Exam In-service In-service COMLEX I II III ? OSCE? OSCE OSCE OSCE

  19. Summary • Standards should identify minimum outcomes and evaluation processes • Standards should require programs to demonstrate self study activity and declare outcome goals • Standards should encourage (identify?) outcome “markers of excellence” which rise above the minimum expectations

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