ECOS

Michel LEVEQUE

Arkangelsk

02/02/2012

ECOS (french) OSCE (english)

• Objective

• Structured

• Clinical

• Examination

Levels for evaluation

KNOWLEDGE

SKILLS

PERFORMANCE

Adapted from Miller’s triangle 1990

For what?

• Explore the competencies or performance in :– diagnostic– interview– examination– assessment– medical reasoning– sharing médical decision– treatment plan – doctor patient relationship

WHO ?

Post graduate students

– Prerequisite for ECOS:• Training in clinical

• Have skills….

WHEN ?

• Formative evaluation– During the professionnal training

• Final evaluation– Performance for professionnal certification

• Strasbourg:– First expérience for training ( 2000)– Today only final evaluation (efficiency)

HOW ?

• Path between stations:– 19 stations ( U Laval)– 7 stations (Strasbourg)

• On each station– simulated patient– Physician observer– document specifying the task

HOW ?

• Path between stations:– 19 station ( U Laval)• Clinical stations• Questionnaire station related with clinical station • Questionnaire station not related with clinical station • Rest station…

– 7 station (Strasbourg)• Only clinical stations

Clinical station

• Patient (simulated)• Task, problèms

• Observer rating

Questionnaire station

• Questionnaire• Open-ended

questions and short

Recommandation to the students

need clear and précise candidate instructions

•« Red them carefully before starting !!•before any question•if you are unclear as to what you are being ask to do clarify the task with the examinator… »

Contents of stations

Commons situations in primary care

Examples …

• The diabetic foot– Examination

• Announcement of a diabetes– Explanations

• Contraception (teenager)– Explanations and

prescription

• Infant immunization– plan

• Announcement of a AD– Explanations

• Visual disorder (elderly)– Diagnostic and plan

Examples …

• Skin redness (Lyme)– Diagnostic and plan

• Chronic complaint– Relationship

• Insomnia– assement and

prescription

• Sadness– Diagnostic,

assement,suicidal risk

• Fatigue– Diagnostic and plan

Method

Team (professors, lecturers) only GP : n=15-Step 1 : choice of situations-Step 2: writing the clinical case-Step 3: selection criteria-Step 4: scientific validation-Step 5: writing evaluation grid-Step 6: test stations with GP-Step 7: plan the examination-Step 8: examination-Step 9: assesment of teaching…

Example (instruction for the student)

• Ms. Richard, 45, teacher, comes to you at the request of others to a "loss of form": it sleeps badly, crying often, feeling irritable and does not know what is happening.She is married with two children (16 and 20 years).

• Your task is to conduct the examination to clarify the diagnosis and propose a course of action.

Example (instructions for the actor)

• You are Ms. Richard, 45, teacher. You tell the doctor that you have at the request of your family, because you have a loss of form. Your husband has supported and is in the waiting room.

In response to questions from the doctor:• • You cannot stand your students

• You are no longer the household (too tired)• Grocery shopping is a charge• unrest begins one to two months• No more appetite (loss of six pounds in 6 weeks)…

Example (evaluation grid)

Name surname:Note/20

•Personnal history– dépression 1– SuicidE attempt 0,5– Mania episode 0,5– Alcohol consimption 0,5– Médication 0,5

Example (evaluation grid)b

• Dépressive symptomatology– Sad mood 2– Inhibition 2– dévalorisation 2– Eating disorder 0,5– Sleeping disorder 0,5

• Support at home? 1• Sucidal ? 2

Example (evaluation grid)

• Support– Statement of the diagnostic 1– Treatement proposal 1– Close monitoring 1– Sick leave 1

• Empathy, listening, reformulation 0 – 1 – 2 – 3

• TOTAL :

The path

Station 1

Station 1

Station 7

Station 7

Station 6

Station 6

Station 5

Station 5

Station 2

Station 2

Station 4

Station 4

Station 3

Station 3

ECOS

timing

• Each station: 7 minutes

• Clock: 1 minute for change

• Clock : start the station

To learn more about OSCE

• http://w3.fmed.ulaval.ca/cessul/index.php?id=792

• http://w3.fmed.ulaval.ca/cessul/fileadmin/template/main/cessul/documents/document/PPTECOSFaculte.mov

Centre d’Evaluation des Sciences de la Santé Université de Laval

STUDENTSTUDENT

EXAMINATOREXAMINATORACTORACTOR

Kamtchatka, Ru