Post on 16-Jan-2016
transcript
ECOS
Michel LEVEQUE
Strasbourg
10 novembre 2011
ECOS (french) OSCE (english)
• Objective
• Structured
• Clinical
• Examination
Levels for evaluation
KNOWLEDGE
SKILLS
PERFORMANCE
For what?
• Explore the competencies or performance in :– diagnostic– interview– examination– assessment– medical reasoning– sharing médical decision– treatment plan – doctor patient relationship
WHO ?
Post graduate students
– Prerequisite for ECOS:• Training in clinical
• Have skills….
WHEN ?
• Formative evaluation– During the professionnal training
• Final evaluation– Performance for professionnal certification
• Strasbourg:– First expérience for training– Today only final evaluation (efficiency)
HOW ?
• Path between stations:– 19 stations ( U Laval)– 7 stations (Strasbourg)
• On each station– simulated patient– Physician observer– document specifying the task
HOW ?
• Path between stations:– 19 station ( U Laval)
• Clinical stations• Questionnaire station related with clinical station • Questionnaire station not related with clinical station • Rest station…
– 7 station (Strasbourg)• Only clinical stations
Clinical station
• Patient (simulated)• Task, problèms
• Observer rating
Questionnaire station
• Questionnaire• Open-ended
questions and short
Recommandation to the students
need clear , précise candidate instructions
•« Red them carefully before starting !!•before any question•if you are unclear as to what you are being ask to do clarify the task with the examinator… »
Contents of stations
Commons situations in primary care
Examples …
• The diabetic foot– Examination
• Announcement of a diabetes– Explanations
• Contraception (teenager)– Explanations and
prescription
• Infant immunization– plan
• Announcement of a AD– Explanations
• Visual disorder (elderly)– Diagnostic and plan
Examples …
• Skin redness (Lyme)– Diagnostic and plan
• Chronic complaint– Relationship
• Insomnia– assement and
prescription
• Sadness– Diagnostic,
assement,suicidal risk
• Fatigue– Diagnostic and plan
Method
Team (professors, lecturers) only GP : n=15-Step 1 : choice of situations-Step 2: writing the clinical case-Step 3: selection criteria-Step 4: scientific validation-Step 5: writing evaluation grid-Step 6: test stations with GP-Step 7: plan the examination-Step 8: examination
Example (instruction for the student)
• Ms. Richard, 45, teacher, comes to you at the request of others to a "loss of form": it sleeps badly, crying often, feeling irritable and does not know what is happening.She is married with two children (16 and 20 years).
• Your task is to conduct the examination to clarify the diagnosis and propose a course of action.
Example (instructions for the actor)
• You are Ms. Richard, 45, teacher. You tell the doctor that you have at the request of your family, because you have a loss of form. Your husband has supported and is in the waiting room.
In response to questions from the doctor:• • You can not stand your students
• You are no longer the household (too tired)• Grocery shopping is a charge• unrest begins one to two months• No more appetite (loss of six pounds in 6 weeks)…
Example (evaluation grid)a
NOM et PRENOM :Grille de correction :
Note/20•Antécédents personnel
– dépression 1– tentative de suicide 0,5– épisode maniaque 0,5– consommation alcoolisée 0,5– prise de médicaments 0,5
Example (evaluation grid)b
• Symptomatologie dépressive– humeur triste 2– inhibition psycho-motrice 2– dévalorisation 2– troubles de l’appétit 0,5– troubles du sommeil 0,5
• Soutien de l’entourage 1• Idées suicidaires 2
Example (evaluation grid)
• Prise en charge– énoncé du diagnostic 1– traitement médicamenteux ou psychothérapie 1– suivi rapproché dans les 8 jours 1– arrêt maladie 1
• Empathie écoute, reformulation 0 – 1 – 2 – 3• TOTAL :
The path
Station 1
Station 1
Station 7
Station 7
Station 6
Station 6
Station 5
Station 5
Station 2
Station 2
Station 4
Station 4
Station 3
Station 3
ECOS
timing
• Each station: 7 minutes
• Clock: 1 minute for change
• Clock : start the station
To learn more about OSCE
• http://w3.fmed.ulaval.ca/cessul/index.php?id=792
• http://w3.fmed.ulaval.ca/cessul/fileadmin/template/main/cessul/documents/document/PPTECOSFaculte.mov
Centre d’Evaluation des Sciences de la Santé Université de Laval
Step 4 scientific validation
Kamtchatka, Ru