Sir William Osler Father of modern medicine created

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Sir William Osler Father of modern medicine created the first residency program for specialty

Sir William Osler Father of modern medicine created the first residency program for specialty training of physicians the first to bring medical students out of the lecture hall for bedside clinical training “Medicine science of uncertainty an art of probability. ” is a and

Very much more time must be…given to those practical portions of the examination which

Very much more time must be…given to those practical portions of the examination which afford the only true test of…fitness to enter the profession. The day of theoretical test is over. SIR WILLIAM OSLER, 1885

Miller’s Pyramid

Miller’s Pyramid

Professional Authenticity § Professional : paid occupation, especially one that involves prolonged training and

Professional Authenticity § Professional : paid occupation, especially one that involves prolonged training and a formal qualification § Authenticity : based on facts; accurate or reliable So, the Professional By Existentialism, theauthenticitymight is. . be. . (Oxford Dictionary) the degree to to which professional one is true to profession's one's own personality, spirit, or character, 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’s Pyramid in Medicine § Knows : recall of facts, principles, and theories §

Miller’s Pyramid in 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 in controlled setting § Does : observation of real practice unannounced SP

Shifted Paradigms of Medical Education structure- and process-based To Competency-based education and Measurement of

Shifted Paradigms of Medical Education structure- and process-based To Competency-based education and Measurement of outcomes § What is competency and how appropriately teach and evaluate it ? § From

Competency § Webster Dictionary: 필요 having requisite or adequate ability or qualities § In

Competency § Webster Dictionary: 필요 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

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 are we interested in competency? § Social/economic-political debate Relationship between world of work

Why are we interested in 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 principles of competency based education § Focus on outcomes § Greater workplace relevancies

Basic principles of competency based education § 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 § § § of Competency Knowledge Skills Attitude Values Adaptability. . Should be

Attributes § § § of Competency Knowledge Skills Attitude Values Adaptability. . Should be achieved by appropriate education (teaching + training) Should be evaluated by appropriate test

Evaluation of Competency § What (contents), how (format, mode) and usefulness § 3 most

Evaluation of 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 : 객관구조 임상평가 Objective Structured Clinical Examination § CPX

OSCE vs. CPX § OSCE : 객관구조 임상평가 Objective Structured Clinical Examination § CPX : 임상수행평가 Clinical Performance Examination

Checklist vs. Rating Scale 17

Checklist vs. Rating Scale 17

Checklist vs. Rating Scale Checklists Rating Scales § Measures process § Judges process §

Checklist vs. Rating Scale Checklists Rating Scales § Measures process § Judges process § Measures outcome § Judges outcome § Checking specific tasks § Evaluating complex tasks § More reliable, less valid § Less reliable, more valid

Conclusion If you want to sure that each trainee is competent for hepatobiliary surgeon,

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 ? § a person carefully recruited and trained to take on

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.