Key Features Items by lindayy

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									Key Features Items


Liz Farmer & Brian Jolly
New approach

 Cambridge Conference

 Resolution of most clinical problems
 occurs in relatively few steps
   thoroughness vs effectiveness


 Concept of critical steps
               Definition


   A key feature is defined as a
   critical step or steps in the
   resolution of a clinical problem.

Action




                        Action
Key Feature Assessment


             Clinical Scenario


    Action




                           Action



                                    Action
         Key Feature Approach

                            Testing time

                    Case                        Case
                      1                           2
 Test using
 PMP cases

               Case Case   Case   Case   Case    Case   Case
                 1    2      3      4      5       6      7
  Test using
key features
Reliability

 Bordage and Page: MCC
 undergraduates
    0.8 in 40 questions (4 hrs)
 Farmer et al: postgraduate GP
    - 0.7 – 0.76 in 25 questions (3 hours)
 Compared with PMP: 0.8 in 7.5 hrs
               Definition


   A key feature is defined as a
   critical step or steps in the
   resolution of a clinical problem.

Action




                        Action
On a sinking ship?
What two things would be most likely to
help you survive?
  Counsel the captain about the loss of the ship
  Bring last night’s leftover nibbles
  Bring water
  Get onto lifeboat
  Get a lifejacket / lifebuoy
  Get your handbag
  Get the dog
  Bring the movie starlet
  Hang onto ship until last moment
KFP
A written or computerised clinical
problem
Consists of a clinical case scenario
followed by 2 or 3 questions
Each question aims to test clinical
decisions and actions not factual
underlying knowledge
Questions seek out the critical
elements (key features) in the
problem
          Key Features of a Clinical Problem1


        Definition: Critical steps that must be taken to identify and
        manage a patient’s problem
            focuses on a step in which examinees are likely to make an
            error
            is a difficult aspect in identifying and managing the problem
        Example: For a pregnant woman experiencing third-
        trimester bleeding with no abdominal pain, the physician
        should:
            generate placenta previa as the leading diagnosis
            avoid performing a pelvic examination (may cause bleeding)
            avoid discharging from clinic or emergency room
            order coagulation tests and cross-match

1. Page G, Bordage G, Allen T. Developing key-feature problems and examinations to assess clinical
decision-making skills, Acad. Med. 70(3), 1995.
Test Items based on a Clinical Problem




    Jennifer, a 24-year-old woman, G3, P2, 31 weeks pregnant,
    comes to the emergency room at 8:00 PM complaining of bright
    red vaginal bleeding for the past two hours. The three sanitary
    napkins that she used were completely soaked. Her pregnancy
    has been uneventful, as were the previous ones. She has not
    had any contractions or abdominal pain. The fetus is moving as
    usual.
             Her BP is 110/70 mm Hg, and her pulse is 92/min. The
    examination of the abdomen reveals a uterine height of 31 cm.
    with a soft and nontender uterus. The fetus is in a breech
    position and has a heart rate of 150/min. No active bleeding has
    occurred since she arrived 25 minutes ago.
Key Features

 1. What is your leading diagnosis at
 this time? List only one diagnosis.
 Write “normal” if you judge Jennifer’s
 situation to be within normal limits.
 2. What steps would you include in
 your immediate assessment and
 management of this patient? List as
 many as are appropriate.
Scoring the Placenta Previa Clinical Problem

      KF1: To receive one point, must list
      placenta previa or one of the following
      synonyms: marginal placenta or low
      placental insertion
      KF2-4: Receive 1/3 point for listing each
      of the following: 1. Avoid performing a
      pelvic exam, 2. Avoid discharging from
      clinic, 3. Order coagulation tests and
      cross match
      Total for Problem: Add scores for items 1
      and 2 and divide by 2 (range: 0 - 1)

								
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