50 years of assessment · 50 years of assessment john cookson md frcp emeritus professor, hull york...
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50 years of assessment
John Cookson MD FRCPEmeritus professor, Hull York Medical School
Formerly
Professor of Medical Education, Undergraduate Dean HYMS
Professor of Clinical Education and Clinical Sub-dean, Leicester and Warwick Medical Schools
The 60s
1968
Paris riots
Sit-ins in VC offices
The 60s
1968
Paris riots
Sit-ins in VC offices
Passed finals
Finals
Separate subjects; medicine, surgery etc.
Written essay papers
Long cases (unobserved); 1 hour; history, examination, problem solving
Short cases (observed); physical signs
Finals
Essays
UNIVERSITY OF BIRMINGHAM
EXAMINATION PAPERS
SESSION 1965-66
FACULTY OF MEDICINE
PRICE
T wo SHILLINGS AND SIXPENCE
Finals
Essays
‘Describe the clinical features and laboratory findings in a child aged 3 with the nephrotic syndrome’
‘Describe the typical features of organic dementia and list some causes’
‘Write a short essay on the toxicological problems of agricultural use of pesticides’
UNIVERSITY OF BIRMINGHAM
EXAMINATION PAPERS
SESSION 1965-66
FACULTY OF MEDICINE
PRICE
T wo SHILLINGS AND SIXPENCE
Finals
Essays
‘A man aged 50 has been ill for a month with progressive jaundice. Discuss the diagnosis and investigations which may be necessary’
‘A 60-year-old man develops tiredness and stiffness of both lower limbs leading to occasional falls. Discuss the investigation and diagnosis’
UNIVERSITY OF BIRMINGHAM
EXAMINATION PAPERS
SESSION 1965-66
FACULTY OF MEDICINE
PRICE
T wo SHILLINGS AND SIXPENCE
The 70sMRCP
EssaysMCQs
T/FGM & paediatrics
VivaLong caseShort cases
Lectureshipstarted to be responsible for the product
The 80sClinical work
Teaching
UG
PG
College tutor/clinical tutor/ass. PG dean
Examining
finals
The 90s
Tomorrow’s Doctors 1993
Manifesto
Integrated
Reduced material that ‘taxed the memory but not the intellect’
Student choice
Became clinical sub-dean
The 90s
Other ideas
• Miller’s pyramid
• Outcome-based education
• Constructive alignment
• Early clinical exposure
• OSCE
Aims
Outcomes
Assessment
Learning process
The 90s
Revision of the clinical curriculum
Revision of assessment
MCQs
MEQ/SAQ
? Clinical
? OSCE
The 90s
? The OSCE
Professor of surgery
Professor of general practice
Agreed about nothing
The 90s
? The OSCEProfessor of surgery
Professor of general practice
Agreed about nothing
Agreed that they did not like the OSCE
did not reproduce the consultation
The 90s
OSLER
Derived from existing Surgery and GP structures
GP
Categories of competence, component competencies, grade descriptors
Real patients
History, examination, problem solving, investigations, management.
Fully observed
The 90s
The OSLER
How to make it reliable?
Sequential examination
Examine most students too much and a few students not enough
Canadian in origin
All students see 4 cases; those not entirely OK see 4 more
Results based on all 8
The 00s
Hull York Medical SchoolNew school, new course
MCQs
best of 5
EMQs
MEQs
OSLER
OSCE
discrete skills, difficult communication
The 00s
Question writing
NBME guide
higher order thinking
‘cover test’
Standard setting
Hofstee
The 00s
Progressive clinical testing
patients stay the same; students get better
OSLER l, ll & lll in years 2,4 & 5
same framework
increasing number of competencies
increasing standard required
The 10s
Grumpy old man
Too many facts?
Has the SBA had its day?
Too much training and not enough education
National MLE
Competency agenda
tick box
not all who possess the competencies are competent
not everything that counts can be counted
Too much faith in portfolios/reflection
Standard setting seriously defective
The 20s
?
Thank you