Summative assessment tools for undergraduate students

Document Sample
Summative assessment tools for undergraduate students Powered By Docstoc
					Summative assessment
tools for undergraduate
        students
  EURACT 15th INTERNATIONAL
     COURSE LEARNING AND
TEACHING ABOUT COMORBIDITY
 IN GENERAL/FAMILY PRACTICE.
            Group 3:
Jaime Correia de Sousa

•   Darinka Klančar
•   Gerry Wheeler
•   Igor Švab
•   Marko Kocijan
•   Matilda Vojnović
•   Nathalie Bentov
•   Nena Kopčavar-Guček
•   VlastaVodopivec-Jamšek
•   Vojislav Ivetić
            AIMS

• To devise summative assessment
  tools for final year medical students.
• To assess students’ competence in
  using an holistic approach for
  managing comorbidity.
              TOOLS

• MEQ (Modified Essay Question)

• OSCE
(Objective Structured Clinical
 Examination)
                   MEQ
QUESTION 1
A 64 year old woman who has recently
remarried, has moved to the area. She
comes to visit you for the first time. She
complains of dysuria for 3 days. She also
tells you that she has had Type 2 Diabetes
Mellitus since the birth of the last of her 3
children 25 years ago.
    A   What symptoms and signs will you ask
        for?
        (Limit your answer to a maximum of 20
        items).
    B   What examinations and investigations
MEQ MARKING GRID
TOTAL MARKS   100 POINTS
AVAILABLE



PASS MARK     50 POINTS
                  MEQ 1A. Marking Schedule -SYMPTOMS AND
                         SIGNS (ACUTE- 40 POINTS)
* Essentials.   ITEMS                             points
1*              Lower abdominal Pain              5

2*              Frequency                         5

3*              Fever                             5

4               Urgency                           5

5               Flank pain                        5

6               Recurrence                        4

7               Urine colour change               3

8               Incontinence                      3

9               Vaginal discharge                 3

10              Dyspareunia                       2
                  MEQ 1A. (BACKGROUND-
                       25 POINTS).

         ITEMS                           POINTS

1        LIFE STYLE (DM DIET)            5
2        DRUGS (DM)                      5
3*       DIABETIC MONITORING (LAST       5
         BLOOD TESTS)
4        DIABETIC REFERRALS (EYE,        5
         OTHERS)
5        LAST GYNAECOLOGIST VISIT        5
     *essential
            MEQ 1B. EXAMINATION,
            INVESTIGATIONS AND
            REFERRALS (20 POINTS)
    ITEMS                                POINT
                                         S
1 * URINE TESTS (DIPSTICK)               5
2 * PHYSICAL EXAMINATION ( ABDOMINAL +   5
    FLANK PERCUSION)
3 TEMPERATURE                            3

4   URINE CULTURE                        3

5   CONSIDER BLOOD TESTS (CBC)           2

6   BLOOD PRESSURE                       2
            MEQ 1C. PLAN (15 POINTS)


    ITEMS                              POINT
                                       S
1 * ANTIBIOTICS                        5

2 * ARANGE FOLLOW UP VISIT             5

3   DRINKING                           2

4   COMPLEMENTARY THERAPY (ANALGESICS, 2
    CRANBERRY)
5   CONSIDER REFERRAL (UROLOGIST-      1
    HEMATURIA + FEVER, GYNAECOLOGIST-
    VAGINAL DISCHARGE CHRONIC
                     MEQ
QUESTION 2
You invite her for a double time consultation a week
  later. When she returns, her symptoms have
  cleared. She now admits to urinary incontinance
  for 10 years and dyspareunia since her recent
  remarriage.
She brings her file which shows:
• HbA1C 6.9
• BP 130/80
• ECG Normal
• Eye examination; no retinopathy
A. What issues will you address today?
B. Outline your management plan for the next 3
  months
                  MEQ
Question 3
On her next visit, she tells you that she is
  worried about her 30 year-old son, who
  has moved in with her and her
  husband. She confesses to difficulties
  with her husband.
List the factors that might be impacting
  on their relationship.
                    OSCE

Information for the candidate (student)

You are Dr. B, a GP/FP in a practice / health centre.
Mrs. A is a 75 year old woman that has recently
  registered with you.
You haven’t seen her previously and you have a
  blank clinical file in front of you. Mrs. A’s
  previous file has not yet been transferred to you.
  All you have is her name, age and address.

Your task will be to interview this patient, write
  SOAP notes on the consultation and deal with her
  problems and requests.
                                            OSCE
Information for the role player (patient)

Mrs A, a 75 year old woman has recently registered with Dr. B.
Dr.B doesn’t know much about Mrs. A’s previous health problems. When Mrs. A enters the
consulting room coughing, she informs her family physician (FP) that she would like to have her
celecoxib prescription renewed and, by the way, “could you also write down my other usual
prescriptions”? She gives the doctor a paper with the list of regular medication.
Mrs. A, when asked, informs Dr. B. that she has chronic low back pain, was seen by an orthopaedist
in the emergency service two weeks ago and was prescribed celecoxib. This new drug is helping
her.
If asked, Mrs. A. should confess that she sometimes takes both diclofenac and celecoxib.
When asked, Mrs.A. will inform the Dr. that she has been taking paroxetine during her husband’s
terminal disease and since his death she feels lonely and sad. Her feelings are alleviated somewhat
by the paroxetine and she is sleeping better. The only thing she complains about is her weight loss
of about 5 kg in the last month which she attributes to her sadness and depression.
When Dr. B. asks Mrs. A about the reasons for taking salmeterol she will inform her that she was
given that for her COPD and that she feels much better from using it. She was seen by a lung
specialist 3 months ago and had a chest X-ray and everything was OK.
If asked, she will confess smoking 20 cigarettes a day and she has thought about quitting but it is
                               OSCE

Information for the examiner

The student is expected to write SOAP notes on the consultation. The
different elements of these notes will be used for the assessment of the
OSCE station. The consultation will be video recorded. The observers will
use a classification form to mark the student’s performance.
During the interview, the doctor should review the medication together
with the patient and the reasons why she’s taking them.
There will be marks for:
    A.Identification of the problems
    B.Management and prioritisation
    C.Follow-up
    D.Empathy
         OSCE APPENDIX 1
   OBJECTIVE (EXAMINATION)

Blood pressure         135/70
Pulse                  72
Cardiac auscultation   Normal
Pulmonary              Normal
auscultation
Lasseque/              Normal
straight leg raising
Bragard                Negative
Temperature            36.8oC
   OSCE APPENDIX 2
  LIST OF MEDICATION

SALMETEROL        2 puffs bd
500mcg

PAROXETINE 20 mg 1 daily


DICLOFENAC 75 mg 1 bd
  OSCE APPENDIX 3
  LAB tests
CBC                     normal


CRP                     low


Complete biochemistry   normal
tests
Urine analysis          normal
                         OSCE
Information for the candidate (student)


You are Dr. B, a GP/FP in a practice / health centre.
Mrs. A is a 75 year old woman that has recently registered with
you.
You haven’t seen her previously and you have a blank clinical file
in front of you. Mrs. A’s previous file has not yet been transferred
to you. All you have is her name, age and address.


Your task will be to interview this patient, write SOAP notes on the
consultation and deal with her problems and requests.
OSCE Marking Schedule

TOTAL MARKS    30 POINTS
AVAILABLE
PASS MARK      16 POINTS
   OSCE Marking Schedule
   A. Identification of the problems
   (10 points; from SOAP written by the
   student)


Item                            Point
                                s
Weight loss                     3
Bereavement                     2
Smoking                         2
Depression                      1
Low back pain                   1
Cough                           1
            OSCE Marking Schedule
            B. Management and prioriatisation
            (10 points; from video observation)

Item                                       Points
Discussion of weight loss                  3
Discussion concerning diclofenac           3
Discussion concerning smoking              3
Review of salmuterol and other             1
medications
      OSCE Marking Schedule


C. FOLLOW UP (5 points; from SOAP)

     Follow up advice        5

D. CANDIDATE’S ATTITUDE (5 points;
 from video)
     Empathy                 5