Developing a Rubric for Assessment and Feedback for

Developing a Rubric for Assessment and Feedback for Medical Students’ Clinical Reasoning Maria Gabriela Castro MD Archana Kudrimoti MBBS MPH David Sacks Ph. D

Disclosures • none

Show of hands

Our goal

How did I do? • • “Great job!” “Will make an wonderful physician” “Well-liked by patients” “Excellent work” “Kind and thoughtful” “Team player” Pleasant, A&Ox 3, NAD

Learning objectives q Describe existing tools q Create a rubric q Discuss best practices

It is challenging to give feedback

How do your receive feedback?

Think/Pair/Share • Role play (30 seconds) • Give your student feedback • React to the feedback given • Feedback

Overview of tools for medical student assessment

Clinical reasoning is a contextdependent way of thinking and decision making in professional practice to guide practice actions. (Higgs, 2010) • Educational strategies to promote clinical reasoning Judith Bowen MD NEJM 2006 355: 2217 -25

Clinical reasoning • • • Patient’s story Data Acquisition Accurate “Problem representation” Generation of hypotheses Search for and selection of Illness script Diagnosis

EPA for medical students 1. Gather a history and perform a physical examination 2. Prioritize a differential diagnosis following a clinical encounter 3. Recommend and interpret common diagnostic and screening tests 4. Enter and discuss orders/prescriptions 5. Document a clinical encounter in the patient record 6. Provide an oral presentation of a clinical encounter 7. Form clinical questions and retrieve evidence to advance patient care

EPA for medical students 8. Give or receive a patient handover to transition care responsibility 9. Collaborate as a member of an inter-professional team 10. Recognize a patient requiring urgent or emergent care, and initiate evaluation and management 11. Obtain informed consent for tests and/or procedures 12. Identify system failures and contribute to a culture of safety and improvement 13. Perform general procedures of a physician

Levels of skill • Bloom’s taxonomy of cognitive skills (1956)Knowledge, Comprehension, Application, Analysis, Synthesis, Evaluation • Drefyrus level of performance( 1986) Novice, Advanced beginner, Competent, Proficient, Expert , Master • Miller’s learning pyramid ( 1990) Knows, Shows How, Does • Pangaro’s rime scheme (1999) Reporter, Interpreter, Manager, Educator

Methods for student assessment Written Exercises MCQ, problem solving questions, Essays, reflection Learn language and theory of clinical reasoning CR Assessment by supervising clinicians Global, Direct observation, oral exams Clinical simulations Standardized patients, high-tech simulations Gain Exp. CR Understand CR – prelude to real Exp. Multi-source /360 - degree evaluation Peer assessment, patient/ staff assessment self assessment, portfolios • Reflect/reason Assessment in Medical Education Ronald M. Epstein, M. D. N Engl J Med 2007; 356: 387 -396

Direct observation assessment tools • Various tools are available • Assess history taking ability, interpersonal and communication counselling, skills specific like examination, scaled with behavioral anchors Tools for Direct Observation and Assessment of Clinical Skills of Medical Trainees A Systematic Review - Jennifer R. Kogan et al , MD JAMA, September 2009—Vol 302, No. 12 (Reprinted) 13161326

Teaching strategies STFM-Teaching physician • SNAPP model • Five step Microskills- One- Minute Preceptor ( POWER precepting) • Reverse Presentation – ASOAP Format • What if Model

Feedback strategies STFM-Teaching physician • • • Sandwich Model ARCH model Five step microskills RIME model Ask /Teach /Ask model

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