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ECOS
Michel LEVEQUE
Arkangelsk
02/02/2012
ECOS (french) OSCE (english)
• Objective
• Structured
• Clinical
• Examination
Levels for evaluation
KNOWLEDGE
SKILLS
PERFORMANCE
Adapted from Miller’s triangle 1990
For what?
• Explore the competencies or performance in :– diagnostic– interview– examination– assessment– medical reasoning– sharing médical decision– treatment plan – doctor patient relationship
WHO ?
Post graduate students
– Prerequisite for ECOS:• Training in clinical
• Have skills….
WHEN ?
• Formative evaluation– During the professionnal training
• Final evaluation– Performance for professionnal certification
• Strasbourg:– First expérience for training ( 2000)– Today only final evaluation (efficiency)
HOW ?
• Path between stations:– 19 stations ( U Laval)– 7 stations (Strasbourg)
• On each station– simulated patient– Physician observer– document specifying the task
HOW ?
• Path between stations:– 19 station ( U Laval)• Clinical stations• Questionnaire station related with clinical station • Questionnaire station not related with clinical station • Rest station…
– 7 station (Strasbourg)• Only clinical stations
Clinical station
• Patient (simulated)• Task, problèms
• Observer rating
Questionnaire station
• Questionnaire• Open-ended
questions and short
Recommandation to the students
need clear and précise candidate instructions
•« Red them carefully before starting !!•before any question•if you are unclear as to what you are being ask to do clarify the task with the examinator… »
Contents of stations
Commons situations in primary care
Examples …
• The diabetic foot– Examination
• Announcement of a diabetes– Explanations
• Contraception (teenager)– Explanations and
prescription
• Infant immunization– plan
• Announcement of a AD– Explanations
• Visual disorder (elderly)– Diagnostic and plan
Examples …
• Skin redness (Lyme)– Diagnostic and plan
• Chronic complaint– Relationship
• Insomnia– assement and
prescription
• Sadness– Diagnostic,
assement,suicidal risk
• Fatigue– Diagnostic and plan
Method
Team (professors, lecturers) only GP : n=15-Step 1 : choice of situations-Step 2: writing the clinical case-Step 3: selection criteria-Step 4: scientific validation-Step 5: writing evaluation grid-Step 6: test stations with GP-Step 7: plan the examination-Step 8: examination-Step 9: assesment of teaching…
Example (instruction for the student)
• Ms. Richard, 45, teacher, comes to you at the request of others to a "loss of form": it sleeps badly, crying often, feeling irritable and does not know what is happening.She is married with two children (16 and 20 years).
• Your task is to conduct the examination to clarify the diagnosis and propose a course of action.
Example (instructions for the actor)
• You are Ms. Richard, 45, teacher. You tell the doctor that you have at the request of your family, because you have a loss of form. Your husband has supported and is in the waiting room.
In response to questions from the doctor:• • You cannot stand your students
• You are no longer the household (too tired)• Grocery shopping is a charge• unrest begins one to two months• No more appetite (loss of six pounds in 6 weeks)…
Example (evaluation grid)
Name surname:Note/20
•Personnal history– dépression 1– SuicidE attempt 0,5– Mania episode 0,5– Alcohol consimption 0,5– Médication 0,5
Example (evaluation grid)b
• Dépressive symptomatology– Sad mood 2– Inhibition 2– dévalorisation 2– Eating disorder 0,5– Sleeping disorder 0,5
• Support at home? 1• Sucidal ? 2
Example (evaluation grid)
• Support– Statement of the diagnostic 1– Treatement proposal 1– Close monitoring 1– Sick leave 1
• Empathy, listening, reformulation 0 – 1 – 2 – 3
• TOTAL :
The path
Station 1
Station 1
Station 7
Station 7
Station 6
Station 6
Station 5
Station 5
Station 2
Station 2
Station 4
Station 4
Station 3
Station 3
ECOS
timing
• Each station: 7 minutes
• Clock: 1 minute for change
• Clock : start the station
To learn more about OSCE
• http://w3.fmed.ulaval.ca/cessul/index.php?id=792
• http://w3.fmed.ulaval.ca/cessul/fileadmin/template/main/cessul/documents/document/PPTECOSFaculte.mov
Centre d’Evaluation des Sciences de la Santé Université de Laval
STUDENTSTUDENT
EXAMINATOREXAMINATORACTORACTOR
Kamtchatka, Ru