Shifted Paradigms of Medical Education: From Structure to Competency-based Approach
Explore the evolution of medical education from structure-based to competency-based methods, emphasizing the importance of professional authenticity and practical training. Delve into Miller's Pyramid and Sir William Osler's contributions to modern medicine, reflecting on the essence of true fitness for the medical profession. Discover the significance of authenticity in evaluating medical competencies and the shift towards outcomes-based education in the field of medicine.
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Sir William Osler Sir William Osler Father Father of of modern medicine modern medicine created created the for specialty training specialty training of the first residency program first residency program of physicians physicians for the first to bring the first to bring medical students medical students out out of the of the lecture hall lecture hall for bedside clinical training bedside clinical training for Medicine Medicine is a is a science science of an art art of of un uncertainty certainty of probability. probability. and an
Very much more time must begiven to those practical portions of the examination which afford the only true test of fitness to enter the profession. The day of the theoretical test is over. SIR WILLIAM OSLER, 1885
Professional Authenticity Professional Authenticity Professional : paid occupation, especially one that involves prolonged training and a formal qualification Authenticity : based on facts; accurate or reliable By Existentialism, the authenticity is.. So, the Professional authenticity might be.. the degree to which professional is true to profession's own personality, spirit, or character, (Oxford Dictionary) the degree to which one is true to one's own personality, spirit, or character, despite external pressure despite external pressure (wikipedia) If we want to consider professional authenticity in evaluating the competencies of medical doctor, we must test at least the shows how domain.
Miller Miller s Pyramid in s Pyramid in Medicine Medicine Knows : recall of facts, principles, and theories Knows how : ability to solve problems and describe procedures Shows how : using human (standardized patient), mechanical, or computer simulation demonstration of skills simulation in controlled setting Does : observation of real practice unannounced SP
Shifted Paradigms Shifted Paradigms of Medical Education Medical Education of From structure- and process-based To Competency-based education and Measurement of outcomes What is competency and how appropriately teach and evaluate it ?
Competency Competency Webster Dictionary: having requisite or adequate ability or qualities In Medicine : having the ability, knowledge and/or skill necessary to fulfill a role of responsibilities with desirable outcomes under varied circumstances
Shifted Paradigms Structure- and process-based education : the training experience by exposure to specific contents for specified periods Competency-based education : (the desired outcome of training) (the outcome driving the educational process)
Why Why are we are we interested interested in in competency competency? ? Social/economic-political debate Relationship between world of work and world of education Condition : Competency based education should be possible and desirable because it will need to competent workers
Basic Basic principles principles of competency based education competency based education of Focus on outcomes Greater workplace relevancies Outcomes as observable competencies clearly specified achievable by appropriate training Assessments as judgment of competency : Pass-Fail principle, not Grading, or Scoring (competent, or not)
Attributes Attributes of of Competency Competency Knowledge Skills Attitude Values Adaptability . . Should be achieved by appropriate education (teaching + training) Should be evaluated by appropriate test
Evaluation Evaluation of of Competency Competency What (contents), how (format, mode) and usefulness 3 most commonly used methods : 1. Subjective assessment by evaluator 2. MCQ to evaluate factual knowledge 3. Performance test (OSCE, CPX): Assessment for skill, attitude, adaptability etc
OSCE vs. CPX OSCE : Objective Structured Clinical Examination CPX : Clinical Performance Examination
OSCE Original Meaning CPX OSCE : OSCE : : : checklist checklist . . , , Rating Scale Rating Scale . .
Example Example of of Case Case- -specific specific Checklists Checklists . . . . 4 4 . . . .
Example Example of of Rating Scales Rating Scales , . . . . . . ( , ). : 6 : 6 (avoiding central tendency) : (avoiding central tendency) : , , , , , : :
Example Example of of Global Global Rating Scales Rating Scales . ( .) . ( .) . ( .) . ( .)
Checklist vs. Rating Scale Checklist vs. Rating Scale Checklists Checklists Rating Scales Rating Scales Measures process Judges process Measures outcome Judges outcome Checking specific tasks Evaluating complex tasks More reliable, less valid Less reliable, more valid
OSCE/ CPX OSCE ( OSCE ( ) ) CPX ( CPX ( ) ) Station Station 5 5 10 10 ( ( )+ 5 )+ 5 ( ( ) ) skill skill skill skill ( ( , , , , , , ) ) Checklist Checklist ( ( , , ) ) ( ( , , , , ) )
Conclusion Conclusion If you want to sure that each trainee is competent for hepatobiliary surgeon, you must test at least the shows how domain (Performance test). MCQ is not sufficient. 23
What is SP ? What is SP ? a person carefully recruited and trained to take on the characteristics of a real patient thereby affording the student an opportunity to learn skills and to be evaluated on learned skills in a simulated clinical environment.
