EducationalAssessment

Classroom MCQs

Clinical OSCE

Objectives By the end of seminar learners will be able to: Define assessment Overview of assessment and educational assessment Explain attributes of assessment Describe multiple choice questions (MCQs) Discuss the steps of designing MCQs. Identify advantages and disadvantages of MCQs Define OSCE Discuss the process of OSCE Converse approaches/models of OSCE Debate on OSCE Discuss Ethical issues in OSCE Know the views of students and faculty for OSCE

Definition of Assessment Assessment comes from the old French

word assessor, meaning to sit by as an assistant judge or guide.

The process of collecting information on student achievement and performance. Provides information for basis of sound decision making regarding teaching and learning.

http://www.aac.ab.ca/final

Cont… “The process of assessment is to

gather, summarize, interpret, and use data to decide a direction of action”

(Bastable 2003)

“Begins with educational values, works best when program has clear purposes…is ongoing and meets the responsibilities to students and public”

(Billings 2003)

Educational Assessment “Is the process of documenting, usually

in measureable term, knowledge, skills, attitudes, and beliefs”

“It focus on the individual learner, the learning community, the institution, or the educational system as a whole”

http://en.wikipedia.org/wiki/Assessment

Overview of Assessment

Assessment

why

where How

what

Whom

when

Of What

Assessment

What? process of gathering… Why?

Measure academic achievement Identify areas for improvement Predict future performance

Of what? Domains Cognitive (Knowledge)

Affective (Attitude)

Psychomotor (Skills)

Content Facts and principles Processes Signs and symptoms Clinical methods Techniques Management Etc….

How? Written tests

Essay True false MCQs MCIs Viva/oral Practical Long case/short case Osce Projects

How?

Shows how

Does

Knows how

Knows Factual test: MCQs, Essay, Oral

(Clinical) Context based testsMCQ, essay, oral

Performance assessment in vitroOSCE, Standardized-patient based test

Performance assessment in vivoUndercover SPs, Video, Logs only in real world of practice

(Miller 1990)Both areas tested by traditional written exams….

When?

Continuous assessment

End of yearassessment

Strength Multiple points of observation can lead to greater confidence in judgment

Easier to define specific objectives and structured test content

Limitations

Assessor bias Busy facultyMay not observe

More artificial

Where? Testing in situations similar to those in training and practice, enable to make justifiable decisions

Assessment TypesFormative Summative

Strength Can identify weaknesses and further guide student learning

Can provide a clear diagnostic statement about a student competence

Limitations

May not be taken seriously by non self-directed learners

Usually occur too late to have any meaningful impact on learning

Curricular attributes include Program and course objectives Critical learning experiences Learning outcomes

Faculty attributes comprise Level of content knowledge attitude about teaching Instructional skills Appropriate knowledge of teaching learning theories

Students’ attributes consist of Knowledge and skills Cognitive abilities Learning styles Motivation to achievement (Billings 2005)

Attributes of Assessment

How to develop effective Assessments?

Should be RELIABLE and VALID

Reliability: A reliable assessment is one that provides consistent “scores”.

Validity: An assessment is valid when it accurately measures what is to measure.

Multiple Choice Questions. MCQs Consists of twoparts Stem

Can be a question or an incomplete statement, scenario, problem

Several options/ distracters But to choose the

best response

Steps in Designing MCQsStem

Clear single problem Content should be common Independent of all others in the test Information in one stem should not give clue to

another item Scenarios incorporated carefully Use of action verbs of Bloom taxonomy (1956)

according to cognitive level of students Knowledge, comprehension, application, analysis

(Billings, 2005)

Steps in Designing MCQsOptions

Grammatically consistent with stem to avoid giving clues to right one

Arrangement order, alphabetical, numerical

Having same length Give only one best option, to which

all faculty agree Should not use all of above, none of

above

Examples of MCQs Knowledge1. A patient’s father died of Huntington’s

chorea. What are the chances that pt will have the disease?

a) 25%b) 50%c) 75%d) 100%

Comprehension

2. A pt resists the nurse's attempts to get him out of bed. If this attempt is without pt’s approval, what legal charge could nurse face?

a) Assaultb) Batteryc) Negligenced) Tort

Application 3. On the 1st post-op day after an open reduction

and internal fixation (ORIF) of the tibia with application of long leg cast, the pt begins complaining of severe pain uncontrolled by his scheduled pain med. What would be the priority nursing intervention?

a) Administer a narcotic bolus as orderedb) Assess the neurovascular status of legc) Lower the leg to increase arterial flowd) Raise the leg to decrease venous return

Analysis 4. A 70 yrs old woman is admitted to the

hospital with a diagnosis of dehydration. Vital signs are stable. Serum sodium level is 165 mmol/L. Which of the fluid replacement is most likely to be administered?

a) Hypertonicb) Hypotonicc) isotonic

What makes MCQs “Good”? Alignment: to content, learning outcomes/goals, Importance: testing details is a waste of

resources; concentrate on fundamental concepts Clarity: the intent of the task and the meaning of

the options must speak for themselves and be interpreted in the same way by all examinees

Item construction: well-constructed items can be answered successfully by examinees who have the knowledge or skill you are testing, and NOT by examinees who are lacking the skill or knowledge

MCQs Advantages Large content in single

test

Scored easily and objectively

Measure understanding at numerous cognitive levels in taxonomy category

Disadvantages Time consuming in

designing for faculty More time needed by

students to read and understand

Differentiate against creative, verbal student

Writing style affects scores

Difficult to write MCQs at synthesis and evaluation level

CPR being performed on a mannequin used for training

Inspect Palpate Percuss

Auscultate

OSCE

Objective Structured Clinical Examination

OSCE is a competency-based evaluation aimed at testing the psychomotor and affective domains with an inbuilt system for systematic feedback.

OSCE is a modern type of examination often used in health sciences (e.g. medicine, physical therapy, nursing, pharmacy) to test clinical skill performance and competence such as communication, clinical examination,

Cont…

medical procedures / prescription, exercise prescription, joint mobilization / manipulation techniques, and interpretation of results.

http://www.osceskills.com/

Also known as “Standardized Patient Exams SPEs, described as an acceptable and powerful instrument in clinical performance evaluation… pretended patients in an artificial environment designed to simulate actual clinical condition”

(Borbasi & Koop 1994 as cited in Billing 2005)

Process of OSCE

It normally consists of several short (5-10 minute) stations, in which each is examined on a one-to-one basis with an impartial examiner and either real or simulated patients (actors).

Considered to be an improvement over traditional examination methods because the stations can be standardized enabling fairer peer comparison and complex procedures can be assessed without endangering patients health

Cont…

The other ways an OSCE is made objective is by having a detailed mark scheme and standard set of questions.

For example, a station concerning the demonstration to a simulated patient on how to use a Metered dose inhaler would award points for specific actions which are performed safely and accurately (e.g. candidate explains to patient the need for a seal around the mouthpiece, etc.)

http://www.osceskills.com/

Approaches/Models to OSCE

Multi station OSCE

Scenario based OSCE(sometimes called objstructured clinical assessment (OSCA)

Top to ToeAssessment

OSCE /simulated Assessment with randomallocation

(Rushforth 2007)

Some centers also use viva, or Q/A with these models

OSPE

AKU Med students1st & 2nd year

OSCE

3rd & 4th year

Is OSCE debatable? OSCE stations can never be truly standardized and

objective in the same way as a written exam.

It has been known for different patients / actors to afford more assistance, and for different marking criteria to be applied (literature shows marking criteria as pass/fail, checklist, likert scale, percentages, done/not done)

It provides a formative evaluation for both students and the educational institution.

(Rentschler et al, 2007)

Cont… It is a fast and well-organized evaluation method, allows rapid

feedback to students about their clinical deficits (Billings 2005)

OSCE has been tested and found to be reliable, valid in various settings, provides a controlled clinical situation that is realistic and nonthreatening

# of stations 16 minimum, 37 max (as cited in Rushforth 2007)

Easy in controlled setting but difficult in real world

Literature says that it should be mandatory for nursing students as well

(Rentschler et al, 2007)

Ethical Issues in OSCE

Perceived inequity between students

Lack of honesty and professionalism of peers

http://jme.bmj.com/cgi/content/abstract/32/12/734

Cont… Discuss the OSCE cases with other

students after the OSCE?violation of the honor code.

Why not children as simulated patients?

http://www.oucom.ohiou.edu/AcademicAffairs/predoc/osce/index.htm

Views of students and faculty

Students Overall satisfied Stressful Improve

performance Can practice on

peers as well Encouragement and

motivation

Faculty Overall satisfied Students practice

actively Provide

evaluation to students soon after exam

References Billings,D.M,Halstead,J.A. (2003).Teaching in

nursing: A guide for faculty. 2nd ed.

Bastable,S.B.(2003).Nurse as educator:principles of

teaching and learning for nursing practice. 2nd ed.New York: Jones and Bartlett Publishers.

Hammond,L,D & Bransford, J.(eds) (2005). Preparing

teachers for a changing world:what teachers should learn and be able to do. USA. Jossey Bass. pp 275-326

Cont…http://www.oucom.ohiou.edu/AcademicAffairs/predoc/osce/index.htm

Norman, G. (2002) The long case versus objective structured clinical examinations. BMJ 324: 748-749

Objective Structured Clinical Examination. Retrieved Jan 29, 2009 from http://www.osceskills.com/

Parks,R.,Warren,P.M.,Boyd,K.M., Cameron,H.,Cumming, A., & Jones, J.L. (2006). The Objective Structured Clinical Examination and student collusion: marks do not tell the whole truth. Journal of Medical Ethics,32. 734-738

Cont…

Rentschler,D.D; Eaton,J; Cappiello,J; McNally,S.F; & McWilliam,P.(2007). Evaluation of undergraduate students using objective structured clinical examination. Journal of Nursing Education, 46 (3) 135-139

Rushforth, H.E. (2007). Objective structured clinical examination (OSCE): Review of literature and implications for nursing education. Nurse Education Today ,27, 481-490

Stiggins,R. J.(1999). Assessment, Student Confidence, and School Success. Phi Delta Kappan, 81, (3) Retrieved Jan 23, 2009 from http://www.aac.ab.ca/final 2002.doc

Questions

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