Innovations in assessment in basic medical education: Experiences from Tel Aviv

1. Innovations in assessment in basic medical education: Experiences from Tel Aviv Dr. Yonah Yaphe EURACT Council Member for Israel Department of Family Medicine, Rabin Medical Centre and Sackler Faculty of Medicine, Tel Aviv University

2. Objective At the end of this presentation the listener will: • Be aware of three innovations in assessment in BME from Tel Aviv • Consider the applicability of these methods in their own teaching setting.

3. BME in Europe – The numbers • GP in BME in all EURACT countries • 297 faculties, GP/FM in 191(64%) • 4 newcomers (TK ES GR IT) • GP/FM in all faculties in 18 countries

4. Innovation in education • Early Clinical Exposure (Jerusalem) • Clinical skills lab (Maastricht) • Simulated patients (Leicester) • OSCE (Dundee, Oxford) • Summative assessment (Bergen) • Teacher training (Ljubljana, see Medical Education, 1999)

5. Contribution of family medicine to BME in Tel Aviv • Early years: Medicine the patient and Society • Final Year: 4 week clerkship in family medicine in the community • Israeli and American programs at Sackler

6. Objectives of Clerkship • Management of common problems • Undefined problems, uncertainty • Communication skills • Personal, family and community perspective • Whole person medicine • Practice management

7. What do medical students value?Snadden and Yaphe (Medical Teacher, 1996) • Doing rather than observing • A friendly learning environment • A mix of learning styles • Learning practical skills • Timely feedback • Seeing patients as people • Seeing patients in their natural context • Enthusiastic teachers

8. Years of computer use by TAU medical students

9. Extent of computer use by TAU medical students

10. Assessment Methods • Tutor’s assessment (+ one of the following) • Community project • Family presentation • OSCE • Virtual Clinics • Triple Jump Exam

11. OSCE – 1 • Optional examination • 7 years’ experience • 10 to 30/40 students choose OSCE • 9 stations • Doctors act as patients and assessors

12. OSCE 2– Written stations • Referral letter based on brief history • Prescription for acute medication • Prescription for chronic medication • Differential diagnosis by order of urgency and likelihood based on case story • Investigations for above case

13. OSCE 3 – patient simulations • History from patient receiving NSAID • Advice to mother of asthmatic child • History from patient with migraine • Advice to patient for prevention of IHD based on existing risk factors

14. OSCE 4 - Results • No change in scores over 6 years with the same exam • Good correlation between OSCE score and clinic tutor’s assessment (better than projects) • Correlation between global rating by examiners and communication components of OSCE checklist.

15. Triple jump examination • Conclusion of American clerkship • Following participation in seminars and submission of case presentations • 3 part exam: Assess – Learn – Reassess • Computer based, computer graded

16. Triple jump step 1 • Welcome to the Triple Jump Exam in Family Medicine! • The first part of this exam takes 1 hour. • Be brief and to the point in your answers. • There are 7 issues in the first part of the exam, and allot your time accordingly. • PLEASE take notes as you go, since you cannot go backwards in the exam to review information.

17. Sample triple jump question • 69-year-old woman new to practice, P/H bronchitis, bordeline blood pressure elevation • Requests a complete check-up. • 1.What would be the main cause of potential mortality in a woman of this age? • 2.What other information about risk factors NOT listed above would you need to know in order to assess her total risk? List 4. • 3. List 2 other screening procedures recommended for a woman of this age.

18. Sample triple jump question 2 Your patient tells you that she was in the pharmacy where they were running an osteoporosis screening “special”. She brings you the following report: 1.What is your interpretation of this report? 2.What put this patient at increased risk of osteoporosis?

19. Triple jump step 2 Make a list of “learning objectives” which includes issues about this case which you were not sure about. • Be sure and copy your list onto a paper so youcan take it with you • You will not be penalized for not knowing, only for not admitting it • Make your learning objectives specific • One hour to research objectives

20. Triple jump step 3 • Exam repeated with a chance to change answers based on research • No need to re-enter answer if unchanged

21. Virtual clinic • Based on Virtual TAU website • Students play the roles of doctor, patient or observer. • Patients present symptoms, doctors collect information, diagnose and treat. • Observers suggest questions, diagnoses or treatments based on literature. • Asssessment based on active participation.

22. Conclusion • Innovations in assessment will promote achievement of learning objectives and allow us to measure student progress using newly available technology.

23. For more information... • http://Yaphe.esmartweb.com • Yonahyaphe@hotmail.com