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Teaching & Assessment in Phase III of New Curriculum
Ikram A Burney
Senior Consultant in Medicine
Member Curriculum & Examination committee, SQU
Co-ordinator Phase III (clinical Years)
agenda
√ 1. Assessment principles
in new curriculum
2. What methods have been chosen
3. Why were those chosen
× 1. What exactly are these
methods
2. Why they work
3. How they work
Feb 14, 2012 Assessment Workshop 2
PHASE III
Behavioral Medicine, Communication Skills, History Taking,
Physical Examination Skills, Ethics, Prescribing, Medical Records, HIS
Medicine (7)
Child Health
(6)
Surgery (6)
Behavioral
Medicine (7)
Ophthalmology
(3)
FAMCO (5)
Orthopedics,
Rehab and Pain
Management
(4)
Clinical
Genetics &
Counseling (2)
SLT (Anes) (1)
Dermatology(2)
SLT (Lab) (1) SLT (Stats) (1)
SLT Forensic
Medicine (1)
SLT (Geriatrics)
(1) Oral Health (1)
Break (1 week)
Junior Clerkship Exams (1 week)
Buffer (3 weeks)
Medicine (7)
Child Health
(3) Surgery (3)
Obs/Gyne (8) Elective (8)
A&E (4)
FAMCO (3)
ICU (1)
ENT (2)
Hematology (2)
SLT (Lab) (2) Radiology (2) Selective (2) SLT (Therap) (1)
Break (1 week)
Senior Clerkship Exams (1 week)
Buffer (3 weeks)
Pre-Internship
Medicine
(3 weeks)
Surgery
(3 weeks)
Child Health
(3 weeks)
Obs/Gyn
(3 weeks)
Buffer (2 weeks)
FINAL MD EXAM (2 weeks)
Pre
-cle
rksh
ip
(10
wee
ks)
Pre
-Int
erns
hip
(12
wee
ks)
S
enio
r C
lerk
ship
(48
wee
ks)
Ju
nio
r C
lerk
ship
(48
wee
ks)
Feb 14, 2012 3 Assessment Workshop
Clinical years
Old New
Feb 14, 2012 Assessment Workshop 4
5th year
6th year
7th year
Junior Clerkship
Senior Clerkship
Pre-Internship
Pre-clerkship
Early Clinical Exposure?
5
Integrated Modules (3 semesters)
History & Physical (10/52)
Junior Clerkship (52/52)
Senior Clerkship (52/52)
Pre-Internship (12/52) Feb 14, 2012 Assessment Workshop
In summary, the curriculum is …
• Outcome-based
• Presentation-based
• Integrated
– Horizontally
– Vertically
• Provides early clinical exposure
Feb 14, 2012 Assessment Workshop 6
Assessment principles in new curriculum
1. Integration
1. ‘Blocks’ rather than ‘Rotations’
2. End-of-Clerkship exams
3. In-rotation End-of-Clerkship
2. Progression block at stage 1
3. Final mark = Ph II + Ph III + FMD
Feb 14, 2012 Assessment Workshop 7
Medicine & Allied Week A B C D E F
1 Med CH Surgery
Ophthal
BM
FAMCO
2 Med CH Surgery Ophthal BM FAMCO
3 Med CH Surgery Ophthal BM FAMCO
4 Med
CH
Surgery
Orthopedics
BM
FAMCO
5 Med
CH
Surgery
Orthopedics
BM
FAMCO
6 Med
CH
Surgery
Orthopedics
BM
Dermatol
7 Med
Genetics
Anesthesia Orthopedics
BM
Dermatol
8 Lab
Genetics
EBM
Geriatrics
Forensic
Oral Health
Feb 14, 2012 Assessment Workshop 8
Surgery & Allied Week A B C D E F
1 Med CH Surgery
Ophthal
BM
FAMCO
2 Med CH Surgery Ophthal BM FAMCO
3 Med CH Surgery Ophthal BM FAMCO
4 Med
CH
Surgery
Orthopedics
BM
FAMCO
5 Med
CH
Surgery
Orthopedics
BM
FAMCO
6 Med
CH
Surgery
Orthopedics
BM
Dermatol
7 Med
Genetics
Anesthesia Orthopedics
BM
Dermatol
8 Lab
Genetics
EBM
Geriatrics
Forensic
Oral Health
Feb 14, 2012 Assessment Workshop 9
Ambulatory Medicine Week A B C D E F
1 Med CH Surgery
Ophthal
BM
FAMCO
2 Med CH Surgery Ophthal BM FAMCO
3 Med CH Surgery Ophthal BM FAMCO
4 Med
CH
Surgery
Orthopedics
BM
FAMCO
5 Med
CH
Surgery
Orthopedics
BM
FAMCO
6 Med
CH
Surgery
Orthopedics
BM
Dermatol
7 Med
Genetics
Anesthesia Orthopedics
BM
Dermatol
8 Lab
Genetics
EBM
Geriatrics
Forensic
Oral Health
Feb 14, 2012 Assessment Workshop 10
PHASE III
Behavioral Medicine, Communication Skills, History Taking,
Physical Examination Skills, Ethics, Prescribing, Medical Records, HIS
Medicine (7)
Child Health
(6)
Surgery (6)
Behavioral
Medicine (7)
Ophthalmology
(3)
FAMCO (5)
Orthopedics,
Rehab and Pain
Management
(4)
Clinical
Genetics &
Counseling (2)
SLT (Anes) (1)
Dermatology(2)
SLT (Lab) (1) SLT (Stats) (1)
SLT Forensic
Medicine (1)
SLT (Geriatrics)
(1) Oral Health (1)
Break (1 week)
Junior Clerkship Exams (1 week)
Buffer (3 weeks)
Medicine (7)
Child Health
(3) Surgery (3)
Obs/Gyne (8) Elective (8)
A&E (4)
FAMCO (3)
ICU (1)
ENT (2)
Hematology (2)
SLT (Lab) (2) Radiology (2) Selective (2) SLT (Therap) (1)
Break (1 week)
Senior Clerkship Exams (1 week)
Buffer (3 weeks)
Pre-Internship
Medicine
(3 weeks)
Surgery
(3 weeks)
Child Health
(3 weeks)
Obs/Gyn
(3 weeks)
Buffer (2 weeks)
FINAL MD EXAM (2 weeks)
Pre
-cle
rksh
ip
(10
wee
ks)
Pre
-Int
erns
hip
(12
wee
ks)
S
enio
r C
lerk
ship
(48
wee
ks)
Ju
nio
r C
lerk
ship
(48
wee
ks)
Feb 14, 2012 11 Assessment Workshop
PHASE III
Behavioral Medicine, Communication Skills, History Taking,
Physical Examination Skills, Ethics, Prescribing, Medical Records, HIS
Medicine (7)
Child Health
(6)
Surgery (6)
Behavioral
Medicine (7)
Ophthalmology
(3)
FAMCO (5)
Orthopedics,
Rehab and Pain
Management
(4)
Clinical
Genetics &
Counseling (2)
SLT (Anes) (1)
Dermatology(2)
SLT (Lab) (1) SLT (Stats) (1)
SLT Forensic
Medicine (1)
SLT (Geriatrics)
(1) Oral Health (1)
Break (1 week)
Junior Clerkship Exams (1 week)
Buffer (3 weeks)
Medicine (7)
Child Health
(3) Surgery (3)
Obs/Gyne (8) Elective (8)
A&E (4)
FAMCO (3)
ICU (1)
ENT (2)
Hematology (2)
SLT (Lab) (2) Radiology (2) Selective (2) SLT (Therap) (1)
Break (1 week)
Senior Clerkship Exams (1 week)
Buffer (3 weeks)
Pre-Internship
Medicine
(3 weeks)
Surgery
(3 weeks)
Child Health
(3 weeks)
Obs/Gyn
(3 weeks)
Buffer (2 weeks)
FINAL MD EXAM (2 weeks)
Pre
-cle
rksh
ip
(10
wee
ks)
Pre
-Int
erns
hip
(12
wee
ks)
S
enio
r C
lerk
ship
(48
wee
ks)
Ju
nio
r C
lerk
ship
(48
wee
ks)
Feb 14, 2012 12 Assessment Workshop
Stage 1
Stage 2
Final Mark
• Pre-clinical 3.3 10% 0.33
• Stage 1 2.41 20% 0.482
• Stage 2 2.58 20% 0.516
• Final MD C- 1.70 50% 1.70
• Overall GPA 2.18
Feb 14, 2012 13 Assessment Workshop
What methods have been chosen
In-rotation
• Observed long case
• Mini-CEX
• SAQ/MEQ/KFQ
• Portfolio – Seminars
– Ward round presentations
– Bedside procedures
– Extra-curricular activities
End-of-clerkship
• MCQ/SAQ
• OSCE
Feb 14, 2012 Assessment Workshop 14
Final MD
•MCQ/SAQ •OSPE •PACES style Short Cases
Why were those chosen
Feb 14, 2012 Assessment Workshop 16
Validity
Feasibility Reliability
Assess all outcomes
Work-place based
Allow integration
Formative
Why were those chosen
Feb 14, 2012 Assessment Workshop 17
Validity
Feasibility Reliability
Assess all outcomes
Work-place based
Allow integration
Formative
X Resource-intense
X Expensive
? Numbers
Why were those chosen
Feb 14, 2012 Assessment Workshop 18
Validity
Feasibility Reliability
Assess all outcomes
Work-place based
Allow integration
Formative
X Resource-intense
X Expensive
? Numbers
Between 12 an 14
patient encounters are
sufficient to achieve a
reliability of 0.8
Norcini et al 1995; Holmboe et al 2003
Pre-Clerkship
1 2 3 4 5 6 7 8 9
GPE Mini-CEX
Abd Mini-CEX
Chest Mini-CEX
CVS Mini-CEX
CNS Mini-CEX
MSS Mini-CEX
HEENT Mini-CEX
CH Mini-CEX
Obs/Gy Mini-CEX
MCQ/SAQ
Feb 14, 2012 Assessment Workshop 19
Junior Clerkship Week A B C D E F
1 Med X
CH X
Surgery X
Ophthal X
BM X
FAMCO X
2 Med x
CH x
Surgery x
Ophthal Mini-CEX
BM x
FAMCO x
3 Med Mini-CEX
CH Mini-CEX
Surgery Mini-CEX
Ophthal Mini-CEX
BM Mini-CEX
FAMCO Mini-CEX
4 Med OLC
CH Mini-CEX
Surgery OLC
Orthopedics X
BM OLC
FAMCO Mini-CEX
5 Med Mini-CEX
CH Mini-CEX
Surgery Mini-CEX
Orthopedics Mini-CEX
BM Mini-CEX
FAMCO OLC
6 Med Mini-CEX
CH OLC
Surgery OLC
Orthopedics Mini-CEX
BM Mini-CEX
Dermatol KFQ
7 Med OLC
Genetics SAQ
Anesthesia Mini CEX
Orthopedics Mini-CEX
BM OLC
Dermatol KFQ
8 Lab SAQ
Genetics SAQ
EBM MEQ
Geriatrics SAQ
Forensic MEQ
Oral Health KFQ
Feb 14, 2012 Assessment Workshop 20
Numbers
OLC miniCEX Written Total
Medicine 3 6 3 12
Surgery 2 8 2 12
Ambulatory 4 5 3 12
Total 7 19 8 36
Feb 14, 2012 Assessment Workshop 21
Challenges
Change vs Status quo
People seem to want to follow the
beaten path; the difficulty is that
the beaten path does not seem
to lead anywhere
Feb 14, 2012 Assessment Workshop 22
SQUH RH AFH KH NH IbneS LHC
Med X X X
Lab X
CH X X X X
Genetics X
Surgery X X X
Anesth X X X
EBM X
Opthal X X
Orthop X
Geriatric X
BM X X
FM X
FAMCO X XXXX
Derma X X
OH X X
Feb 14, 2012 23 Assessment Workshop