Transcript ارزشيابي صلاحيت باليني بوسيله OSCE

‫ارزشیابی صالحیت بالینی‬
‫به وسیله آزمون بالینی ساختارمند عینی)‪(OSCE‬‬
‫زهرا موفقی‬
‫صالحیت بالینی چیست؟‬
‫تلفیق دانش‪ ،‬مهارت عملی و نگرش های حرفه ای در ضمن‬
‫انجام یک وظیفه بالینی پیچیده‬
‫نگرش‬
‫دانش‬
‫مهارت‬
‫عملی‬
‫‪Rice et al., Competency-based objectives for clinical training. Can. J. Med. Technol. 57:136, 1995‬‬
‫صالحیت بالینی‬
‫“به کارگیری عادتگونه و مدبرانهي‬
‫دانش‪ ،‬مهارتهای ارتباطاتی‪ ،‬مهارتهاي عملي‪ ،‬استدالل‬
‫باليني‪ ،‬عواطف‪ ،‬ارزشها‬
‫و بازانديش ي در فعاليت حرفهاي روزمره‪،‬‬
‫در جهت خدمت به فرد و جامعه"‬
‫‪Epstein and Hundert, Designing and assessing professional competence. JAMA 287:226, 2002‬‬
What is the best way to evaluate
Clinical Competency?
Behavior
Skills & attitudes
Performance assessment: Masked SP
Competency assessment: OSCE
Clinical based tests: MCQ
Knowledge
Knowledge tests:
MCQs
Miller’s Pyramid of Competency
Miller GE. The assessment of clinical skills, competence, performance Acad Med, 1990; 65(Suppl.):S63-S67.
Objective Structured Clinical
Examination
Station
‫‪OSCEs - Objective‬‬
‫‪‬‬
‫همه دانشجویان با یک معیار ارزشیابی می شوند‬
‫‪OSCEs - Structured‬‬
‫‪‬‬
‫ابزار اندازه گیری در هر ایستگاه‪ ،‬ویژه همان ایستگاه تنظیم شده‬
‫است‬
‫‪‬‬
‫در هر ایستگاه یک مهارت بالینی ویژه مورد ارزشیابی قرار می گیرد‬
OSCE – Clinical Examination
‫آزمون توانایی انجام مهارتهای بالینی است‬OSCE

Students have to demonstrate their skills,
not just describe the theory

‫‪Clinical Examination‬‬
‫‪ ‬ارزشیابی رفتار حرفه ای و مهارتهای ارتباطی‬
‫‪ ‬ایستگاه هایی با حضور بیمارنما‬
‫‪ ‬فرایند را ارزشیابی کنید‪ ،‬نه محتوا را‬
‫مثال دانشجو چگونه صحبت کرد نه اینکه چه گفت‬
‫‪ ‬ارزشیابی مهارتهای بالینی‬
‫‪ ‬توانمندی دانشجو و فرایند انجام مهارت را ارزیابی کنید‪،‬‬
‫نه نتیجه کار را‬
Competencies:
Six
and Improvement: The
Responds
HOW YOUThe
GET BETTER
Competencies:
Six Domain
Sample Behaviors Within Each Domain
Educational Outcomes Service Group
Educational Outcomes Service Group
Sample Behaviors Within Each Domain
Writes legi
Interpersonal
and
Sample Behaviors Within
Each Domain
Considers
Communication
Skills: patients
Gathers essential and accurate
information about
Documents
Gathers
essential
and
accurate
information
about pa
Prioritizes the purpose(s) ofHOW
the visit
YOU
INTERACT
Prioritizes
the purpose(s)
of the visit
Uses effec
Interpersonal
and OTHERS
Makes accurate
diagnoses
WITH
Gathers
essential
and
accuratediagnoses
information
about patients
Makes
accurate
Possesses
Prescribesthe
appropriate
therapeutic
interventions
Communication
Skills:
Prioritizes
purpose(s)
of
the
visit
Patient Care:
appropriate
therapeutic interventions
Creates an
Counsels
andPrescribes
educates
patient
and families
Patient Care:
HOW
YOU
INTERACT
Makes
accurate
diagnoses
Interpersonal
and
Counsels
and
educates
patient
and
families
WHAT YOU DO
and colleag
Incorporates
prevention
into care plan
WHAT YOU DO
Prescribes
appropriate
therapeutic
interventions
WITH
OTHERS
Incorporates
prevention
into
care
plan
Creates an
Patient Care:
Communication
Skills:
Conductsand
an appropriate
history
and
physical
exam
Counsels
educates
patient
and
families
Conducts
an
appropriate
history
and
physical
examan
families,
WHAT YOU DO
HOW
YOU INTERACT
Performs procedures
well
Incorporates
prevention
into
care
plan
Performs
procedures
well
Works effe
Orders appropriate
diagnostic
tests
WITH
OTHERS
Conducts
an appropriate
history
and
physical
exam
Orders appropriate diagnostic tests
Presents a
Performs procedures well
Orders appropriate diagnostic tests
Applies knowledge to patient care
Professionalism:
knowledge
to patient
care
Responds
DemonstratesApplies
investigatory
and
analytic
thinking
HOW
YOU
ACT
Demonstrates
investigatory
and
analytic
thinking
Reliably co
Knows knowledge
and appliestobasic
sciences
Applies
patient
care basic sciences
Medical Knowledge:
Knows
and
applies
Sees patie
Medical Knowledge: Demonstrates
Understands a)
anatomy
b)a)
physiology
c)
biochemistry
investigatory
and
analyticb)
thinking
Professionalism:
Understands
anatomy
physiology
c) Demonstra
biochemis
WHAT YOU KNOW
d) microbiology
e)
pathology
f)
pharmacology
g)
neuroscience
WHAT YOU KNOW Knows
and
applies
basic
sciences
d) microbiology
pathology f) pharmacology
g) n
HOW YOU e)
ACT
Medical Knowledge:
Demonstra
Understandsa)psychology/behavioral
medicine
Understands
anatomy b) psychology/behavioral
physiology
c) biochemistry
Understands
medicine
gender, dis
WHAT YOU KNOW
Professionalism:
Understands
function
of surgical
instruments
d) microbiology
e) pathology
f) pharmacology
g) neuroscience
Understands
function
of surgical instruments
Serves effe
HOWmedicine
YOU ACT
Understands psychology/behavioral
Understands function of surgical instruments
Reads
Reads
Uses information
totechnology
support own
Knows
how
Usestechnology
information
to education
support own
educatio
Practice Based
Learning
Locates, evaluates
andevaluates
utilizes
evidence-based
resources
Systems-Based
Practice:
Practice Based Learning Reads
Knowsreso
how
Locates,
and utilizes
evidence-based
Teaches
students
and
other
health
care
professionals
(facilitates
and Improvement:
Uses
information
technology
to
support
own
education
HOW
Understand
Teaches students
andYOU
otherWORK
health care professiona
and Improvement:
Practice
Based
Learning
learning)evaluates
Locates,
and
utilizes
evidence-based
resources
HOW YOU
GET
BETTER
Bills appro
learning)
WITHIN
THE SYSTEM
HOW YOU GET BETTER Engages in continuing medical
education
Teaches students
and
other
health
care
professionals
(facilitates
and Improvement:
Systems-Based
Practice:
Engages in continuing medical education Understand
Responds
to
feedback
learning)
Responds
feedback
HOW YOU GET BETTER
Able to use
HOW to
YOU
WORK
Engages in continuing medical education
Understand
WITHIN THE
SYSTEM Practice:
Systems-Based
Responds to feedback
Practices c
HOWby
YOU WORK
Handout prepared
Ensures ac
Writes legiblyWrites Lynne
legibly
Tomasa,
PhD
WITHIN THE SYSTEM
Effectively
Considers literacy
level520-626-7823
of
others
A more extens
Considers
literacy
level of others
Competencies: The SIX Domains
،ABMS ‫ و‬ACGME ‫بر اساس دستور العمل مشترک‬
:‫بهترین روش برای ارزشیابی مهارتهای زیر می باشد‬OSCE
Interviewing
 Counsel & educate pt’s. & families
 physical exam
 Medical procedures
 Preventive health services
 Creating therapeutic relationship with patients
 Listening skills
 Respectful, altruistic
 Sensitive to cultural, age, gender, disability issues

OSCE : blueprint
History
Interpersonal
Physical Procedure
communication Exam
CVS
RS
GIS
Repro
NS
MS
Chest pain
Disch drugs
Cardiac
BP
Haemoptysis
Smoking
Resp
Peak flow
Abdo pain
Gastroscopy
Abdo
PR
Generic
Pre-op assess
Amenorrhoea Abnormal smear
Cx smear
Headache
Eyes
Backache
Hip
Consent for post
mortem
Ophthalmosc
IV canulation
Blood trans