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Assessment 101:
How to determine and design effective tools for resident assessment
Anna Oswald, MD MMEd FRCPC Lara Cooke, MD, MSc (MedEd), FRCPC Clinician Educators, RCPSC 1
By the end of this, you will be able to…
• Summarize six tips for learner assessment.
• Describe at least two different tools for assessing physician competencies.
• Use blueprinting to link objectives and assessment methods.
2
Outline
• Types of Assessment • Cognitive Domains • Linking Objectives & Assessment • Blueprinting • Making ITERs more user-friendly
3
Take-Home Messages:
1. There is a tool for every CanMEDS Role 2. No single tool can do it all 3. Assessment is multimodal 4. It is unnecessary to assess all Roles all the time 5. Appropriate tools may be tailored to specialty
4
Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S7.
Knows
Shows how
Knows how
Does
Prof
essi
onal
aut
hent
icity
Written, Oral or Computer based assessment
Performance or hands on assessment
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What do we really want to assess?
Assessment of Competency
CLINICALLY-BASED: Mini CEX DECs ITERs MSF Practice assessments Chart audits
EXTRA CLINICAL: Written tests Oral exams OSCEs & SPs Logbooks & Portfolios “Long cases” with real
patients Simulations & labs
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Link Objectives and Assessment Methods
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Objectives
Teach Assess
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Linking Objectives & Assessment
• Look at each key competency or objective and decide which domain(s) it links to:
– Knowledge – Skills – Attitude
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Example Core Competencies: CanMEDS Health Advocate
Physicians are able to… 1.Respond to individual patient health needs
and issues as part of patient care; 2. Respond to the health needs of the
communities that they serve; 3. Identify the determinants of health of the
populations that they serve; 4. Promote the health of individual patients,
communities and populations.
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Example Enabling Competency #2:
Respond to the health needs of the communities that they serve
Describe the practice communities that they serve
Identify opportunities for advocacy, health promotion and disease prevention in the communities that they serve, and respond appropriately
Appreciate the possibility of competing interests between the communities served and other populations
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Identify the core competencies of interest Specify: Knowledge, Skills or Attitudes Figure out where these are best
demonstrated in the program
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Task 1: Linking objectives to cognitive domains
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TASK #1
Assign one or more of Knowledge (K), Skills (S), or Attitudes (A) to each enabling Objective for the Health Advocate objectives:
Describe the practice communities that they serve
Identify opportunities for advocacy, health promotion
and disease prevention in the communities that they serve, and respond appropriately
Appreciate the possibility of competing interests between the communities served and other populations
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Respond to the health needs of the communities that they serve
Describe the practice communities that they serve K
Identify opportunities for advocacy, health promotion and disease prevention in the communities that they serve, and respond appropriately KS
Appreciate the possibility of competing interests between the communities served and other populations A
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Task 2: Using cognitive domains to choose the right assessment methods
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Task 2: Assign K-S-A
CLINICALLY-BASED: Mini CEX DECs ITERs MSF Practice assessments Chart audits
EXTRA CLINICAL: Written tests Oral exams OSCEs & SPs Logbooks & Portfolios “Long cases” with real
patients Simulations & labs
18
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Blueprinting 101
Who uses a curriculum blueprint?
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CanMEDS ROLE**
Written Exam
Oral Exam
ITER
Expert
Collab.
Comm.
Prof.
Advocate
Scholar
Manager
Abbreviated Curriculum Blueprint
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CanMEDS ROLE
Written Exam
Oral Exam
ITER Simula- tions
Portfolio
Expert x Collab. x Comm. x Prof. x Advocate x Scholar x Manager x
Abbreviated Curriculum Blueprint
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CanMEDS ROLE
Written Exam
Oral Exam
ITER Simula- tions
Portfolio
Expert x x x x Collab. x x Comm. x x Prof. x x x Advocate x Scholar x x X
Manager x x x
Abbreviated Curriculum Blueprint
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Tip 1: Identify the Gap
• What are the specific knowledge, skills and attitude elements (of your gap)? (eg-Uh oh, we are not assessing residents’
competence around the social determinants of health)
• Where are these elements found in your
curriculum? (e.g. in hypertension clinic, where we look at at risk
populations and primary prevention of cardiac disease)
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Task 3: Blueprinting Exercise
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Task #3
Choose one core competency from the CanMEDS Framework (the GAP in your
program) and complete the blueprint grid in your worksheet.
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Moving On…
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ITERs & Observation
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Tip 2: Observe!
Enhance direct observation for assessments
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Tip 3: Modify your ITER
In-training Evaluation (Report)
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The ITER
Universal Familiar Easy Multi-dimensional Documentation Practice-Based
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The ITER
• Halo & Millstone effect – Comprehensiveness vs. objectivity
• Leniency Bias • Generic vs. specific to the rotation • Based on direct observation???
33
Problematic ITER Descriptors:
“Acts as a health advocate” hard to rate is meaning clear?
“Advocates for individual health promotion” a bit better
“Consistently reports risk factors for disease and identifies opportunities for preventative interventions” Can evaluate Can provide feedback
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Task #4: Enhancing ITER descriptors
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Task #4: Change Your ITER
• Modify the following ITER items to be more useful: – “Acts as an effective collaborator.” – “Demonstrates lifelong learning.”
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Task #4: Enhancing ITER descriptors
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High Quality ITERS: EMPHASIZE COMMENTS!!
• Justify the Likert rating • Include trainee’s response to feedback • Have specific examples (+/-) • Provide recommendations for improving
performance • Be detailed enough for an independent
reviewer • Dudek et al, Medical Education, 2008
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Tip 4: Tailor existing tools to serve multiple functions
39
One option is to tailor a CLASSIC tool for your purposes:
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Example: Tailor an Existing Tool e.g. SAQ
STEM: A 70 year old female is brought to the ED
after a fall. Her vital signs are normal and she complains of right hip pain.
THE QUESTION: What SAQ would address a HEALTH ADVOCATE or other CanMEDS objective?
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Tailor an Existing Tool The NEW standard:
List SIX preventable complications of this injury and
identify ONE potential intervention to reduce the likelihood of EACH
This is the patient’s fourth fall in two weeks. List THREE interventions that should be considered upon discharge to reduce the risk of a recurrence.
Which social determinants of health might put the patient at risk for falls?
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try a new assessment tool
Portfolio Multi-source feedback
TIP 6: Don’t be a Loner
Build a Community of Practice
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Take Home Messages:
1. There is a tool for every CanMEDS Role 2. No single tool can do it all 3. Assessment is multimodal 4. It is unnecessary to assess all Roles all the time 5. Appropriate tools may be tailored to specialty
45
Outstanding Issues?
46
Acknowledgement:
Assessment 101: How to determine and design effective tools for resident
assessment
Jonathan Sherbino MD MEd FRCPC Emergency & Trauma Physician,
Director CPD, Division EM McMaster University
Clinician Educator, RCPSC
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Hyper Links
Portfolio: “Instrument of instruments”
Strengths: Representative data Promotes reflection Flexible, multifaceted Authentic Longitudinal Contrast: logbooks Good for assessing complex,
integrative competencies
Weaknesses: Only as good as its parts Reliability Adherence Standardization Time consuming to evaluate Limited utility:
Medical Expert Collaborator
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Example: Creating a New Tool - Portfolios
Residents must submit a 500 word essay each quarter detailing: An interaction during which they have
identified an advocacy issue Identify which key or enabling competency
is reflected in the interaction What role the resident played in the
interaction What lessons were learned or changes
resulted from the interaction.
50
Outcomes
• Increases individual responsibility for learning
• Promote reflection (?)
• No data on changes in learner behaviour or organization changes
51
MSF: Definition
• Survey
• Responses sampled from sphere of influence
• Aggregate ratings – Compared to mean ratings of other individuals
assessed – May include comparison to self-assessment
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Strengths Multiple perspectives on
behaviour Good for:
Communicator Collaborator Professional
Weaknesses Resource-intensive Poor for:
Medical Expert Scholar
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Key Elements
• Administrative infrastructure – Collecting & aggregating data is labor intensive
• Sample Size (reliability) – 6 peers, 6 co-workers, 22 patients (PAR) – 10 peers, 25 patients (ABIM)
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Encounter Cards (DECs)
Strengths Useful for multiple assessors Face validity Promote feedback Contribute to reliability /
validity of ITER
Weaknesses: Administration Fatigue Gaming Halo /millstone effects Limited Utility
Health Advocate Professional
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