1. Assessment of clinical skills
Joseph Cacciottolo Josanne Vassallo
UNIVERSITY OF MALTA
ANNUAL CONFERENCE - OSLO - MAY 2007

2. Assessing clinical skills
1. WHY do we need to assess ?
2. WHAT do we want to measure ?

3. WHY do we assess ?
• To ensure safety of patients
our responsibility to the public
• Achievement of a minimum standard
responsibility to the candidate and University
In principle…

4. WHY do we assess ?
• To ensure competence
• Often as a means of academic competition
In practice: the scope

5. WHY do we assess ?
• Formative: to give feedback and advice
• Summative: to grade
• Qualificative or licensing
In practice: the purpose

6. WHAT do we measure ?
To test not only presence of knowledge
…but also the application of knowledge
In principle…

7. Several types of clinical assessment
One model presented in some detail to
provide a framework for later discussion

8. One model of clinical assessment
• Certification of competence - pass / fail
a state (and legal) requirement
• Grading in rank order
for employment / placement purposes
• A competition for the award of a prize
In principle…a three-fold aim

9. One model of clinical assessment
Measurement of:
• adequacy of basic clinical skills
• ability to interpret clinical findings
• facility of communication in practical settings
• ability to think analytically about diagnosis
• ability to discuss management logically
In practice…

10. Practical steps for assessment
• 6 encounters with different clinical situations
• Two examiners at every encounter, each
examiner giving an individual assessment
• Highly structured examination and detailed
assessment of skills
• Examiners from other Universities for
process evaluation and quality control

11. Practical steps for assessment
• Encounters with at least six real patients
• Ability to interpret and discuss clinical data
• Management of an emergency scenario
• Appraisal of communication skills and attitude

12. Set-points for testing
• Attitude to patient
• Actual examination skills
• Presentation of findings
• Clinical judgment
Clinical examination of patients

13. Set-points for testing
• Evaluation of data
• Significance of data
• Clinical reasoning
Interpretation of clinical data

14. Set-points for testing
• Ability to solve problems
• Ability to discuss logically
• Clinical judgment and prioritization
• General medical knowledge
Management of emergency situations

15. Set-points for testing
• Attitude to ‘patient’
• Ability to communicate well
• Clinical judgment
• General medical knowledge
Communication skills

16. Evaluation
• Subjective evaluation: looking in the mirror
• Objective evaluation of outcome

17. Evaluating ourselves
“Examinations are
formidable even to the
best prepared…
…for the greatest fool
may ask more than the
wisest man can answer”
Charles Caleb Colton
1780 - 1832

18. Evaluating outcome
• Pattern of results
• Consistency of results
• Patterns of marking
• Process shortcomings
• Basis for improvement
Analysis of data to assess effectiveness

19. What happens to candidates who fail ?
• Review of performance – a formative exercise
• Counselling at a personal level
• Specific attention and individual training
• Repeat assessment after a period of time

20. Points for discussion
• Competence versus performance
• Exam based versus continuous assessment
• Methodology related issues
• Organisational issues

21. Competence versus Performance
• In relation to methods used
• Use of core curriculum with additional
modules as required
• Eventual medical practice in different
environment
• Impact on mobility

22. Competence versus Performance
• In relation to methods used
• Use of core curriculum with additional
modules as required
• Eventual medical practice in different
environment
• Impact on mobility

23. Competence versus Performance
• In relation to methods used
• Use of core curriculum with additional
modules as required
• Eventual medical practice in different
environment
• Impact on mobility

24. Competence versus Performance
• In relation to methods used
• Use of core curriculum with additional
modules as required
• Eventual medical practice in different
environment
• Impact on mobility

25. Exam based vs continuous assessment
• Assessment of a modular curriculum
• Written exams: MCQs, SAQ, Essays
• Real-time exams
• Orals: clinical / table viva, OSCEs
• Clinical assessment on site: mini-CEX,
DOPS, multi-source feedback
• Log books, portofolios, CATs

26. Exam based vs continuous assessment
• Assessment of a modular curriculum
• Written exams: MCQs, SAQ, Essays
• Real-time exams
• Orals: clinical / table viva, OSCEs
• Clinical assessment on site: mini-CEX,
DOPS, multi-source feedback
• Log-books, portfolios, CATs

27. Methodology-related issues
• Reliability
• Validity
• Practicality
• Transparency

28. Organisational issues
• Resources available
• Student numbers
• Patient availability
• Invasive procedures
• Scheduling

29. Role of grading
• Is there need for grading ?
• Selection process for employment
• Selection for postgraduate training
• Quality of assessment method and
performance of candidates

30. Conclusions
There is wide diversity among European medical schools
regarding methods of assessment of clinical skills:
• some schools aim at pass/fail outcomes, others use systems that
lead to grading
• several quality assurance mechanisms are used to varying degrees
There is place for widespread application of agreed
standard methods to:
• assess clinical competences in core curricula
• assess additional competences essential to individual practice

31. UNIVERSITY OF MALTA MEDICAL SCHOOL
1676 - 2007
EU UNIVERSITY PARTNER
● joseph.cacciottolo@um.edu.mt ● josanne.vassallo@um.edu.mt

32. Thank you
ANNUAL CONFERENCE - OSLO - MAY 2007