Integrated Assessment in Medical Education

Objectives for this brief session

• Consider integration as a continuum – from Isolation to Trans-disciplinary holism

• Share personal experience in Integrated assessment in a hybrid UG curriculum

• Consider various tools for integrated assessment of competencies especially for postgraduate residencies

Intro…

– “Learning is by connecting things. If you can not connect, you can not learn.”

– Lord Chesterton (paraphrased)

• Integration as an educational strategy • Medical Teachers are polarized (For/Against)• Ronald Harden described a 11-step ladder

between the two extremes.

From Isolation to Authentic T-L - in 11 steps (Harden et al)

Fragmentation | Anarchy

Connection | Consultation

infusion

concurrent teaching

Integrate !

joint teaching

concomitant program

mixed program contributory

monolithicImmersion | authentic

Integrated Curriculum needs Integrated Assessment

I Year Integrated MBBS

MCBM = Molecular and Cellular Basis of MedicineHBM = Human Basis of Medicine

II Year Integrated MBBSSystems-based approach

Year 1 – Concurrent “Slice of Pie” Model of Assessment

• Molecular & Cellular Basis of Medicine – Paper-1 – Structure & Function (Anat-Physiol)– Paper-2 – Biochemical & Gen Pharma– Paper-3 – Gen-Path, Immunology, Microbiology

• Human Basis of Medicine– Paper-4 – Epidemiology, Basic statistics etc– Paper-5 – Ethics, Bio-psycho-social approach etc

• Integrated 24 station OSPE

Year 2 – Multi-Disciplinary Model

• Systems based Theory papers (n=6)– LAQ – SAQ – MCQ • With “Slice-of-Pie” division among departments

• Integrated OSCE in 2 sessions – 18 to 24 station performance (5-10-min stations) +– 40 to 50 items for response (3 min per item)– This avoids duplication of skills across subjects

Years 3 & 4 – Purposive Outcomes Oriented Integrated OSCE

• Theory Papers (isolated & Subject based )– LAQ/SAQ/MCQ

• Outcomes based integrated OSCE– Clinical skills: Paeds OG & Forensic in Year-3– Clinical skills: Med – Surgery – Com-Med (year-4) – 15 to 20 station performance (5-10-min stations) + – 40 to 50 items for response (3 min per item)– This avoids duplication of skills across subjects

Final Exams in Year-5 • Theory – multi-disciplinary papers (n=2)– Medical specialties | Surgical specialties

• Clinical Exam – Integrated – Long case: 1 of 4 (Med/Sur-Ortho/Paed/OG) – Short case: other 3 of 4 (joint vs. concurrent)– OSCE: 24 station Integrated OSCE• 12 each for Medical & Surgical specialties • History – physical exam – Dx tests – Rx advice –

counseling on diet/life-style etc

Assessment during PG Residency In-training formative assessment by• Clinical Skills Exam (CHEX)• DOPS (direct observation of procedural skills) • Self evaluation using e-Portfolio• Peer assessment • Multi-source / 360o evaluation • Tools: Check list / Rating scale / Rubric

Haldane T. “Portfolios” as a method of assessment in medical education”http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017561/ (accessed on 9-9-2015)

Rubric – more explicit than Rating Scale

• Rubrics have 4 parts: – 1- description of the task = Check-list– 2- the scale to be used = Rating scale– 3- the dimensions of the task – 4- the description of each dimension on the scale.

• The Development of a Competency Based Assessment Rubric to Measure Resident Milestones - DOI: 10.4300/01.01.0008

Many requirements of task are missing

All requirements of task done; partial understanding

All requirements of task done with full understanding

Most requirements of task are done; some understanding

Rubrics for Outcomes1. Measure outcomes based on real-life criteria2. Specify graded performance indicators 3. Permit assessment of outcome level achieved

in a specific competency 4. Ensure coherent and consistent assessment 5. Improve the quality of assessment 6. A collage of rubrics may permit integrated

assessment of professional behaviour

Be a Trail-blazer

• One more trail to blaze: • Making rubrics for effective assessment of

specialty training to suit your training objectives

• Will you do it soon to enhance the quality of assessment ?

• Strive for Success – Best wishes…