Gordon Page

Guidelines for assessing clinical competence

Medical organizations responsible for assessing the clinical competence of large numbers of examinees have traditionally used written, oral, and observation‐based examination methods. The results from these examinations form the basis for major professional decisions regarding promotion or privileges of medical students or physicians. In this article, we present a set of guidelines that examining bodies should follow in developing and implementing assessment procedures that are a valid reflection of examinees’ current level of competence and of their ability to perform satisfactorily at the next stage of training or practice. The guidelines are based on our collective experiences as well as the growing literature on assessment of clinical competence. The discussion covers issues that have not been fully addressed in previously published reviews, including identifying the competencies to be tested, selecting appropriate and realistic test methods, dealing with test administration and scoring, and setting s...

A practical guide to assessing clinical decision-making skills using the key features approach.

Aim  This paper in the series on professional assessment provides a practical guide to writing key features problems (KFPs). Key features problems test clinical decision‐making skills in written or computer‐based formats. They are based on the concept of critical steps or ‘key features’ in decision making and represent an advance on the older, less reliable patient management problem (PMP) formats.

How specific is case specificity

Objectives  Case specificity implies that success on any case is specific to that case. In examining the sources of error variance in performance on case‐based examinations, how much error variance results from differences between cases compared with differences between items within cases? What is the optimal number of cases and questions within cases to maximise test reliability given some fixed period of examination time?

Student learning experiences in a longitudinal clerkship programme.

Objective  To identify how medical student learning experiences in a new longitudinally integrated clinical clerkship (LICC) programme impacted students’ learning.

Problem-Based Learning

The purpose of this chapter is “to serve those contexts where the decision to adopt PBL... has been made and where now as part of the planning process a list of challenges options or issues that require informed choice or resolution becomes apparent”. These include: the identification of effective approaches for training faculty as PBL tutors identification of the roles and behaviors of effective tutors whether to use “expert” or “non-expert” tutors how to evaluate students for the educational objectives uniquely associated with PBL and whether PBL can be usefully applied in the clinical curriculum. The chapter offers critical reviews and summaries of the pertinent recent literature relating to these five topics. The authors conclude that notwithstanding the existence of a considerable literature in the contexts of the five topics addressed it presents as a collection of independent case studies rather than as coherent and well articulated. Consequently, in the opinion of the authors, the generalizability of the results presented is limited. “Their utility lies in the experiences they reflect, the precedents they define, nd the chance that another institution may present enough similarity in program and context to allow some valid application of findings or experience.”

Reliability and acceptance of the mini-clinical evaluation exercise as a performance assessment of practicing physicians.

Background The purpose of this study was to evaluate the reliability and acceptance of the mini-Clinical Evaluation Exercise (mini-CEX) as an assessment of practicing primary care physicians. Method Six raters were recruited to conduct the assessments. After a training session, their ability to discriminate between levels of performance was evaluated using videotaped clinical scenarios. Fifteen physicians were assessed in an office setting by the raters who scored multiple clinical encounters using a validated mini-CEX form for each encounter. Participants were given a postassessment survey regarding the process. Results Raters distinguished between performance levels on the videotaped scenarios (P < .001). A total of 188 physician–patient interactions were assessed. The generalizability coefficient for 10 encounters was 0.92. In the postassessment survey, the raters (94%) and physicians assessed (75%) both felt that the mini-CEX is an acceptable assessment. Conclusions The mini-CEX seems to be a reliable and acceptable instrument for the assessment of practicing physicians.

Teaching in medicine: an elective course for third‐year students

Summary. An elective course titled ‘Teaching in Medicine’ was given to eight third‐year medical students in response to the policy of the University of British Columbia medical school to expand its elective offerings. Course objectives focused on the skills that doctors need to fulfil their role of teacher of patients, students or colleagues. Instructional methods included directed reading, group discussions, microteaching, evaluation of videotaped samples of teacher behaviour, role play, demonstration and practice in developing and using audiovisual materials, and analysis of research in teaching and learning in medicine. The course culminated in each student presenting a major teaching session which was videotaped and assessed by the student and course teachers. All students rated the course as excellent. This paper describes the course and the teacher and student perceptions of it. The experience of this medical school is that a course of this nature is extremely worthwhile.

The effect of continuing medical education programmes on clinical practice: fact or fantasy

This paper reports an evaluation study of a continuing medical education programme on the haemagglutination‐inhibition (H.I.) test for rubella antibodies in terms of its effect on the practice of the doctors in attendance. The study employed a pre‐post control group design. The data on the doctors’ use of the H.I. test were extracted from laboratory records. Through an analysis of co‐variance of these data, the lecture was shown to have had an apparently significant impact on the practice of the doctors in attendance. However, available data describing the number of H.I. tests requested by a population of doctors place serious doubt on this conclusion. This paper describes the design of this study as a prototype, identifies constraints which impede the implementation of such studies, and justifies the need to pursue studies of this nature in spite of these constraints.

Estimating Educational Costs of Clinical Placements for Occupational Therapy Students

Estimates of the number of hours of single-purpose and joint-purpose instructional activities and percentage estimates of direct-contact time were provided by clinicians from a sample of 12 of 28 agencies providing clinical placements for occupational therapy students. These agencies provided 77.3 % of the total clinical hours for the student population during a 12-month period. The sample data from these agencies were used to estimate the educational costs to agencies for the total occupational therapy clinical program. Both the methodology and the findings of this study are relevant to government, educational institutions, and clinical agencies to assist in defining policies and funding mechanisms for clinical training programs.