uso de osces en evaluación - unam · uso de osces en evaluación john (jack) r. boulet, ph.d....
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Uso de OSCEs en Evaluación
John (Jack) R. Boulet, Ph.D.Foundation for Advancement of International Medical Education and
Research
Jornadas de Educación Médica 2010“Educación por Competencias: Cambio de Paradigma”
FAIMER®
“Educación por Competencias: Cambio de Paradigma”
Universidad Nacional Autónoma de MéxicoFacultad de Medicina UNAM
February 2010
Objective Structured Clinical Examination
� Series of short stations� Candidate assessed on � Candidate assessed on
same content� Multiple evaluators� Standardization
� Conditions
FAIMER®
� Conditions� Scoring tools
OSCE� Objective
� All candidates assessed with same content and marking schememarking scheme
� Structured� Stations have a specific task or tasks� Detailed scripts for standardized patients� Candidate instructions
FAIMER®
� Clinical Examination� Measures applied clinical and theoretical
knowledge� Post-encounter exercises
OSCE Content?
� Standardized or “real” patients
� Mannequin� Part-task trainer
� Haptic models
� Computer-based
FAIMER®
� Computer-based case simulation
� Hybrid models
Assessment OSCEs in Medicine� United States Medical Licensing Examination (USMLE™)
� Step 2 CS (ECFMG Clinical Skills Assessment)� Step 3
� National Board of Osteopathic Medical Examiners� National Board of Osteopathic Medical Examiners� Medical Council of Canada� General Medical Council (UK)
� Professional Linguistics and Assessment Board� Various specialty board examinations
� American Board of Emergency Medicine� American Board of Internal Medicine
� Royal College of Physicians and Surgeons of Canada
FAIMER®
� Royal College of Physicians and Surgeons of Canada
� Dillon, G.F., Boulet, J.R., Hawkins, R.E. & Swanson, D.B. (2004). Simulations in the United States Medical Licensing Examination™(USMLE™). Quality & Safety in Health Care, 13(Suppl 1), i41-i45.
Standardized (Simulated) Patients Examinations
� Performance-based� “Standardized”� “Standardized”
� Same conditions for all test takers
� Individuals trained to portray patients with specific conditions
FAIMER®
specific conditions� Chest pain� Depression� Shortness of breath
Performance Measures� Link measures to scenario
events� Focus on observable � Focus on observable
behaviors� Incorporate multiple
measures from different sources
� Capture performance
FAIMER®
� Capture performance processes in addition to outcomes
Types of Scores� Explicit Process
� Checklists� Key actions� Key actions
� Implicit Process� Rating scales
� Timing� Sequencing
� Explicit outcome
FAIMER®
� Explicit outcome� Patient status� Complications, etc.
Why are OSCEs Important for Assessment?
� Assessment drives learning� Efficient� Efficient
� large numbers of ‘examinees’
� Provides clinical exposure� Clinical skills assessment
� Practice-based learning� Tailored feedback
FAIMER®
� Tailored feedback
� Quickly identify curricular problems
� Patient safety
Competencies Assessed with OSCEs
� Knowledge� Communication�� Counseling� Crisis management� Procedures� Physical examination� Medical decision making
FAIMER®
� Medical decision making� Leadership� Teamwork� Interviewing
Important OSCE Issues� Standardization of
conditions an content�� Choice of tasks
� Generalization
� Training� Raters, SPs
� Scoring
FAIMER®
� Scoring� QA
� Standards
Content Under-representation� Some conditions cannot be simulated very well
� Not as important for basic skills� Programming for mannequins is imperfect� Programming for mannequins is imperfect� “Real” patients can vary over time
FAIMER®
Consequences of Testing� Candidate self-selection / preparation
� want to learn� specialized preparation courses� specialized preparation courses
� Changes in curriculum� Development of training centers
FAIMER®