Example of video-assisted assessment of the consultation process
University of Copenhagen, Denmark
The example illustrates the use of video recorded consultations with patients for the assessment of clinical competency as part of the Clinical Course in Family Medicine at the University of Copenhagen, Denmark.
Learning outcomes of clinical course
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Use previously learned knowledge in the meeting with the unvisited patient, as well as know and be able to use the patient-centered consultation process.
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Involve the patient in the decision-making process and act based on the patient's entire life situation and prerequisites.
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Diagnose and treat commonly occurring conditions in general practice.
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Use the "consultation process" as a communicative tool for diagnostics and treatment.
Physician roles addressed: medical expert, health advocate, professional, communicator and collaborator.
Teaching and learning strategies
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Workplace training with a general practitioner, lectures, and student-centered group teaching.
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During the stay with the general practitioner, the student must record videos of some of their consultations after obtaining permission from the patient. In group teaching, students analyze at least one of their own videos in relation to the consultation process and the professional context.
Assessment
1. Course certificate: obtained on the basis of an approved stay with the general practitioner and approved participation in group teaching.
Compulsory elements: Recording of a video showing a consultation with a patient in general practitioner’s office, with the student in the role of the doctor. The video is the starting point for the subsequent oral exam in general medicine.
Co-examiner: internal
Grading: pass/fail
Assessment criteria: in order to obtain approval of the logbook and thereby obtain a course certificate, the student must be able to
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receive the patient, analyze, assess, and propose treatment of acute conditions,
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receive the patient, analyze, assess, and propose follow-up procedures for patients with chronic diseases in general practice,
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analyze and assess the need for contact with other clinical and paraclinical specialties, with the secondary sector and with social authorities,
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analyze and discuss the usefulness of the "consultation process" as a communication tool in the meeting with the patient in a patient-centered consultation,
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apply the patient-centered model in the doctor-patient conversation,
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apply the consultation process and the response model in the doctor-patient conversation
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analyze the consultation based on the above principles,
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diagnose the patient based on general medical diagnostic strategies,
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apply diagnostic tests and paraclinical examinations and make medication prescriptions based on rational principles,
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analyze and evaluate available preventive health measures in relation to the individual patient,
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perform the gate-keeper function, i.e., analyze and assess the patient's need for treatment in the primary sector or in the secondary sector,
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write problem-oriented notes according to the PSOAP model, i.e., in relation to problems, subjective symptoms, objective findings, analysis and plan; notes must be ICPC coded,
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in the group teaching, analyze at least one of your own videos in relation to the consultation process and the professional content, and in this context be able to use the patient-centered consultation in general practice and view the patient in a holistic perspective.
2. Oral examination: the examination lasts approximately 50 minutes, including grading. The examination consists of three parts. The first part is based on a consultation video lasting 10-20 minutes. The video, which shows the student's independent completion of a consultation, was recorded by the student in connection with their stay with the supervising general practitioner during the clinical course in Family Medicine. The examinee chooses which consultation video is to be used for the exam, but the video must not have been seen in teaching at the university. First, the examiner, co-examiner, and examinee watch the consultation video, and then it is reviewed and analyzed by the examinee. The logbook that is linked to the recorded consultation is included in this part of the examination. The first part weighs approximately 50%. The second part of the examination is based on a clinical question, which is assigned to the examinee by lottery. The second part weighs approximately 25%. The third part of the examination is based on a theory question, which is assigned to the examinee by lottery. The third part weighs approximately 25%.
Co-examiner: external
Grading: 7 step scale
Assessment criteria: The student must be able to
Knowledge
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explain clinical practice in the primary sector based on the theoretical syllabus
Skills
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ask about relevant symptoms based on the hypotheses about diseases that the student forms during history taking, as well as include knowledge of the epidemiology of the diseases in general practice,
- assess the patient's symptoms, propose a tentative diagnosis, suggest any paraclinical examinations, suggest relevant treatment and follow-up and agree on a relevant safety net.
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analyze your consultation in terms of both communication and clinical content and discuss any shortcomings, of which there must be only a few or insignificant ones,
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use the consultation process when meeting new patients (patient-centered practice).
Example of assessing the Medical Expert role in virtual and simulated settings
Faculty of Medicine, Vilnius University
Assessment strategy of Internship (final examination of practical skills, year 6, semester 12) at the Faculty of Medicine, Vilnius University:
The aim of the internship at the Faculty of Medicine of Vilnius University is to develop knowledge, skills, abilities, and attitudes required for independent medical practice according to the Lithuanian Medical Standard ‘Medical Doctor’.
Teaching and Learning Activities:
working under the supervision in healthcare institutions, training at the simulation lab
Summative Assessment: Examination in a computer room (50 %), Examination in simulation rooms (50 %). The details of the assessment are described in Appendix 3
The examination takes place in the online and offline (onsite) mode.
First step: Examination in a computer room (online examination) – weight of assessment is 50%. Assessment takes place within a week after the end of the Internship at the end of May. The examination is held in the computer room of the Information Technology Services Centre of Vilnius University. A student is given four clinical cases: in obstetrics and gynaecology, surgery and traumatology, children’s diseases, and internal diseases during the examination.
At the beginning of each clinical case the student sees an initial part of a clinical case on a computer screen. The student asks to specify anamnesis on the computer (Part 1). Then (s)he gets the continuation of the clinical case. The student writes down how (s)he would further clinically examine the patient (Part 2). The continuation of the clinical examination is presented. The student orders laboratory tests that are the most needed for the diagnosis (Part 3). The results of essential laboratory tests are presented. The student asks for the results of instrumental tests that (s)he requires (Part 4). The results of instrumental tests are presented. The student determines the clinical diagnosis and the planned place of treatment (outpatient or inpatient) (Part 5). Clinical diagnosis and treatment location is provided. The student assigns appointments if the patient is treated in a hospital or gives a prescription(s) if the patient receives ambulatory treatment (Part 6). The treatment is provided. The information displayed on the computer screen does not necessarily coincide with the student's preferred information. The amount of information requested or provided by the student is limited. The time required to ask for information, determine the diagnosis and prescribe the treatment is limited.
The duration of the examination is 2.5 hours. Time given for the solution of one clinical case is 37 min. Space given for the answer is limited. All students finish the exam at the same time.
In summary: each clinical case consists of six sections (Parts).
A student:
in Part 1, refines a medical history;
in Part 2 describes the clinical examination of the patient;
in Part 3, administers the laboratory tests needed to make a diagnosis;
in Part 4, asks for instrumental test results;
in Part 5, makes a clinical diagnosis;
in Part 6, prescribes treatment.
Next step: Examination in simulation rooms – weight of assessment is 50%. Examination takes place after examination in a computer room. The examination is held in simulation rooms. During the examination, a student solves clinical assignments and performs practical exercises in the clinical cases of obstetrics and gynaecology, surgery and traumatology, children’s diseases, internal diseases, and emergency medicine.
Final grade is calculated as the mean average of the examinations held in computer and simulation rooms.
Example of a summative final MD assessment with a Time Constrained Scenario-based Practical Examination (TSPE)
University of Malta Medical School
At the University of Malta Medical School, the degree programme combines both theoretical and practical activities (e.g didactic teaching, small group discussions, observation in real life settings, participation in simulated situations, supervised consultations, consultations with real life patients in a real life hospital setting.
Structure of a summative final MD assessment targetting knowledge, skills and competences - Time constrained scenario based practical examination (TSPE)
The TSPE consists of 5 stations
Station 1 patients with cardiovascular and/or respiratory conditions 2 cases
Station 2, patients with gastroenterological, nephrological, neurological and musculoskeletal conditions. 2 cases
Station 3 Data interpretation (ECGs, Imaging, laboratory analysis} in a given scenario : 3 scenarios
Station 4 Emergencies – Diagnosis and management = 1 scenario
Station 5 Communication – history taking, management plan – generally using actors on this station: 1 scenario
Skills and competences assessed:
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students are able to carry out an appropriate systematic history and examination when presented with a patient with a specific complaint
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students analyse the clinical findings and discuss differential diagnosis, propose critical investigations ( first line and subsequent) for the establishment of a diagnosis, analyse results (laboratory, ECG, imaging)
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discuss treatment options and follow up .
Specific example of TSPE and patient encounter in our summative final MD assessment
Station 1 – Duration 20 minutes. This station includes includes a real life patient consultation and oral examination with internal and external assessors.
The candidate is presented with a short scenario and asked to examine a particular system in this case 10 minutes cardiovascular 10 minutes respiratory. They are then assessed on examination technique, ability to detect abnormal findings, ability to form differential diagnosis and outline the essential points of a management plan. Attitude to the patient (caring, empathic, inclusive) is also observed and assessed.
Example of assessing the role of Medical Expert in a simulated setting with an Objective Structured Clinical Examination (OSCE)
Augsburg University, Germany
Example of a more complex OSCE station for senior students (9/10th semester) at Augsburg University, Germany. This OSCE station integrates various competencies and addresses Entrustable Professional Activities as:
The student
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conducts a targeted medical history and physical examination on a patient with a common medical condition or presenting complaints and typical manifestations.
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defines a problem based on the gathered information and findings, demonstrating differential diagnostic or therapeutic reasoning.
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summarizes the results with a structured problem identification.
further assessment objectives:
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Patient-centered empathetic communication and relationship building.
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Narrowing down the suspected diagnosis by probability.
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Targeted/symptom-oriented questioning and physical examination relevant to the current medical concern and inquiry into pertinent symptoms.
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Demonstrates a clear connection between the medical history questions, physical examination findings, and differential diagnostic considerations.
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Patient-friendly, comprehensible summarization of the gathered medical history with the opportunity for patient questions and additions.
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Summarizes the medical history to the supervising physician.
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Explains differential diagnostic considerations and provides well-grounded possible diagnoses and related questions.
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Demonstrates recognizable medical knowledge regarding the presented medical condition.
Design of the OSCE Station
Focus disease: Heart failure.
assessment time: 10 minutes
The station is designed in a hybrid format, with a standardized patient along a scripted role and pathological auscultation findings via simulation trainer.
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Student information: A 59-year-old female patient was brought to the emergency department by the patient's son due to increasing shortness of breath. Upon admission, the blood pressure was 134/84 mmHg, and the heart rate was rhythmical at 74/min. Acute laboratory tests have already been conducted.
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Conduct a symptom-oriented and focused medical history and physical examination.
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Verbally describe your examination findings and formulate the patient's main problem, taking into account the pathomechanisms.
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Verbally explain and justify, based on your findings, the probable differential diagnoses for this patient.
View and download the examiner's rating sheet:
