EVALUATION OF

PERFORMANCE

Prof. Mohamed Ezzat Moemen

Founder of Anaesthesia & Intensive Care,

Faculty of Medicine, Zagazig University

Expectations

What do you expect to learn from this lecture?

Answer

At the end of this lecture you will be able

to:

define a new paradigm of clinical performance,

know how it can be implemented,

know how to achieve clinical competence,

know how to evaluate clinical performance.

Performance

The past paradigm:

performing number of cases,

completing number of years,

a core of learning by doing,

The new paradigm:

competence-based knowledge,

technical & non-technical skills,

Affection : attitude & behavior.

TOT = Patient Safety C

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Change in Practice

TOT frame

Scientificsupervisor

Trainer

Trainee

Requirements for

Implementation

Change of culture

Institution & Individuals:

tools,

real patients,

feedback.

Tools

videos

context

lectures

cases scenarios

simulators

The Feedback

Dialogue between trainer and trainee,

Fuel of the evaluation process,

Reflection of the positive and negative,

Informal & formal process, not an event,

Motion of trainer round the learning cycle.

Domains of Supervision

Performance Evaluation

Domains of Supervision

Types: Clinical & Educational,

Examples: Appraisal, Mentoring, Coaching,

In Practice: The 7 C’s:

Conversation

Curiosity

Contexts

Complexity

Creativity

Caution

Care

Promotion of Learning

Miller's Pyramid Educational Model

The Cycle of Appraisal

KOLB’S Learning Cycle

Pendleton Rules

Learner is ready for feedback,

Learner says what he did well,

Observer says that he did well,

Observer says what should be improved,

Observer shows how it can be improved,

Plan for improvement is agreed upon,

Summary and agenda for next dialogue.

The Competence Model

Unconscious Incompetence

Conscious Incompetence

Conscious Competence

Unconscious Competence

Log – Book is checked periodically

Learning in the OR

A challenge context for learning,

Trainer is willing to learn,

Trainee is prepared and oriented,

Knowledge, skills and affections are the

core.

Evaluation Aspects

Evaluation of Knowledge,

Evaluation of Skills,

Evaluation of Affection,

Needs: Costs, change of culture

What to Evaluate?

The SMART Learning Process

How to evaluate?

OSCE

Real patients

Pre – and Post - testing

Evaluation of Performance

Goals:

To give feedback on past performance,

To chart continuing progress,

To identify developmental needs,

To prevent developing problems,

To root out poorly performing doctors,

To help re-validation, re-licensing and

re – certification.

Evaluation of knowledge

Written,

MCQs,

Oral,

Clinical.

Evaluation of Skills

Training devices,

Simulators,

Real patients,

Pretest & post test,

OSCE.

Evaluation of Non-technical

Skills

OSCE:

Ethics and communication skills,

Dynamic decision – making,

Affection:

Observation of attitude,

Safety Attitude Questionnaire,

Observation of behavior,

Incident Report.

Incident reporting

Evaluation of Technical

Skills

Doctor – Patient interaction:

OSCE,

Difficult Airway,

Vascular Access,

CPR,

Pre – and Post – Testing,

Doctor – Machine interaction:

Anaesthetic Machine & ventilators, adjuncts,…

Evaluation of Performance

in Anaesthesia

Anesthesia Clinic:

History: Ethics and communication skills,

Examination: knowledge,

Investigations: decision – making.

Operating Room:

Anesthesia machine, ventilators, monitors, adjuncts,

Skills: technical and non-technical.

PACU:

Knowledge, skills and affection.

FDRTPC including BLS

Evaluation by PRE- and POST-

TESTING,

Course Content,

Trainers,

Trainees,

Implementation,

Evaluation,

Conclusions

The new paradigm of performance is of value.

Its core is a change in culture and feedback.

The SMART learning process should be

simple and

cost – effective.

Education should aim at

skill acquisition

knowledge retention and

attitude development.

Conclusions(cont’d)

Evaluation should include

dynamic decision-making and

human-machine interaction

Evaluation is of benefit for

the organization,

the line-manager and

the job-holder.