Friday, May 3, 2013
Assessing Clinical Performance
Clinical Performance, really any performance, can be assessed using a number of methods. The choice of methods really depends on the level of the learner and your expectations. In most cases, we expect the naïve learner to "know about", while the advanced learner should be "able to do" in practice. Being clear about expectations can be your "best friend" when setting up a system for clinical assessment. BLOG AWAY... I look forward to reading your reflections on the session.
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I know we have not yet had our Master's course on assessment but I thought this session provided a nice practical overview on the subject of clinical assessment. I liked the instructional blueprinting grid as a practical way to think about an instructional activity in order to ensure that some thought is given to aligning the assessment method or tool with purpose. The concept that assessment drives learning resonated with me. I think in many formal education settings, students learn what they think they have to know or titer their learning in order to perform well on the assessment (just enough work to do so and no more). In many ways, traditional assessment strategies in the formal education setting (i.e. tests) set the parameters for what is likely to be learned and may diminish the potential learning that might otherwise transpire. I think the method(s) of assessment chosen can mitigate this to some extent. In the absence of such assessments, however, the learner has to be pretty self-motivated to learn, since the external inducement to master the material is not present. It takes a particularly self-directed learner to be able to accomplish this. Self-directed learning is a developed skill. I think assessments are potentially useful tools (if employed properly) to help one develop this skill
Epstein's table outlines commonly used assessment methods and can be helpful in choosing the appropriate assessment method when planning an educational activity (using instructional blueprinting).
I know that we need to identify the goals and objectives of any educational activity upfront, but what about assessment method?
When we identify to learners the assessment method that we plan on using, do we limit their learning?
As Rich said, many learners will tailor their learning towards the method of assessment. The other option would be to combine different assessment methods in hope of creating a synergistic effect.
I liked Epstein's table as a list of choices we can use to help design our assessment tool. We have to realize that assessment is a system not simply a single tool to derive all learning. I disagree with the premiss that assessment drives learning. If you look at the blueprinting method we discussed in class you will see that learning actually drives assessment. Meaning that we decide what we want to teach and test then pick the assessment mode that assess that goal. We also must remember that assessment is continuous, and requires multiple inputs to from summative judgements.
I found the NEJM article and the essentials course full of useful, practical information. Tables 1 and 2 from the article contained helpful summaries of assessment methods and principles. I agree with Rich and Maged that traditional education assessment does drive learning. Students are mostly concerned with passing tests with the best grade possible and hone their learning around that event. Curriculum that will help learners develop SDL and a more holistic approach to education is what I would like to utilize. Assessment in healthcare education is a necessity and using multiple methods of assessment, selecting the right assessment tools and frequent feedback are vital components. I do not think by identifying the assessment methods we are using to the learner limits the learner's potential for learning. Revealing the assessment methods is essential to learners but having a variety of methods(not just standardized testing)is key.
It was an excellent session. In healthcare we are thrown into teaching and defining goals and objectives without even understanding what the correct assessment tools are. Before starting the Masters I have to admit that I did not even know about many of the potential assessment tools that are available. I did not even understand the importance of having a blueprint that aligns goals and objectives with the appropriate assessment methods. I agree with Rich that self-directed learning is a developed skill. We hope that as resident and fellows progress through their training they understand better what their educational needs and goals for each rotation are. The milestones make sense when one thinks about progression of goals and objectives. Junior residents are worried about capturing and understanding the basics of a profession. Many times junior anesthesia residents are very focus on the basic skills and knowledge. Assessing more advanced understanding of the profession may not be appropriate for the beginner learner. At the same time residents in the same year of training may be at very different levels of their development and knowledge. Different assessment tools may identify these differences and help each learner achieve their goals.
Like the previous bloggers, I too enjoyed the session. The concept of instructional blueprinting resonated with me as well. I think many of the problems that we encounter in teaching adults stem from our forgetting to plan the entire teaching episode before we begin the teaching process. Since adult teaching is so context oriented, we can neglect to plan and just “wing it” as we get caught up in the event, eg. teaching on rounds or in the operating room. My biggest revelation while working with the ACGME was that the key to my helping to shape the learners’ experience and knowledge acquisition was the development of well-defined goals and objectives for the teaching/learning event. Once I had written down objectives, then creating the right content, teaching style, and the most appropriate method of assessment seemed logical. Otherwise, it seemed I was lost in a hopeless pile of assessment tools that were chosen more on convenience factors than on educational appropriateness. The tables provided reinforce the correct concepts of choice.
On the issue of assessment driving learning, I can’t help but to weigh in. I am a self-motivated learner, but in the end I also have to pass the course to get the credit I deserve for working hard and creating knowledge, therefore I do tailor my actions somewhat to the assessment methods. For example, I actually do not love blogging, but I do it to pass the course and along the way have come to appreciate the benefits of it in reinforcing learning and hearing different perspectives. So I would have to agree with Lily that assessment does drive learning at least a little bit, and this is all the more reason to consider the methods carefully when planning a teaching activity. BB
Felecia
I found today’s seminar covering Assessments enlightening. I also agree with most that assessment drives learning. I find the subject of Portfolios and their use to be very interesting. I believe the use of portfolios along with various assessment tools, would also help in mapping a blueprint tailored to the learners needs. For me, it is hard to understand why the use of portfolios is not widespread within the clinic. Talking to a class mate gave me a little insight, yet I still feel if there were facilitators specifically hired to manage a group of residents portfolios, help them and the assigned physician keep up with paperwork, clinical experiences, needed competencies (based on written and verbal feedback) etc., would make portfolios a viable tool for all residents. I do understand how challenging this would be for one person, but with help, could be very advantageous for all parties involved.
Kathy Baker
Identifying clear methods of assessment and concrete areas that the learner needs to learn is rather difficult. I enjoyed the session on assessing clinical performance because those that were in the course provided some good insight and ways they work through things with learners. I think having an overview of goals for the session or time period really provides added benefit to the learner and the educator. The only hesitation I have with setting out concrete guidelines of what to study and learn versus having a more open idea then focusing in on the key points is that learners might only learn what they are told to, not all the extra stuff that might be beneficial to them one day. I agree with Maged and Brian about Epstein's table and how it can be very beneficial with designing our assessment tools.
The upfront planning of the curriculum and the assessment go hand in hand. As others have pointed out, Epstein's table is helpful in selecting a method for assessment. Miller's pyramid is also helpful to bucket the knowledge according to the most basic to the epitome of using and applying the knowledge in a meaningful way. The idea of instructional blueprinting is a very clear method for organization and clearly points out any gaps in the process.
David Wheeler
I quite agree with my fellow bloggers in that I found this section quite interesting. It is essential that we create clear expectations for our learners and then fashion mindful assessments both formative and summative. This class along with the very informative paper is the beginning of our toolbox of assessment methods. For many of us are educational experience consisted of a very limited selection of assessment tools. This class was informative both in the number of assessment tools that are available to the clinical instructor in to the appropriate use of the assessment tool. I plan on using multiple assessment methods in a way that is context specific to the domain to be assessed and the knowledge or skill set being evaluated. I think it is important that we understand that confidence is a developmental habit brought about through a lifelong disposition of continual learning. Additionally, a thorough multifaceted assessment is essential when evaluating an adult professional
Assessment methods should be chosen based on individual learners and their scenarios. It is unfair to assess every learner in the same fashion and I believe the material has wonderful guidelines. Brian Johnson spoke about the unfairness and unrealistic ability to assess a resident he sees very infrequently, and this is very true. I believe assessment should be continuous and from an array of superiors. I think the information is a wonderful tool for us and I look forward to learning more about assessment in our program.
I thought the course was very thought provoking and was a great refresher on some of the fundamentals of assessing learners. The one point that made the most sense for me was the need to write clear learning objectives before preparing and educational program. If you are dealing with a group of unknown learners it may be very difficult to assess their knowledge before you meet them face to face. Developing clear objectives allows the teacher to be able to make spontaneous adjustments while teaching. Objectives also, as Lilly said, drive the curriculum of the course. They provide a game plan for teaching and a reference for assessment.
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