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Student Oral Case Analysis to Medical Student

Student Oral Case Analysis to Medical Student

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Published by wardoyo_eh
A psychometric test is always challenging assessment option to apply, especially in the area of medical education.
A psychometric test is always challenging assessment option to apply, especially in the area of medical education.

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Published by: wardoyo_eh on Apr 12, 2011
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04/11/2013

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434
| AGUSTUS 2010
Medical education has shifted to prob-lem-based learning paradigm. Lecturethat used to be the main learning ac-tivities, now simply act only as instruc-tional class assignment or introductionto learning objectives. Tutorial as mainlearning activity enhanced student’sability to orally present their opinion.The introduction of competence-based curriculum that integrate differ-ent knowledge and skills to producecertain competencies requires properassessment.
 
In many medical schools,Student Oral Case Analysis (SOCA) isone of the instrument to assess stu-dent’s performance in clinical clerk-ship. Oral case presentation is vital inmedical career, i.e. to present a case,and to explain the disease to a patientor their family.
1,2
 SOCA has low psychometric indi-cators with low reliability and valid-ity. These criticisms are justifi ed if theobjectives are to produce relativelyhomogeneous products for diversetrades or professions. But these samecharacteristics may be quite powerfulto promote diversity of student per-formance; active discussion may serveas a powerful incentive to go beyondmere competence and to demon-strate air.
3
 It is possible to increase the reliabilityusing several rather than single oralexamination
(2)
.SOCA has been widely implementedin clinical clerkship in many medicalschools in Indonesia but implementa-
Introduction of Student Oral Case Analysis (SOCA) toAssess Student’s Performance in Pre-clinical Settingin Faculty of Medicine, Mataram University
Eustachius Hagni Wardoyo
1
, Bobby Marwal Syahrizal
1
,Dyah Purnaning
1
, Ida Ayu Eka Widiastuti
1
, Ardiana Ekawanti
1
, Muhammad Farid Wajdi
2
1. Faculty of Medicine, Mataram University (FMMU), Mataram, Indonesia2. Dept. of Internal Medicine, Mataram General Hospital / FMMU, Mataram, Indonesia
ABSTRACT
Background: The competence-based curriculum that integrate different knowledge and skills to produce certain com-petencies requires proper assessment. In clinical setting, Student Oral Case Analysis (SOCA) has been widely used toassess student’s performance; however, the evidence in preclinical setting with more students is still limitedObjective: To describe the implementation of SOCA in pre-clinical settingMethod: The study is a descriptive study. Every student participating in Metabolism and Energy Block were includedin the study. SOCA was used to assess student’s performance in the following manner: 1) developing dietary plan fornormal individual, 2) developing dietary plan for patient with nutritional disorder (under-nutrition), and 3) developing di-etary plan for patient with organ disorders (kidney, heart and liver) and metabolic disorders (diabetes and hypertension).Each student was assessed in 20 minutes : 5 minutes for the scenario, 5 minutes for explanation with a simple fl owchart,10 minutes for answering 4-5 questions. Evaluation components was on the presentation (40%), the answers (50%) andgeneral performance (10%). The score was from 60 to 100 : frequent inaccuracy and guesses (60-69), occasional inac-curacy (70-79), generally accurate, no guess (80-89), exceptionally complete (90-100). A semi-structured interview wasconducted to explore student’s perception on SOCA.Result: Participants were 61 students. Sixty (98.36%) students passed SOCA (cut-off point: 70). Fifty two (85.24%) stu-dents perceived that SOCA had helped them understand the topic, transforming basic medical science to clinical set-ting. Forty nine (80.33%) students also mentioned that the motivation to study was enhanced through SOCA.Conclusion: SOCA in FMMU helped students in topics understanding and increased study motivation.Keywords: SOCA, competence-based curriculum
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435
| AGUSTUS 2010
tion in pre-clinical setting is poorly doc-umented. In 2007 The Faculty of Medi-cine Mataram University has introducedSOCA to assess student’s performancein preclinical setting in the fi fth blockMetabolism and Energy.This study described the implementa-tion SOCA in pre-clinical setting.
METHODSParticipant’s characteristics
The participants consist of 61 students:43 (70.49%) female and 18 (29.51%)male in Metabolism and Energy block.All participants fulfi lled 75% attendancein all learning activities in Metabolismand Energy block to qualify SOCA.
Examiner’s characteristics
Examiners were tutors of Metabolismand Energy block; consist of 5 personsand 3 additional examiners. All exam-iners were trained as SOCA examiner.The training was technical on how toexamine using existing instruments
PROCEDURESDevelopment of SOCA protocol
SOCA protocol was developed as apart of Metabolism and Energy block.Modifi cations was needed to adjustSOCA in clinical clerkship setting toa pre-clinical setting,. Real case inclinical setting was modied by casescenario (bedside presentation is notapplicable in pre-clinical setting) and‘SOAP’ (subjective, objective, assess-ment, plan and prognosis) presenta-tion in clinical setting is modifi ed by ashort scheme / fl owchart. In this study,students were asked to develop a di-etary plan.
SOCA’s implementation
Students were divided into threegroups, each group underwent SOCAin three different days. SOCA’s exam-iners were all fi ve tutors in Metabolismand Energy block plus three otherexaminers. All were trained as SOCAexaminers. Different scenarios wereused in different days. Each studentunderwent 20 minutes of SOCA and5 minutes interval. The time allocationwere summarized in table 1.
Tabel 1.
SOCA Time allocation
Time Time allocation
The rst 5 minutes Read the scenario carefully
-69),occasionally inaccurate (70-79), gener-ally accurate, no guess (80-89), excep-tionally complete (90-100).
Table 2.
Components of assessment
Components of assessmentScore(60-100)
tween pre and post SOCA students.A semi-structured questionnaire wasconducted to explore student’s per-ception of SOCA
RESULTImplementation of SOCA
Introduction of SOCA in pre-clinicalsetting at FMMU was started in Me-tabolism and Energy block. SOCAwas held in May 26 – 28, 2008. Sixty(98.36%) among 61 students passedthe exam (cut off: 70). One student un-derwent remedial SOCA a week laterbecause of sick leave.Objectivity of SOCA was increasedthrough several efforts: 1) Randomstudent’s queue 2) Random scenario3) Drawn scheme as part of assess-ment 4) Examiners trained as SOCAexaminer.
Perceptions of students
Fifty two (85.24%) students perceivedthat SOCA helped in transforming ba-sic medical science to clinical setting.Some students changed their learn-ing strategy by reading more learningresources weeks before, and by prac-ticing SOCA assessed by peers. Fortynine (80.33%) students also mentionedthat motivation was enhanced throughSOCA.Implementation of SOCA increasedanxiety among students, but nallystudents felt excited and relieved.Some of their comments: “So relieveafter the exam, I thought it is going tobe hard, but I can make it!”, “I am veryanxious on what is going to be, but Iam satisfi ed for what I’ve learned.”,and “I imagine I can implement myknowledge to a real patient.” One stu-dent is really tired and think SOCA isunnecessary, has not enough time toprepare; and the ringing bell during
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CDK ed_179 Agustus-September'10 DR.indd 435
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7/23/2010 10:33:17 PM

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