The statement “assessment drives learning” emphasizes the critical place of assessment in a learner’s education. Attributed to the educator George Miller, this statement is of particular importance in medical education nowadays given the focus on clinical competency assessment. Miller proposed in 1990 a schematic hierarchical representation (pyramid) of clinical competence: factual knowledge (knows), concept building and understanding (knows how), competence to perform (shows how) and ability to carry out a task competently in real life situations (does). The context-specific nature of medical education requires educators to rely on multiple assessment methods in multiple levels in this competence pyramid to reliably gauge a medical learner’s skills. As one moves up the levels, performance approaches professional authenticity or expertise.
A fine example of an outcome focused (summative) assessment product in the POGOe Library is the OSCE Geriatric Patient with Fall and Cognitive Impairment: Margaret Donovan from Dr. Lisa Strano-Paul at SUNY Stony Brook School of Medicine.
Designed as a 20-minute station in a multi-station OSCE, it assesses clinical students’ or residents’ performance of functional and cognitive assessments. The standardized patient (SP) case scenario is of an older adult person in whom the spouse notices progressive memory loss. Set in an outpatient clinic, the station requires the learner to evaluate the patient's and the spouse’s chief concerns; assess the patient's functional status through history including ADLs, IADLs and social support; perform the Get Up and Go Test, a Mini Mental status exam, and clock drawing and make recommendations to improve the patient’s functional status.
The product consists of SP instructions and facilitator guide, a presenting case scenario, a multi-domain skills checklist including communication and interpersonal skills and a critical action sheet. Highlights include the straightforward case scenario, minimal SP requirement, and detailed instructions that provide examples of what to look for when observing the learner’s performance. However the presence of multiple items in a single checklist may make it difficult for the observer to provide an accurate assessment of the learner’s performance. It also would be helpful to have specific descriptions of poor or borderline performance to anchor observations and increase inter-rater reliability.
The use of OSCEs to make judgments about the attainment of competence requires that sufficient evidence is collected. Studies have shown that OSCEs with more stations of shorter duration have better reliability and validity of performance assessment than those with fewer and longer stations. This is a 20-minute encounter followed by a 10-minute rest; if the other stations follow a similar pattern, a 2-hour OSCE would just consist of 4-6 stations at most. Shorter stations with fewer more specific skills performance may improve the overall multi-station OSCE performance.
This OSCE provides an easy to use assessment of a student’s ability to evaluate and begin management for geriatric Patients with falls and cognitive impairment. Try this month’s POGOe Editor’s Choice now, and browse through the POGOe Library which currently contains 58 other learner assessments that address multiple levels in Miller’s clinical competence pyramid.