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Clinical Work Sampling
Tri Wahju Astuti
Background
In-Training Evaluation
(ITE)
Existing systems for assessing
student performance
have been criticized
Unreliable
&
Invalid
Basing performance
data on observed
behaviours
Using multiple observers & occasions
Recording data at the time of performance
Allowing for a fasible system to receive feedback
Clinical Work Sampling
• Assessment Method , developed in Canada
• Direct observation of clinical performance in the workplace (Turnbull et al.2000)
• Collection of data concerning specific patients encounters for a number of different domains (at the time of admission, during the hospital stay)
• Completed by faculty members directly observing trainee performance
Clinical Work Sampling • Tests specific skills separately ( communication, diagnostic,
investigative, health promoting )
• Number & type of team members can assess
• Blinded patient encounters
• On the spot assessment
The domains assessed, include :
• Communication skills
• Physical examination skills
• Diagnostic acumen
• Consultation skills
• Management skills
• Interpersonal behaviour
• Continued learning skills
• Health advocacy skills
Clinical Work Sampling Assessed by : • Ward nursing staff (using the multidisciplinary team rating form) • Patients (using the patient rating form) who in the care of the trainees Completed on the basis of the dirrectly observed behaviour : • Therapeutic strategies • Communication skills • Consultion with other health care proffesionals • Management of resources • Discharge planning • Interpersonal relation • Collaboration skills • Health advocacy skills • Profesionalism
Turnbull et al. 2000
This assessment method → valid & reliable
• Sufficient number of encounters are observed
• Approximately 7 encounters for a reliability of 0.7
• Diagnostic/therapeutic plan
• Differential diagnosis
• Physical examination
• Communication skills (writen & verbal)
• Overall impression
Admission Rating Form
• Diagnostic/therapeutic plan
• Communication skills
• Management of resources
• Health advoacy skills
• Interpersonal skills
• Fund of knowledge
• Overall impression
Ward Rating Form
• Diagnostic/Therapeutic plan
• Communication skills
• Consultation skills
• Management of resources
• Discharge planning
• Interpersonal skills
• Overall impression
Multidisciplinary Team Rating Form
• Communication skills
• Collaboration skills
• Health advocacy skills
• Profesionalism
• Overall impression
Patient Rating Form (conten domains:
administered through interview)
Rating scale used: 1=unsatisfactory; 2= meets expectation; 3 = good; 4 = very good and 5 = excellent Adapted from: Turnbull. J, Macfadyen. J, Barnefeld. C, Van & Norman. G (2000) Clinical work sampling: a new approach to the problem of in-training evaluation, J. Gen. Inter. Med 15: 556-561. used with authors’ permission.
Item Evaluated in Clinical Work Sampling (CWS)
Tata Laksana Pasien TB-RO
• Diagnostic: penentuan kriteria suspek (TCM)
• Therapeutic plan : STR / Individual
• Physical examination
• Communication skills (writen & verbal) : apakah pasien bersedia diterapi STR/individual
• Overall impression
Admission Rating Form
• Diagnostic : baseline (Ax, PE, Lab, EKG, audiometri)
• Therapeutic plan; STR / Individual
• Communication skills
• Management of resources: rapat Tim Ahli Klinis
• Health advocacy skills : ESO
• Interpersonal skills : Pharmacies, Nurses, Nutritionists, ENT, Cardiologist
• Fund of knowledge : BPJS
• Overall impression
Ward Rating Form
• Diagnostic/ Therapeutic plan
• Communication skills
• Consultation skills
• Management of resources
• Discharge planning
• Interpersonal skills
• Overall impression
Multidisciplinary Team Rating Form
Puskesmas, RS, DinKes
• Communication skills
• Collaboration skills
• Health advocacy skills
• Profesionalism
• Overall impression
Patient Rating Form (conten domains:
administered through interview)
PANTER
Implementasi
Divisi Infeksi
Tata Laksana
TB -RO
Tata Laksana TB-DOTS
Hospital DOTS
Linkage
Divisi Onkologi
Tata Laksana Kanker
Paru
Multi Discipline
Team
Penegakan Diagnosis: CT
Scan, FOB, FNAB
Kemoterapi
Divisi Paru Kerja &
Lingkungan
Upaya Berhenti
Merokok : a.Identifikasi
Status px, pemeriksaan fisik. b. Profil perokok
(Skor Horn ) c. Ketergantungan Nikotin(kuesioner
Fagerstroom_. d. Pengukuran kadar CO udara ekspirasi. e. tingkat motivasi.
f. Terapi
Divisi Gawat
Napas & Intervensi
RHCU
NIV
Tatalaksana Intervensi
Divisi Imunologi
ILD
Multi Discipline
Team
Divisi Asma PPOK
Spirometri
Body-
Phletysmografi