Assessment of ‘borderline’ clinical competence using generalisability and decision studies in dental skills training

A few words about this paper…

A historically significant paper I have to say, and although not yet cited it formed the basis of what I eventually pursued for the last 10 years in the spin-off company, Qpercom.  According to the Irish Times, we are “dragging exam assessment out of the dark ages (Oct. 2016). This suppressed paper actually forms the basis of what Qpercom has worked to achieve since 2008 with client partners worldwide. From being a PT clinician by training, I moved into medical education. As clinical researchers, we put a lot of effort into developing the Smallest Detectable Difference (SDD), to be detected using a ‘ruler’. Measuring maximal mouth opening with a metal ruler is one of the outcome variables in patients with maxillofacial pain. With the newly acquired evidence that you had to measure at least 12 mm difference in mouth opening before and after an intervention to be successful in patients with temporomandibular joint disc displacement, I changed jobs and moved into medical/dental education. I was immediately challenged to look into comparable measurements used in oral hygiene training. Probing depth measurements were used as an example to demonstrate the use of generalisability and decision studies in educational decision-making. Fourteen years after this publication, we are comparing 10 different European Universities on their quality assurance outcome of OSCEs. Have a read, use the evidence, and I hope this will help students and staff measuring any kind of assessment outcome, plus this historically significant paper needs citations! read more

Assessment of professional behaviour – A comparison of self-assessment by first year dental students and assessment by staff

Authors

S Zijlstra-Shaw, Thomas JB Kropmans and J Tams 

Abstract

Objective

A study was set up to assess usefulness and acceptability of a method of assessing professional behaviour of undergraduate dental students.

Setting

The first year preclinical course at the Department of Dentistry and Oral Hygiene, University of Groningen, the Netherlands.

Materials and Method

A form was developed with an ordinal scale to assess undergraduate professional behaviour. A standard means of carrying out assessment was then undertaken and subsequently used to give feedback to the students at the end of each of three terms. The students’ self-assessment was then compared to that of the staff. read more

Situational awareness within objective structured clinical examination stations in undergraduate medical training – A literature search

A few words about this paper…

A great new PhD track was launched with Markus Fischer’s idea to look into situation awareness (SA). The latter term is known from the aviation industry and requires pilots to be aware of all critical situations that may occur while flying a plane. More and more evidence is emerging to suggest SA is also applicable to medicine (particularly emergency medicine and surgery). However, the question arose whether we can find any similarities in OSCE stations that might not be designed to detect SA, but which contain item descriptors that could be linked to three different types of SA. Markus Fischer’s first paper provides insight in the literature on situational awareness and OSCEs. A pretty advanced subject that just recently received it’s first citation. I am sure there are more to come once Dr Fischer’s other papers are published.  read more

Measuring situation awareness in medical education objective structured clinical examination guides

A few words about this paper…

This paper was written by two undergraduate medical students. This is another good example of student participation in undergraduate medical education research. John and Margaret performed a pilot according to Markus’s initial observation that aspects of Situation Awareness could be measured in OSCEs. Both students used the station OSCE score-sheets of three freely available OSCE training guides, and addressed what was already proclaimed by Markus: that all three aspects of SA can be identified in an OSCE score-sheet, although not developed as such. As John and Margaret correctly addressed, it was ‘easy to do’, but reliability and validity was still an issue as this type of research was never done before. It was the step-up for Markus after his literature research to design and conduct his PhD track developing a consecutive training on how to assess SA using OSCE score-sheets. Unfortunately, this breaking news appears hard to publish and maybe we are a bit ahead of the music. This paper however, provides good insight into how important SA is in training and assessing students at an early stage of their curriculum.   read more

True communication skills assessment in interdepartmental OSCE stations: Standard setting using the MAAS-Global and EduG

A few words about this paper…

In medical education it is extremely helpful to compare outcomes. To be able to compare communication skills outcomes between students, years of study or between institutions is very challenging. If the measurement of particular learning outcomes is not standardised, just as using a standardised measurement tape to measure length, you cannot trust the outcome. In this study we attempted to compare communication skills outcomes between groups of students.

Since communication skills assessment forms are not standardised at our School of Medicine within the College of Medicine, Nursing and Health Sciences of the National University of Ireland in Galway, we developed the MAAS-Global proportion (MG-P) as a result of one of our previous studies. If we know how large the MG-P of an assessment form is we might be able to compare different students, groups of students or years of the curriculum. We therefore introduced the MAAS-Global score followed by MAAS-Global proportion and section percentage. read more

The fairness, predictive validity and acceptability of multiple mini interview in an internationally diverse student population- a mixed methods study

A few words about this paper…

For the Irish and moreover in an international context, an important paper written by my colleague in the School of Medicine/National University of Ireland, Galway, Dr Maureen Kelly. Once multiple-mini-interviews were made available in an electronic fashion, data retrieval, storage and analysis appeared more accessible than collecting all data from paper score-sheets. International medical students, those attending medical school outside of their country of citizenship, account for a growing proportion of medical undergraduates worldwide. This study aimed to establish the fairness, predictive validity and acceptability of Multiple Mini Interview (MMI) in an internationally diverse student population. MMI appears to be a welcome addition to assessment armamentarium for selection, particularly with regard to stakeholder acceptability. Understanding the mediating and moderating influences for differences in performance of international candidates is essential to ensure that MMI complies with the metrics of good assessment practice, and principles of both distributive and procedural justice for all applicants, irrespective of nationality and cultural background.  read more

Calibration of Communication Skills Items in OSCE Checklists according to the MAAS-Global

A few words about this paper…

After the discovery that about 17 different styles of communications skills are used in the field of communication skills training in medical education, it was apparent we needed to validate the communication skills items included in OSCE checklists. Within our own School of Medicine, in the College of Medicine, Nursing and Health Sciences of the National University of Ireland in Galway, about 280 OSCE stations assessment forms throughout 4 years, and from 4 different medical specialties contained a variety of communication skills items. None of these were ever validated using existing reliable and valid Communication Skills Questionnaires. read more

Reliability and validity of OSCE checklists used to assess the communication skills of undergraduate medical students: A systematic review

A few words about this paper…

In 2011, Winny from Indonesia approached me to ask whether he could join us for a PhD track. It would be an opportunity to investigate the wide range of communications stations used within our School of Medicine. Data was collected using our OSCE Management Information System. A systematic review was commenced to find out where the flaws in practice were, and it was successful. If a clinical skills trainer addresses that he/she is responsible for a communication skills station I ask, which of the 18 domains of communications skills are you going to assess? Silence usually follows and low Cronbach’s alpha (internal consistency of the assessment form) at a later stage is very likely. Winny’s paper (to date, November 2018) is referenced 17 times by other researchers. read more

Back to the Future 1: Electronic Marking of Objective Structured Clinical Examinations and Admission Interviews Using an Online Management Information System in Schools of Health Sciences

A few words on this paper…

‘Back to the Future’ refers to the 1985 American science fiction film directed by Robert Zemeckis, featuring Micheal J. Fox as teenager Marty McFly. Marty, a 17-year-old high school student, is accidentally sent thirty years into the past in a time-traveling DeLorean invented by his close friend, the maverick scientist, Doc Brown.

We looked back 44 years, to when Professor R.M. Harden invented the paper-based OSCE in 1974. The future would have to be about the actual results. Facing 30% errors in our paper assessment results, we had a problem to solve. With incomplete forms and failures in adding up the results, we decided to automate the OSCE procedure. Planning, form submission and data analysis is all done electronically and this paper provides insights in the automated features. read more

An Online Management Information System for Objective Structured Clinical Examinations

A few words about this paper…

During 2006 – 2008, David Cunningham, as an intern, and myself as a lecturer, were engaged with teaching & learning in the National University of Ireland, Galway, in the School of Medicine (Medical Informatics & Medical Education in those days). Our OSCE procedures involving the planning and execution of the examination was typically laborious, as it is for this exam. Planning was one thing, but what about results? We encountered issues with forms and results. On top of this, the study recorded one typical OSCE exam with 30% errors and a high cost of automation. With Cussimano’s €4.70 staff cost per student, per station and our estimate of €2.80 administration costs per submitted paper form, total cost of an OSCE could be estimated to be €7.50 per student, per station.  read more

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