Summative assessment tools for undergraduate students

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Summative assessment tools for undergraduate
students

• EURACT 15th INTERNATIONAL COURSE LEARNING AND
  TEACHING ABOUT COMORBIDITY IN GENERAL/FAMILY
  PRACTICE.

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Group 3

• Jaime Correia de Sousa
• Darinka Klancar
• Gerry Wheeler
• Igor Švab
• Marko Kocijan
• Matilda Vojnovic
• Nathalie Bentov
• Nena Kopcavar-Gucek
• VlastaVodopivec-Jamšek
• Vojislav Ivetic

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AIMS

• To devise summative assessment tools for final
  year medical students.
• To assess students competence in using an
  holistic approach for managing comorbidity.

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TOOLS

• MEQ (Modified Essay Question)
• OSCE
• (Objective Structured Clinical Examination)

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MEQ

• QUESTION 1
• A 64 year old woman who has recently remarried,
  has moved to the area. She comes to visit you for
  the first time. She complains of dysuria for 3
  days. She also tells you that she has had Type 2
  Diabetes Mellitus since the birth of the last of
  her 3 children 25 years ago.
• A What symptoms and signs will you ask for?
• (Limit your answer to a maximum of 20 items).
• B What examinations and investigations would you
  do today? (Maximum of 7 items)
• C Outline a brief plan of management for the next
  7 days (Maximum 7 items).

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MEQ MARKING GRID
TOTAL MARKS AVAILABLE 100 POINTS
PASS MARK 50 POINTS
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MEQ 1A. Marking Schedule -SYMPTOMS AND SIGNS
(ACUTE- 40 POINTS)
Essentials. ITEMS points
1 Lower abdominal Pain 5
2 Frequency 5
3 Fever 5
4 Urgency 5
5 Flank pain 5
6 Recurrence 4
7 Urine colour change 3
8 Incontinence 3
9 Vaginal discharge 3
10 Dyspareunia 2
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MEQ 1A. (BACKGROUND- 25 POINTS).
ITEMS POINTS
1 LIFE STYLE (DM DIET) 5
2 DRUGS (DM) 5
3 DIABETIC MONITORING (LAST BLOOD TESTS) 5
4 DIABETIC REFERRALS (EYE, OTHERS) 5
5 LAST GYNAECOLOGIST VISIT 5
essential
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MEQ 1B. EXAMINATION, INVESTIGATIONS AND REFERRALS
(20 POINTS)
ITEMS POINTS
1 URINE TESTS (DIPSTICK) 5
2 PHYSICAL EXAMINATION ( ABDOMINAL FLANK PERCUSION) 5
3 TEMPERATURE 3
4 URINE CULTURE 3
5 CONSIDER BLOOD TESTS (CBC) 2
6 BLOOD PRESSURE 2
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MEQ 1C. PLAN (15 POINTS)
ITEMS POINTS
1 ANTIBIOTICS 5
2 ARANGE FOLLOW UP VISIT 5
3 DRINKING 2
4 COMPLEMENTARY THERAPY (ANALGESICS, CRANBERRY) 2
5 CONSIDER REFERRAL (UROLOGIST- HEMATURIA FEVER, GYNAECOLOGIST- VAGINAL DISCHARGE CHRONIC INCONTINENCE) 1
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MEQ

• QUESTION 2
• You invite her for a double time consultation a
  week later. When she returns, her symptoms have
  cleared. She now admits to urinary incontinance
  for 10 years and dyspareunia since her recent
  remarriage.
• She brings her file which shows
• HbA1C 6.9
• BP 130/80
• ECG Normal
• Eye examination no retinopathy
• A. What issues will you address today?
• B. Outline your management plan for the next 3
  months

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MEQ

• Question 3
• On her next visit, she tells you that she is
  worried about her 30 year-old son, who has moved
  in with her and her husband. She confesses to
  difficulties with her husband.
• List the factors that might be impacting on their
  relationship.

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OSCE

• Information for the candidate (student)
•  
• You are Dr. B, a GP/FP in a practice / health
  centre.
• Mrs. A is a 75 year old woman that has recently
  registered with you.
• You havent seen her previously and you have a
  blank clinical file in front of you. Mrs. As
  previous file has not yet been transferred to
  you. All you have is her name, age and address.
•  
• Your task will be to interview this patient,
  write SOAP notes on the consultation and deal
  with her problems and requests.

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OSCE
  Information for the role player (patient)   Mrs
A, a 75 year old woman has recently registered
with Dr. B. Dr.B doesnt know much about Mrs. As
previous health problems. When Mrs. A enters the
consulting room coughing, she informs her family
physician (FP) that she would like to have her
celecoxib prescription renewed and, by the way,
could you also write down my other usual
prescriptions? She gives the doctor a paper with
the list of regular medication. Mrs. A, when
asked, informs Dr. B. that she has chronic low
back pain, was seen by an orthopaedist in the
emergency service two weeks ago and was
prescribed celecoxib. This new drug is helping
her. If asked, Mrs. A. should confess that she
sometimes takes both diclofenac and celecoxib.
When asked, Mrs.A. will inform the Dr. that she
has been taking paroxetine during her husbands
terminal disease and since his death she feels
lonely and sad. Her feelings are alleviated
somewhat by the paroxetine and she is sleeping
better. The only thing she complains about is her
weight loss of about 5 kg in the last month which
she attributes to her sadness and depression.
When Dr. B. asks Mrs. A about the reasons for
taking salmeterol she will inform her that she
was given that for her COPD and that she feels
much better from using it. She was seen by a lung
specialist 3 months ago and had a chest X-ray and
everything was OK. If asked, she will confess
smoking 20 cigarettes a day and she has thought
about quitting but it is her only comfort in here
loneliness / sadness.
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OSCE

• Information for the examiner
•  
• The student is expected to write SOAP notes on
  the consultation. The different elements of these
  notes will be used for the assessment of the OSCE
  station. The consultation will be video recorded.
  The observers will use a classification form to
  mark the students performance.
• During the interview, the doctor should review
  the medication together with the patient and the
  reasons why shes taking them.
• There will be marks for
• Identification of the problems
• Management and prioritisation
• Follow-up
• Empathy

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OSCE APPENDIX 1OBJECTIVE (EXAMINATION)
Blood pressure 135/70
Pulse 72
Cardiac auscultation Normal
Pulmonary auscultation Normal
Lasseque/ straight leg raising Normal
Bragard Negative
Temperature 36.8oC
Pain scale 4/10
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OSCE APPENDIX 2LIST OF MEDICATION
SALMETEROL 500mcg 2 puffs bd
PAROXETINE 20 mg 1 daily
DICLOFENAC 75 mg 1 bd
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OSCE APPENDIX 3LAB tests
CBC normal
CRP low
Complete biochemistry tests normal
Urine analysis normal
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OSCE

• Information for the candidate (student)
•  
• You are Dr. B, a GP/FP in a practice / health
  centre.
• Mrs. A is a 75 year old woman that has recently
  registered with you.
• You havent seen her previously and you have a
  blank clinical file in front of you. Mrs. As
  previous file has not yet been transferred to
  you. All you have is her name, age and address.
•  
• Your task will be to interview this patient,
  write SOAP notes on the consultation and deal
  with her problems and requests.

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OSCE Marking Schedule
TOTAL MARKS AVAILABLE 30 POINTS
PASS MARK 16 POINTS
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OSCE Marking ScheduleA. Identification of the
problems(10 points from SOAP written by the
student)
Item Points
Weight loss 3
Bereavement 2
Smoking 2
Depression 1
Low back pain 1
Cough 1
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OSCE Marking ScheduleB. Management and
prioriatisation (10 points from video
observation)
Item Points
Discussion of weight loss 3
Discussion concerning diclofenac 3
Discussion concerning smoking 3
Review of salmuterol and other medications 1
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• OSCE Marking Schedule
• C. FOLLOW UP (5 points from SOAP)
• D. CANDIDATES ATTITUDE (5 points from video)

Follow up advice 5
Empathy 5