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Clinical Examination Levels for Evaluation: Enhancing Competencies in Medical Practice

Learn about structured clinical evaluation levels for assessing skills and knowledge in medical practice, tailored to postgraduate students. Enhance competencies in diagnostic, interview, examination, and more. Practical guidance and evaluation tools provided.

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Clinical Examination Levels for Evaluation: Enhancing Competencies in Medical Practice

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  1. ECOS Strasbourg 10 novembre 2011 Michel LEVEQUE

  2. ECOS (french) OSCE (english) • Objective • Structured • Clinical • Examination

  3. Levels for evaluation PERFORMANCE SKILLS KNOWLEDGE

  4. For what? • Explore the competencies or performance in : • diagnostic • interview • examination • assessment • medical reasoning • sharing médical decision • treatment plan • doctor patient relationship

  5. WHO ? Post graduate students • Prerequisite for ECOS: • Training in clinical • Have skills….

  6. WHEN ? • Formative evaluation • During the professionnal training • Final evaluation • Performance for professionnal certification • Strasbourg: • First expérience for training • Today only final evaluation (efficiency)

  7. HOW ? • Path between stations: • 19 stations ( U Laval) • 7 stations (Strasbourg) • On each station • simulated patient • Physician observer • document specifying the task

  8. 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

  9. Clinical station Questionnaire station • Patient (simulated) • Task, problèms • Observer rating • Questionnaire • Open-ended questions and short

  10. Recommandation to the students need clear , 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… »

  11. Contents of stations Commons situations in primary care

  12. 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

  13. Examples … • Skin redness (Lyme) • Diagnostic and plan • Chronic complaint • Relationship • Insomnia • assement and prescription • Sadness • Diagnostic, assement,suicidal risk • Fatigue • Diagnostic and plan

  14. Method Team (professors, lecturers) only GP : n=15 • Step 1 : choice of situations • Step 2: writing the clinical case • Step 3: selectioncriteria • Step 4: scientific validation • Step 5: writingevaluationgrid • Step 6: test stations with GP • Step 7: plan the examination • Step 8: examination

  15. Example (instruction for the student) • Ms. Richard, 45, teacher, comes to youat the request of others to a "loss of form": itsleepsbadly, cryingoften, feeling irritable and does not know whatis happening.Sheismarriedwithtwochildren (16 and 20 years). • Yourtaskis to conduct the examination to clarify the diagnosis and propose a course of action.

  16. 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 can not 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)…

  17. Example (evaluation grid)a NOM et PRENOM : Grille de correction : Note/20 • Antécédents personnel • dépression 1 • tentative de suicide 0,5 • épisode maniaque 0,5 • consommation alcoolisée 0,5 • prise de médicaments 0,5

  18. Example (evaluation grid)b • Symptomatologie dépressive • humeur triste 2 • inhibition psycho-motrice 2 • dévalorisation 2 • troubles de l’appétit 0,5 • troubles du sommeil 0,5 •  Soutien de l’entourage 1 • Idées suicidaires 2

  19. Example (evaluation grid) • Prise en charge • énoncé du diagnostic 1 • traitement médicamenteux ou psychothérapie 1 • suivi rapproché dans les 8 jours 1 • arrêt maladie 1 • Empathie écoute, reformulation 0 – 1 – 2 – 3 • TOTAL :

  20. The path Station 2 Station 1 Station 3 ECOS Station 7 Station 4 Station 6 Station 5

  21. timing • Each station: 7 minutes • Clock : 1 minute for change • Clock : start the station

  22. 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

  23. Step 4 scientific validation

  24. Kamtchatka, Ru

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