1. assessment units
Assessment instruments

2. assessment units
Types classroom assessment
Placement assessment
• Screening assessment
• Formative assessment
• Summative assessment
(Berk R A, 2002)
Are the students qualified, to advance to the
next, course level?

3. assessment units
Millers Pyramid
Types of classroom assessment
Placement assessment
• Screening assessment
• Formative assessment
• Summative assessment
(Berk R A, 2002)

4. assessment units
Exercise
Reflect for a moment and write down
assessment instruments that you
know and how they influence your
learning!
Remember difference between method and
instrument:
Method of travel = by land, sea, air…
Instrument of travel = train, bus, ship,
plane…

5. assessment units
Taxonomies
Classification of objectives or skills
• Hierarchic
– To achieve higher level one must
master lower one
• Motivation for holistic form of
education

6. assessment units
Bloom’s taxonomy

7. assessment units
Millers pyramid

8. assessment units
Millers pyramid

9. assessment units
Millers pyramid

10. assessment units
Validity
Proper assessment instrument?
– Thermometer -> Temperature
– Thermometer x-> Weight
– MCQ -> Know & understand
– MCQ x-> Show, demonstrate,
do

11. assessment units
• Content (=direct) validity
– Relevance?
– Representative?
– Subjective!
• Construct (=indirect) validity
– Test result -> Competence?

12. assessment units
Reliability
Test-retest reliability
• Equivalent forms reliability
• Split-half reliability
• Scorer/rater reliability
– Inter- vs. intrarater reliability

13. assessment units
Factors in clinical skills assessment that lead to
lower reliability
Two few stations or too little testing time
Check list that do not discriminate (too
easy or too hard)
Unreliable patients or inconsistent role
players
Idiosyncratic examiners
Administration problems

14. assessment units
Engaging with data
Write down some observationsabout the
data. What do you see?
2. Suggest explanations (hypotheses)
for the data.
3. How would you test the hypotheses?

15. assessment units
Feasibility
Cost in terms of resources and time of
Construction
• Marking
• Organisation
• Quality feedback

16. assessment units
Utility
• U = Utility
• R = Reliability
• V = Validity
• E = Educational impact
• A = Acceptability
• C = Cost

17. assessment units
Types of assessment
 Multiple Choice Questions (MCQs)
 Modified Essay Questions (MEQs)
 Patient Management Problems
(PMPs)
 Traditional essays questions
 Structured questions .filling the blanks
 True or false questions

18. assessment units
Able
to do

19. assessment units
Does
Performance assessment in vivo
Undercover,sps, videos logo
Shows how
Performance assessment in virtro, OSCE,sp
based tests
Knows how
Clinical context based tests
MCQs,essays,orals
Knows-
Factual tests-mcq,essays,oral

20. assessment units
12 curriculum outcomes. SMS

21. assessment units
What the doctor is able to do 1-7
Competence in clinical skills
Competence to perform procedures
Competence to investigate a patient
Competence to manage a patient
Competence in health promotion and disease
control
Competence in skills of communication
Competence to retrieve and handle information

22. assessment units
How the doctor approaches their
practice 8-10
With understanding of basic and clinical
sciences
With appropriate attitudes, ethical
understanding and understanding of legal
responsibilities.
With appropriate decision making skills
and clinical reasoning and judgment

23. assessment units
The doctor as a professional 11-12
Appreciation of the role of the doctor
within the health service
Attitude for personal development

24. assessment units
Multiple Choice Questions
They are designed to test knowledge
Outcomes assessed- knowledge of basic
skills and clinical sciences
8patient investigation
3 Patient management
4 health promotion
Clinical reasoning ands judgment

25. assessment units
Multiple Choice Questions
They are designed to test knowledge
Outcomes assessed- knowledge of basic skills
and clinical sciences
8patient investigation
3 Patient management
4 health promotion
Clinical reasoning ands judgment

26. assessment units
What do multiple choices
questions measure
 Knowledge of specific facts
 Knowledge of terminology
 Knowledge of principles
 Knowledge of procedures
 The understanding and application of
facts and principles
 The understanding of procedures
Reasoning to some extent

27. assessment units
How to construct MCQs
 State the question positively
 Construct options that are grammatically
consistent with the item.
 Do not use MCQs when other instruments
are more appropriate.


28. assessment units
Multiple choice questions-
principles(rules)
 The question itself or the stem must be
appropriate
 Have one correct response to the question
 Distracters or the incorrect responses
among the choices should be plausible

29. assessment units
Extended Matched Items
Management of diabetes in the community?
1.1. start on oral hypoglycemic
2. do diabetic annual review
3. three monthly blood tests and review
4. monthly blood tests and review
5. Refer to podiatrist
6. refer to hospital diabetes specialist nurse
7. Trial diet control for 3 months
8. 2start on twice daily insulin injection
9. Do fasting blood sugars
10. Do haemoglobin A/c blood test

30. assessment units
Extended matching
Select the most appropriate course of action for the
following patients
1. Woman, mid 20s ,14 weeks pregnant to have
glycosuria on routine resting in GP ante natal clinic
2. Woman,mid 50s ,BMI 30, just found to have fasting
blood sugar 15mmol/l,HBA a18.5%
3. South Asian woman, mid 30s complaining of fatique,
thirst and dry mouth

31. assessment units
Extended Matched Items (EMIs)
Purpose – test knowledge and reasoning skills
Outcomes assessed- all outcomes with an
emphasis on knowledge and clinical
science
8patient investigation
3 Patient management
4 health promotion
5Clinical reasoning ands judgment

32. assessment units
MCQ
Multiple Choice Questions are used to tests
students’ factual knowledge and to some
extent the critical thinking of students. An
attempt is made to test higher levels of
Bloom’s taxonomy and not mere recall of
facts.
I
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33. assessment units
 1. A cervical smear taken from a
thirty five year old lady was found to
have the following:
 Mitotic cells
 Multinucleated cells
 Loss of chromatin granules
 Cells that have lost adhesiveness

34. assessment units
Mcq
Which of the following will be the best
classification of this smear?
a) CIN I
b) CIN III
c) CIN IV
d) CIN V
e) CIN II

35. assessment units
Which of the following will be the best
classification of this smear?
a) CIN I
b) CIN III
c) CIN IV
d) CIN V
e) CIN II

36. assessment units
2. Tissue Processing in Histology is the most
critical stage in entire processes that go on
in a Histology lab. Which of the following
will determine the processing procedure?
Urgent diagnosis
 The element to be demonstrated
 The materials available
The skills involved
The size of tissue for examination

37. assessment units
MEQ
Modified Essay Questions will be used to
assess the students’ ability to integrate facts
and problem solving skills, which are
fundamental to good practice. Question
requiring consolidation of facts and critical
thinking will be asked.

38. assessment units
1. A tissue section was found to be
having a brown colour that was
intracellular upon staining with H/E
staining technique. The pigment was
found to be soluble in alcoholic picric
acid.

39. assessment units
Possible scenarios
i. What is the possible name of this
pigment?
ii. What features enabled you to identify the
pigment?
iii. What class would this pigment fall into?
Assuming the pigment was not soluble in
alcoholic acid picric acid, how would this
affect your identification

40. assessment units
Formatively as learning tool to stimulate
discussion and top plan future development
Can be used to stimulate and provide
feedback – may be every three months what
is going , intriguing / exciting ,worrying
phenomenon.

41. assessment units
What can MEQ measure ?
MEQ can be used as a formal assessment
technique
 It can be used as an aid to learning.
 It can be used as an adjunct to a lecture.
 It presents good questions for group
discussion.
 It can be used as a self-instruction method.
It can be used as a self-audit device.

42. assessment units
Construction of MEQ
 Drawing up a draft of the subject area.
 Circulating the draft to a team of fellow
professionals to study it.
 Each of the professional colleagues should be
asked to provide the answer to each of the
questions.
 These responses should be studied and forms
the basis for model answers.
The marks should be allocated according to
consensus decisions

43. assessment units
PATIENT MANAGEMENT PROBLEM (PMP)
Patient management problem (PMP) consists of
short questions that require also short answers that
revolve around managing a patient. They are
intended to equip the student with knowledge,
skills and attitude that are necessary in
professional practice.
The main feature is that a series of questions are
asked about a case and options are provided that
leads to proper management of the patient. It tests
students on a wide range of subjects.

44. assessment units
What PMP can assess
Like the MEQ, PMP provides the opportunity for
students to demonstrate their ability in patient
management skills and problem solving skills in a
variety of scenario.
The students are presented with simulated
patients, real patient or imaginary patient in a
paper and pencil format. The unfolding scenario
is presented logically and the student is evaluated
on the basis of the proper steps taken leading to
the proper management of the patient.

45. assessment units
Constructing a PMP
Constructing a PMP begins with a
description of the symptoms of the patient
and the resources that are available. The
student is presented with the problem
followed by a series of questions relating to
management, diagnosis and investigations.
Each question has a number of options from
which the student must select. Beside each
option are hidden instructions about how
the student should proceed.

46. assessment units
Steps in constructing PMP
 Clearly define what it is you wish to test in the
problem. Set realistic objectives for the group you
are testing.
 Select a problem that is meaningful and suitable.
 Ensure that the sequence of management is
logical.
 Prepare the opening scene. This should compose
of: the actual setting for the case, the presenting
features of the patient, and the role of the user, the
resources available and clear instructions.

47. assessment units
Steps continue
 Prepare a list of clinical choices which
are consistent with the problem.
 Pretest the PMP using a group of subject
experts. Also try it out with one or two
potential candidates.
 Score the PMP. Allocate a mark for each
individual choice on the PMP.