Integrated Assessment in Medical Education
Objectives for this brief session
• Consider integration as a continuum – from Isolation to Trans-disciplinary holism
• Share personal experience in Integrated assessment in a hybrid UG curriculum
• Consider various tools for integrated assessment of competencies especially for postgraduate residencies
Intro…
– “Learning is by connecting things. If you can not connect, you can not learn.”
– Lord Chesterton (paraphrased)
• Integration as an educational strategy • Medical Teachers are polarized (For/Against)• Ronald Harden described a 11-step ladder
between the two extremes.
From Isolation to Authentic T-L - in 11 steps (Harden et al)
Fragmentation | Anarchy
Connection | Consultation
infusion
concurrent teaching
Integrate !
joint teaching
concomitant program
mixed program contributory
monolithicImmersion | authentic
Integrated Curriculum needs Integrated Assessment
I Year Integrated MBBS
MCBM = Molecular and Cellular Basis of MedicineHBM = Human Basis of Medicine
II Year Integrated MBBSSystems-based approach
Year 1 – Concurrent “Slice of Pie” Model of Assessment
• Molecular & Cellular Basis of Medicine – Paper-1 – Structure & Function (Anat-Physiol)– Paper-2 – Biochemical & Gen Pharma– Paper-3 – Gen-Path, Immunology, Microbiology
• Human Basis of Medicine– Paper-4 – Epidemiology, Basic statistics etc– Paper-5 – Ethics, Bio-psycho-social approach etc
• Integrated 24 station OSPE
Year 2 – Multi-Disciplinary Model
• Systems based Theory papers (n=6)– LAQ – SAQ – MCQ • With “Slice-of-Pie” division among departments
• Integrated OSCE in 2 sessions – 18 to 24 station performance (5-10-min stations) +– 40 to 50 items for response (3 min per item)– This avoids duplication of skills across subjects
Years 3 & 4 – Purposive Outcomes Oriented Integrated OSCE
• Theory Papers (isolated & Subject based )– LAQ/SAQ/MCQ
• Outcomes based integrated OSCE– Clinical skills: Paeds OG & Forensic in Year-3– Clinical skills: Med – Surgery – Com-Med (year-4) – 15 to 20 station performance (5-10-min stations) + – 40 to 50 items for response (3 min per item)– This avoids duplication of skills across subjects
Final Exams in Year-5 • Theory – multi-disciplinary papers (n=2)– Medical specialties | Surgical specialties
• Clinical Exam – Integrated – Long case: 1 of 4 (Med/Sur-Ortho/Paed/OG) – Short case: other 3 of 4 (joint vs. concurrent)– OSCE: 24 station Integrated OSCE• 12 each for Medical & Surgical specialties • History – physical exam – Dx tests – Rx advice –
counseling on diet/life-style etc
Assessment during PG Residency In-training formative assessment by• Clinical Skills Exam (CHEX)• DOPS (direct observation of procedural skills) • Self evaluation using e-Portfolio• Peer assessment • Multi-source / 360o evaluation • Tools: Check list / Rating scale / Rubric
Haldane T. “Portfolios” as a method of assessment in medical education”http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017561/ (accessed on 9-9-2015)
Rubric – more explicit than Rating Scale
• Rubrics have 4 parts: – 1- description of the task = Check-list– 2- the scale to be used = Rating scale– 3- the dimensions of the task – 4- the description of each dimension on the scale.
• The Development of a Competency Based Assessment Rubric to Measure Resident Milestones - DOI: 10.4300/01.01.0008
Many requirements of task are missing
All requirements of task done; partial understanding
All requirements of task done with full understanding
Most requirements of task are done; some understanding
Rubrics for Outcomes1. Measure outcomes based on real-life criteria2. Specify graded performance indicators 3. Permit assessment of outcome level achieved
in a specific competency 4. Ensure coherent and consistent assessment 5. Improve the quality of assessment 6. A collage of rubrics may permit integrated
assessment of professional behaviour
Be a Trail-blazer
• One more trail to blaze: • Making rubrics for effective assessment of
specialty training to suit your training objectives
• Will you do it soon to enhance the quality of assessment ?
• Strive for Success – Best wishes…
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