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CHANGING TRENDS IN THE MEDICAL EXAMINATIONS

CHANGING TRENDS IN THE MEDICAL EXAMINATIONS

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Published by doctorrao
CHANGING TRENDS IN THE MEDICAL EXAMINATIONS
CHANGING TRENDS IN THE MEDICAL EXAMINATIONS

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Published by: doctorrao on Oct 20, 2013
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12/06/2013

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 Methods for student assessment in medical education has changed over the past 50 years. We havemoved from a standard of pen-and-paper tests of knowledge and facts toward a more complexsystem of evaluation. Medical students today are tested on knowledge, attitudes, and skills acrossmultiple settings and methods, which are often triangulated to reach summative decisions. Currenteducational and assessment strategies include problem-based learning, computer simulations, andchecklists, standardized patients, and team-based learning that we call as seminars. When westarted our life in Medicine; we were few students in a Unit for training, my teachers who werealways willing to spend the time in training us. Patients were poor in many Government hospitals,helpful to cooperate, and willing to answer many questions put many times with our ignorance.Medical council of India wishes that graduates should have the knowledge, skills, professionalbehaviours and attitudes necessary to enter the unsupervised practice of medicine in India, asGraduates must be able to diagnose and manage health problems and provide comprehensive,compassionate care to their patients. Today we teach the students on comprehensive andintegrated care of the patients, as it is desired to be a competent physician as Prospectivecandidates should be aware that, cognitive, physical examination, management skills,communication skills, and professional behaviours are all evaluated in timed simulations of patientencounters. Doctors should be able communicators both in good and as well in critical times andstudent must be able to speak, to hear and to observe patients in order to effectively and efficientlyelicit information, describe mood, activity and posture and perceive non-verbal communication. Astudent must be able to communicate effectively and sensitively with patients, families and any
member of the health care team. A student must also be able to summarize coherently a patient’s
condition and management plan verbally and in writing. To the students, we should teach to beeffectually to use motor functions. A student must demonstrate sufficient motor functions to safelyperform a physical examination on a patient, including palpation, auscultation and percussion. Theexamination must be done independently and in a timely fashion. A student must be able to usecommon diagnostic aids or instruments either directly or in an adaptive form (e.g.sphygmomanometer, stethoscope, otoscope and ophthalmoscope). A student must be able toexecute motor movements reasonably required to provide general and emergency medical care topatients. Compassion, integrity, concern for others, interpersonal skills, interest and motivation areall personal qualities that physicians must demonstrate and are expected qualities of students.efficient motor function to safely perform a physical examination on a patient, including palpation,auscultation and percussion ability to use common diagnostic aids or instruments either directly orin an adaptive form (e.g., sphygmomanometer, stethoscope and needles)ability to execute motormovements that are reasonably required to provide general and emergency medical care topatients. Many Medical assessment examinations in India and abroad are changing to the neweducational assessment for the new generation of students to eliminate the older examinationsystem fraught with poor assessment criteria, designated
as Objective Structured ClinicalExaminations (OSCEs).
 
An Objectively Structured Clinical Examination (OSCE) is a modern type of examination often used in health sciences (e.g. Midwifery, orthopaedics, optometry, medicine,chiropractic, physical therapy, radiography, nursing, pharmacy, dentistry, naturopathic medicine,Para medicine, podiatry, veterinary medicine). It is designed to test clinical skill performance and
 
competence in skills such as communication, clinical examination, medical procedures / prescription,exercise prescription, joint mobilisation / manipulation techniques, radiographic positioning,radiographic image evaluation and interpretation of results. An OSCE usually comprises a circuit of short (the usual is 5
 –
10 minutes although some use up to 15 minute) stations, in which eachcandidate is examined on a one-to-one basis with one or two impartial examiner(s) and either realor simulated patients (actors or electronic dummies). Each station has a different examiner, asopposed to the traditional method of clinical examinations where a candidate would be assigned toan examiner for the entire examination. Candidates rotate through the stations, completing all thestations on their circuit. In this way, all candidates take the same stations. It is considered to be animprovement over traditional examination methods because the stations can be standardisedenabling fairer peer comparison and complex procedures can be assessed without endangering
patient’s health. Medical
schools in many developed countries are increasingly relying on ObjectiveStructured Clinical Exams as a method to evaluate their medical students' clinical skills andcommunications skills. As
OSCE
exams are now the method of the licensure examination in theUSA, Canada, UK, Australia, and New Zealand and many other countries, most schools are nowimplementing these clinical skills assessment exams right from the first year for their medicalstudents.OSCEs for Medical Student tend to be system oriented as you move from placement toanother, like while they do their surgery clerkship, the topics will be around surgical topics, and soon. However, medical students have to keep their minds open to all possible diagnoses and explorethe relevant ones as time permits. Differential diagnosis is still needed to be covered in all medicalstudent OSCEs. The best way for a medical student to prepare for an
Objective Structured ClinicalExams (OSCE Exam)
is repetitive practicing following a well prepared systematic approach model.Acquire a systematic organized approach that covers clinical skills, communication skills, anddifferentials. Start as early as possible in your medical education and keep repeating and practicingyour approach over and over for months and all through your medical school years. Make it a habitin order to master patient encounters. It will be one practicing for all your coming medical OSCEexams. Does it make sense, The OSCE is an assessment format in which the candidates rotatesequentially around a series
of structured cases located in ‘stations’, at each of which specific tasks
have to be performed, usually involving a clinical skill, such as history taking, examination of apatient or a practical skill. The marking scheme for each station is structured and determined inadvance. There is a different examiner and a time limit for each station. The basic structure of anOSCE may be varied in timing for each station, use of checklist or rating scale for scoring, use of clinician or standardised patient as examiner, use of real patients or manikins, but the fundamentalprinciple is that every candidate has to complete the same assignments in the same amount of timeand is marked according to a structured marking schedule. Many Medical Institutions and somedeemed universities are planning for a change. The
DNB
courses have successfully implementedmany aspects of 
OSCE
. My little experience
with OSCE in a Medical College
, it is far moreconfusing than the traditional system, for the undergraduates, I think who are implanting the systemshould be sound in doing the procedures or else it is confusing to the Teacher as well as taught.However Successful OSCEs are often the result of significant planning, coordination of multipleresources, commitment to large-scale testing, and judicious use of assessment data. More researchis needed about the best uses of the
OSCE
method and how to maximize reliability and validity.Advocates of the OSCE method should continue to produce and disseminate evidence of the far-

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