Assessment of clinical & practical skills

1. Assessment of Clinical &
Practical skills
Dr Vijayata Sangwan
MEU Member

2. Learning Objectives:
• Assess skills effectively
• Assess skills at the workplace
• Use a skill lab to assess competency in skills
• Design a skill assessment station.

4. Classification of skills
• Intellectual/cognitive skill
• Psychomotor skill
• Communication skill
• Team skill

5. Principles of skill acquisition & application
• Predefined outcome according to phase & level of training
• Standard approved steps needs to be clearly outlined.
• Feedback for self improvement
• Skill lab to practice repeatedly, in structured format, in a safe & non
threatening environment

7. •OSCE
• O Objective
• S
Structured
• C Clinical
• E
Examinatio
n
•OSPE
• O Objective
• S
Structured
• P Practical
• E
Examinatio
n

9. History Examination Procedure
CVS Chest pain Cardiovascular
system
ECG interpretation; BP
Chest Fast breathing
cough
Respiratory
System
Chest
physiotherapy/peak
flow
Abdomen Abdominal
distension
Abdomen
examination
Ascitic tap
CNS Headache Nervous system Fundoscopy
Cardiac rest CPR

10. OSCE
STATI-
-ON

11. Checklist

12. OSCE Station No. _____ Max Marks 10 _____ Student Roll No.______
The Task: Demonstrate proper technique of hand washing and dressing prior to entering the operation
theater.
The Checklist
Items Max. marks Adequate Inadequate
Bares hands up to elbows and removes
watch/jewellery
½
Use soap/solution and makes lather/foam ½
Cleans/scrubs
Palms and fingers ½
Interdigital clefts ½
Back of hands and knuckles 1
Thumb 1
Finger tips 1
Forearm upto elbow ½
Scrubs vigorously for 2 minutes 1
Rinse properly (hand to wrist) ½
Dries hands 1
Wears gown and mask correctly 1
Performs fluently 1
Grand total 10

14. Patient selection

15. Trainees
counselling

16. Examiners
role

17. Logistics & manpower

18. Factors affect OSCE outcome
Factors Limitations
Number of stations Requires min 14-18 stations
Time for assessment 10 min station is more reliable compared to 5min
Unreliably standardized patients Limits reliability
Individualised way of scoring Limits reliability
Assessing only one component at a time Limits face validity
Item analysis Increases reliability
Skill of person preparing checklist May hamper objectivity
Identification & deletion of problem stations Increases reliability
Blueprinting Increases content validity
Competencies assessed Not for cognitive domain
Expensive & labour intensive Limits practicality & feasibility

19. Workplace based assessment
• Represents Does level of Millers Pyramid
• High Face Validity
• Content & context specific
• Learner centered
• Feedback

20. Methods of WPBA
• Mini CEX( Mini Clinical Evaluation exercise)
• DOPS( Direct observation of procedural skills)
• Case based discussions
• Evaluation of clinical events
• Multisource feedback
• Mini Pear Assessment tool
• Clinical work sampling
• Clinical encounter cards
• Blinded patient encounters

21. Mini Clinical Evaluation Exercise
• Developed by the American Board of Internal Medicine.
• 15-minute snapshot of doctor-patient interaction.
• Assessor work
• Trainee work
• Estimated time= 20 minutes (15+5)
• No 6-8

23. Competencies assessed by Mini-CEX
• History taking
• Physical Examination
• Communication skills
• Clinical Judgement
• Professionalism
• Organization efficacy

24. Direct Observation of Procedural Skills
• Definition
• Assessor
• Trainee
• Structured checklist/global rating
• Feedback
• No. of DOPS

26. Case based discussion

29. Group A Activity
Design a workplace based assessment station for 3rd phase
part I 20 students in OPD/ward and demonstrate by role play
OP9.1 Demonstrate the correct technique to examine extra
ocular movements (Uniocular & Binocular)
Plan assessment:
What to assess: Knowledge, Communication skill, psychomotor
skill and attitude (respond to the patient’s concerns, inform the
patient about findings advise about treatment & required
investigations conclude).
Method of assessment:
Logistic Preparation:
Sr.no. Requirements
1. Venue:
2. Staff requirement
3. Furniture & other accessories
4. Stationary
5. Checklist

30. Group B: Design OSCE assessment station for first phase student.
PY 5.12: Record blood pressure at rest in different postures in a volunteer/
simulated environment.
Learning Objectives: The student should be able to record blood pressure of
volunteer by palpatory & auscultatory method with sphygmomanometer in
right/left upper limb, stepwise in sitting/lying down/standing position at rest.
Plan assessment:
What to assess: Knowledge, communication skill, psychomotor skill and
attitude (respond to the patient’s concerns, inform the patient about findings
& conclude)
Logistics specific:
Sr. No Points to be taken
care
Requirements
1 Venue for OSCE
2 Furniture
3 Timing
Device/Stationary
4 Manpower(Faculty/
Residents & other
workers)
5 No.& type of station
(procedure, question
& rest )
6 Timing & mobility of
students

31. Group D activity
Use a skill lab to assess competency in skill of paediatric IV
cannulation for 20 students of 3rd yr part II student. Demonstrate
by role play.
Learning Objectives: the student should be able to demonstrate the steps of
inserting an IV canula in a model.
What to assess: knowledge on indications, contraindications, complications &
IV fluids to be given, required equipments, pre procedure counselling,
procedure & post procedure advise.
Method of assessment:
Grading of assessment:
Logistic Preparation:
Sr.no. Requirements
1. Venue:
2. Staff requirement
3. Furniture & other accessories
4. Stationary
5. Checklist

32. Group E activity
Design an assessment station for 20 first phase student of competency by
OSCE.
Competency: Counsel & administer informed consent prior to lumbar
puncture to a patient and family in a simulated environment.
Learning Objectives: The student should be able to demonstrate good
communication skills & empathy, counsel a patient regarding the purpose,
steps and complications related to lumbar puncture, obtain informed consent
& document it as per legal requirements.
Plan assessment:
What to assess: Knowledge, communication skill, and attitude, documentation
(respond to the patient’s concerns, inform the patient about findings &
conclude)
Logistics specific:
Sr. No Points to be taken
care
Requirements
1 Venue for OSCE
2 Furniture
3 Timing
Device/Stationary
4 Manpower(Faculty/
Residents & other
workers)
5 No.& type of station
(procedure, question
& rest )

33. Group C Activity
Design a workplace based assessment station( Mini CEX) for 3rd phase part I
student to take clinical history and local examination in a patient with pain in
abdomen and demonstrate by role play
Plan assessment:
What to assess: Knowledge, Analytical capability, Communication skill,
psychomotor skill and attitude (respond to the patient’s concerns, inform the
patient about findings advise about treatment & required investigations
conclude).
Method of assessment:
Logistic Preparation:
Sr.no. Requirements
1. Venue
2. Staff requirement
3. Furniture & other accessories
4. Stationary
5. Checklist