Transcript Simulated Clinical Encounter Examination (SCEE)

UK Council problems with
OSCE assessment
Jonathan Silverman
2012
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
Reliable?
Sacrificed
validity for
reliability?
Valid?
Are the
stations
apples and
pears?
Is it a glorified
Timing of stations
What
is the educationalcompromises
knowledge
You
can
never
get
it
right
test?
validity?
impact of all this?
Has integration
compromised the
Integratedexam?
but with
what?
Examiner training
effective?
UNIVERSITY
OF
CAMBRIDGE
Are you
disadvantaging the
thoughtful shy
student?
Standard
setting and
how easy to get
it wrong?School
of
Clinical Medicine
Utility function
U = wrR x wvV x weE x waA x wcC
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U = Utility
R = Reliability
V = Validity
E = Educational impact
A = Acceptability
C = Cost
W = Weight
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
Domain based marking
The problem of atomised communication
The concept of professional judgement and
flexibility and contextualisation
Internalised grids
Why this might not work in communication
The problem of too few domains
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
Process Marking in information gathering
stations:
7 overall scores
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Initiating the Session
Problem Identification
Problem Exploration
Patient’s Perspective
Non-verbal Communication
Developing Rapport
Providing Structure
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
Process Grid
Initiating the session
Greets patient and obtains patient’s name
Introduces self, role and nature of interview; obtains consent
Demonstrates interest and respect, attends to patient’s physical comfort
Uses appropriate opening question
Overall Score for Initiating the Session
Gathering Information
Listens attentively, minimising interruption and leaving space for patient
Encourages patient to tell the story of the problem(s) from when first started to the present
Checks and screens for further problems (eg, so that’s headaches, anything else you’ve noticed?)
Overall Score for Problem Identification
Uses open and closed questions, appropriately moving from open to closed
Facilitates patient's responses verbally and non–verbally e.g. silence, repetition, paraphrasing
Picks up and responds to verbal and non–verbal cues (body language, speech, facial expression)
Clarifies statements which are vague or need amplification
Periodically summarises & invites patient to correct interpretation or provide further information.
Uses clear, easily understood language, avoids jargon
Overall Score for Problem Exploration
Actively determines patient’s perspective (ideas, concerns, expectations, feelings, effects on life)
Appropriately and sensitively responds to and further explores patient’s perspective
Overall Score for Patient’s Perspective
Building the relationship
Demonstrates appropriate non–verbal behaviour eg eye contact, posture, position, movement, facial
expression, use of voice
Overall Score for Non-verbal Communication
Acknowledges patient's views and feelings; is not judgmental
Uses empathy to communicate appreciation of the patient’s feelings or predicament
Provides support: expresses concern, understanding, willingness to help
Overall Score for Developing Rapport
Providing Structure
Progresses from one section to another using signposting; includes rationale for next section
Structures interview in logical sequence, attends to timing, keeps interview on task
Overall Score for Providing Structure
Individual areas for guidance:
overall areas marked only
Content marking
UNIVERSITY OF
CAMBRIDGE
School of
Clinical Medicine
Content grid
Symptoms
1.
2.
3.
4.
5.
6.
tired, few months
septic spots
rash
thirst
polyuria
weight loss
Other symptoms
7. joint aches
8. blurred vision
Relevant functional enquiry
9. no loss of appetite
Ideas and thoughts
10. diabetes
11. hep C
Concerns
12. amputations or blindness
Expectations
13. tests
Feelings
14. to be taken seriously
Past medical history
15. migraine
16. hepatitis
17. asthma
18. vitiligo
Drugs
19. atenolol
20. two inhalers
21. steroids intermittently
Yes (1)
No (0)
Plus structured oral - 5 minutes