The document discusses integrated assessment in medical education, emphasizing the continuum from isolation to holistic approaches. It outlines various tools and models for competency assessment in undergraduate and postgraduate medical curricula, including multi-disciplinary and outcomes-oriented assessments. Additionally, it highlights the importance of rubrics in evaluating residents' milestones and the need for coherent assessment strategies.

1. Integrated Assessment
in Medical Education

2. Objectives for this brief session
• Consider integration as a continuum
– from Isolation to Trans-disciplinary holism
• Share personal experience in Integrated
assessment in a hybrid UG curriculum
• Consider various tools for integrated
assessment of competencies especially for
postgraduate residencies

3. Intro…
– “Learning is by connecting things. If you can not
connect, you can not learn.”
– Lord Chesterton (paraphrased)
• Integration as an educational strategy
• Medical Teachers are polarized (For/Against)
• Ronald Harden described a 11-step ladder
between the two extremes.

4. From Isolation
to Authentic T-L
- in 11 steps
(Harden et al)
Fragmentation | Anarchy
Connection | Consultation
infusion
concurrent teaching
Integrate !
joint teaching
concomitant program
mixed program
contributory
monolithic
Immersion | authentic

5. Integrated Curriculum needs
Integrated Assessment
I Year Integrated MBBS
MCBM = Molecular and
Cellular Basis of Medicine
HBM = Human Basis of
Medicine
II Year Integrated MBBS
Systems-based approach

6. Year 1 – Concurrent “Slice of Pie”
Model of Assessment
• Molecular & Cellular Basis of Medicine
– Paper-1 – Structure & Function (Anat-Physiol)
– Paper-2 – Biochemical & Gen Pharma
– Paper-3 – Gen-Path, Immunology, Microbiology
• Human Basis of Medicine
– Paper-4 – Epidemiology, Basic statistics etc
– Paper-5 – Ethics, Bio-psycho-social approach etc
• Integrated 24 station OSPE

7. Year 2 – Multi-Disciplinary Model
• Systems based Theory papers (n=6)
– LAQ – SAQ – MCQ
• With “Slice-of-Pie” division among departments
• Integrated OSCE in 2 sessions
– 18 to 24 station performance (5-10-min stations) +
– 40 to 50 items for response (3 min per item)
– This avoids duplication of skills across subjects

8. Years 3 & 4 – Purposive Outcomes
Oriented Integrated OSCE
• Theory Papers (isolated & Subject based )
– LAQ/SAQ/MCQ
• Outcomes based integrated OSCE
– Clinical skills: Paeds OG & Forensic in Year-3
– Clinical skills: Med – Surgery – Com-Med (year-4)
– 15 to 20 station performance (5-10-min stations) +
– 40 to 50 items for response (3 min per item)
– This avoids duplication of skills across subjects

9. Final Exams in Year-5
• Theory – multi-disciplinary papers (n=2)
– Medical specialties | Surgical specialties
• Clinical Exam – Integrated
– Long case: 1 of 4 (Med/Sur-Ortho/Paed/OG)
– Short case: other 3 of 4 (joint vs. concurrent)
– OSCE: 24 station Integrated OSCE
• 12 each for Medical & Surgical specialties
• History – physical exam – Dx tests – Rx advice –
counseling on diet/life-style etc

10. Assessment during PG Residency
In-training formative assessment by
• Clinical Skills Exam (CHEX)
• DOPS (direct observation of procedural skills)
• Self evaluation using e-Portfolio
• Peer assessment
• Multi-source / 360o evaluation
• Tools: Check list / Rating scale / Rubric
Haldane T. “Portfolios” as a method of assessment in medical education”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017561/ (accessed on 9-9-2015)

11. Rubric – more explicit than
Rating Scale
• Rubrics have 4 parts:
– 1- description of the task = Check-list
– 2- the scale to be used = Rating scale
– 3- the dimensions of the task
– 4- the description of each dimension on the scale.
• The Development of a Competency Based Assessment Rubric to
Measure Resident Milestones - DOI: 10.4300/01.01.0008

12. Many
requirements of
task are missing
All requirements of
task done; partial
understanding
All requirements o
task done with full
understanding
Most requirements
of task are done;
some understanding

13. Rubrics for Outcomes
1. Measure outcomes based on real-life criteria
2. Specify graded performance indicators
3. Permit assessment of outcome level achieved
in a specific competency
4. Ensure coherent and consistent assessment
5. Improve the quality of assessment
6. A collage of rubrics may permit integrated
assessment of professional behaviour

14. Be a Trail-blazer
• One more trail to blaze:
• Making rubrics for effective assessment of
specialty training to suit your training objectives
• Will you do it soon to enhance the quality of
assessment ?
• Strive for Success – Best wishes…