الرحيم الرحمن الله بسم

مقدم اساتيد محترم طراح

آزمونهاي باليني ” ساختاردارعيني

وساير آزمون هاي باليني نوين پيشترفت تحصيلي“

را گرامي مي داريم.

مدير 2ٍ مكارم EDCدكتردانشكاه

Teach to and Test DesiredTeach to and Test Desired EndpointsEndpoints::

What is the First Principle of What is the First Principle of EducationEducation??

Educational OutcomesEducational Outcomes

Based on Based on Postgraduate Medical Education Postgraduate Medical Education and Training Board (and Training Board (PMETBPMETB)) requirements requirements

for assessment programs arefor assessment programs are::

.هدف از برنامه سنجش مشخص شود -

.محتواي منطقي داشته باشد -

روشهائي با خصوصيات ومبتني برمواردزير داشته -.باشد

ValidityValidity

ReliabilityReliability

FeasibilityFeasibility.روشهاي استاندارد سازي آن راحت و شفاف باشد -

Test characteristics: Test characteristics: Educational impactEducational impact

Teacher

Curriculum

Student

Assessment

Relationship between assessment and learning

CharacteristicsCharacteristics of of assessment instrumentsassessment instruments

• UtilityUtility = =– ValidityValidity– ReliabilityReliability – Educational impactEducational impact– AcceptabilityAcceptability– FeasibilityFeasibility

Measurement propertiesMeasurement properties

ValidityValidity is the is the hallmark of OSCEhallmark of OSCE (Stillman, et al, Newbel, et al).(Stillman, et al, Newbel, et al).

Van der Vleuten, C. The assessment of professional competence: developments,research and practical implications Advances in Health Science Education 1996, Vol 1: 41-67

Validity

Reliability

Educational impact

Acceptability

Feasibility

ValidityValidity

Validity: does the test measure what it is supposed to?

Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. 2nd ed. Upper Saddle River, NJ: Prentice-Hall; 2000:86-89.

Content validityContent validity

Is there something missing?

Does the test “covers” the content domain?

Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. 2nd ed. Upper Saddle River, NJ: Prentice-Hall; 2000:86-89.

Content validity

آيا محتوي مورد آزمون نمونه •(Sample) كل محتواي درس

است؟مشت نمونه خروار است؟ يا نه•

Construct validityConstruct validity

Statistical difference of the performance of two groups in the same test

Known groups method

The ability of a test to measure a construct or abstract concept

Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. 2nd ed. Upper Saddle River, NJ: Prentice-Hall; 2000:86-89.

راهنمائي جهت باال بردن OSCEروائي

- مشكالت ارائه شده توسط بيمار يا بيمار 1نما مهم و مرتبط با برنامه آموزشي باشد.

- ايستگاه هاي مورد ارزيابي قبال آموزش 2داده شده باشند.

- بررسي و مرور ايستگاه ها توسط 3متخصصين

10- تعداد مناسب ايستگاه ها )كمتر از 4ايستگاه نباشد(

ReliabilityReliability

Reliability: does the test measure consistently

between people and over time?Portney LG, Watkins MP. Foundations of Clinical Research: Applications to Practice. 2nd ed. Upper Saddle River, NJ: Prentice-Hall; 2000:86-89.

ReliabilityReliability

( در زمان هاي Testآيا آين آزمون)•مختلف بدون تغيير و با نتيجه مشابه

يادگيري را اندازه گيري مي نمايد؟

عواملي كه سبب كاهش پايائي OSCEمي شوند

- كم بودن تعداد و يا زمان ايستگاه ها1- چك ليست ها يا آيتم هائي كه افتراق كمي 2

دارند- بيماران غير قابل اعتماد يا بيماراني كه 3

براي همه آزمون شوندگان بطور يكسان نقش ايفا نكنند.

- عدم يكنواختي نظر ممتحنين نسبت به 4پاسخ و عيني نبودن مالك نمره دهي

What is Clinical CompetencyWhat is Clinical Competency??

““IIntegrationntegration of knowledge, skills and attitudes of knowledge, skills and attitudes..””

ReferenceReferenceVan der Vleuten, C. The assessment of professional competence: developments,research and practical implications Van der Vleuten, C. The assessment of professional competence: developments,research and practical implications Advances in Health Science Education Advances in Health Science Education 1996, Vol 1: 41-671996, Vol 1: 41-67

Rice et al., Competency-based objectives for clinical training. Can. J. Med. Technol. 57:136, 1995

نگرش

مهارت دانعملیش

Test characteristicsTest characteristics

• FeasibilityFeasibility– costcost– human resourcehuman resource– physical resourcesphysical resources

Test characteristicsTest characteristics

• AcceptabilityAcceptability– tolerable efforttolerable effort– reasonable costreasonable cost

• AcceptabilityAcceptability– doctorsdoctors– licensing bodieslicensing bodies– employersemployers– patients/consumer groupspatients/consumer groups– studentsstudents– facultyfaculty

ارزشيابي صالحيت باليني دانشجويان با:

OSCE (Objective Structured Clinical Examination)

OSCE Objective Structured Clinical Examination

باليني ، آزمون،

عيني ساختارمند

OOSCEsSCEs -- OObjectivebjective

همه داوطلبين با يك مقياس •مورد سنجش قرار مي گيرند.

OOSSCEsCEs - - SStructuredtructured

است • دار نظام ايستگاه هر برنامه و تدابيرstructuredstructured

مهارت هاي ويژه اي كه در هر ايستگاه مهارت هاي ويژه اي كه در هر ايستگاه •مورد آزمون قرار مي گيرند شامل موارد مورد آزمون قرار مي گيرند شامل موارد

زير است:زير است:History takingHistory taking

Interpersonal communicationInterpersonal communication

Clinical examinationClinical examination

ProceduresProcedures

OSOSCECE –– CClinicallinical EExaminationxamination

مهارت هاي بالينيآزمون صالحيت •دستيار نه آزمودن شناختي محض

)دانش ذهني و نظري او(داوطلبين بايد مهارت هاي باليني خود •

را به نمايش بگذارند.

ACGME (Accreditation Council of Graduate Medical Education)

شوراي اعتبار بخشي فارغ التحصيالن تعليم •و تربيت پزشكي

يك سازمان خصوصي اعتبار بخشي براي •برنامه هاي تعليم و تربيت دستياران

تخصصي در آمريكا است.

What is Clinical CompetenceWhat is Clinical Competence??

““IIntegrationntegration of of

knowledge, skills & attitudesknowledge, skills & attitudes..””

Rice et al., Competency-based objectives for clinical training. Can. J. Med. Technol. 57:136, 1995

ACGME (Accreditation Council of Graduate Medical Education)`

General Competencies

• Medical knowledge

• Patient care

• Interpersonal and communication skills

• Professionalism

• Practice-based learning and improvement

• Systems-based practice

What is Clinical CompetenceWhat is Clinical Competence??

““The habitual and judicious use of The habitual and judicious use of communication, knowledge, technical communication, knowledge, technical

skills, clinical reasoning, emotions, skills, clinical reasoning, emotions, values, and reflection in daily practice values, and reflection in daily practice

for the benefit of the individual and for the benefit of the individual and community being servedcommunity being served..””

Epstein and Hundert, Designing and assessing professional competence. JAMA 287:226, 2002

ACGME ToolboxACGME Toolbox

• OSCE is listed as the most desirable forOSCE is listed as the most desirable for – patient carepatient care

– interpersonal and communication skillsinterpersonal and communication skills

– professionalismprofessionalism

• next best method fornext best method for – practice-based learning and improvement practice-based learning and improvement

– systems-based practicesystems-based practice • The toolbox suggests written and oral exams as the most The toolbox suggests written and oral exams as the most

desirable for assessing medical knowledge.desirable for assessing medical knowledge.

What is Clinical CompetenceWhat is Clinical Competence??

““Competence . . . means being able to Competence . . . means being able to function in function in contextcontext..””

Chambers and Gerrow, Manual for Developing and Formatting Competency Statements. J. Dental Educ. 58:361, 1994.

Knows

Knows how

Shows how

Behaviour~ skills/attitudes

Cognition~ knowledge

Model of competenceModel of competence

Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S67.

Does

Pro

fess

ion

al

au

then

ticit

y

Validity of testing formatsValidity of testing formats

Knows

Knows how

Professional practice assessment

Shows how

Does

Knowledge assessment: MCQs

Problem-solving assessment: EMQs, SEQs

Performance assessment: OSCEs, long/short cases, OSLERs, etc

OSCE : blueprintOSCE : blueprint

HistoryInterpersonal communication

ExamProcedure

CVSChest painDisch drugsCardiacBP

RSHaemoptysis

SmokingRespPeak flow

GISAbdo painGastroscopyAbdoPR

ReproAmenorrhoea

Abnormal smearCx smear

NSHeadacheEyesOphthalmosc

MSBackacheHip

GenericPre-op assess

Consent for post mortem

IV canulationBlood trans

گوش رشته چشم ، )OSCE )پيش نويسblueprintblueprintنمونه اي از اورولوژيو گلو،

تفسير مسائلي كه از روي نوار

سمعي و بصري به كامپيوتر

وصل شده

نسخه و

دستورات

تشخيص

عكسهاو

منحني ها

بررسي پرون

ده

آموزش بيما

ر

تفسير كليشه راديولو

ي ،گزارشات

آزماشگاهي

كار عمل

ي

معاينه

تاريخچه

موارد آزمون

موضوعات

چشم : **استرابيسم

**

گوش و حلق

ترشحات از گوش

ناشنوائي*

****

دستگاه تناسلي ادراري: دستگاه

تناسلي غير طبيعي

ترشحات ***واژن

نكته در طراحي ايستگاه هاي 7OSCE

- نوشتن و نصب دستورات واضح براي داوطلبان بر روي 1در ورودي هر ايستگاه )آنچه را كه دستيار بايد انجام دهد(

- نوشتن دستورات و توضيحات واضح براي آزمون 2گيرندگان در مورد هر ايستگاه

- تهيه فهرست از تجهيزاتي كه براي هر ايستگاه الزم 3است.

- تعيين نياز به بيمار يا بيمار نما براي 4ايستگاه)اگر+ ،سن،جنس و...(

- تهيه سناريو براي بيمار نما در صورتي كه قرار است 5نقشي را ايفا نمايد.

- تنظيم برنامه هر ايستگاه: شامل تمام جوانب مهم 6مهارتي مورد آزمون

- تعيين مدت زمان هرايستگاه7