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Science
A branch of knowledge that produces theoretical explanations of natural phenomena based on experimentation and observation.


Self-Assessment
The process of evaluating ones own deficiencies, achievements, behavior or professional performance and competencies. Self-assessment is an important part of self-directed and lifelong learning because it creates a need for improvement while it justifies confidence in ones competence.


Self-Assessment Questionnaire (SAQ)
Assessment completed by the learner about him- or herself to provide indirect, inexpensive measures of skill attainment and real-life performance. SAQ's serve as an evaluation of ones own deficiencies and achievements, professional behavior, performance and competence. Though important as a tool in motivation for improvement of competence, it has the weakness of being subject to rating biases.


Self-Directed Learning
A form of education that involves the individual learner's initiative to identify and act on his or her learning needs (with or without assistance), taking increased responsibility for his or her own learning.


Self-Empowerment
An event or process whereby an individual or group gains control over decisions and actions affecting their health.


Self-Referral
Ordering of laboratory tests, diagnostic procedures or treatment for a patient by a physician from businesses in which the physician has a financial interest. Many physicians who have such financial interests contend that their participation improves access or quality of care, but results of a number of studies suggest that physician-owned enterprises are detrimental, promoting excessive use of diagnostic tests and treatments and potentially increasing total costs of health care as well as harming the physical and financial well-being of the individual patient.


Short-Answer Questions
An assessment tool that requires students to construct short, written answers to presented questions; often used instead of multiple-choice questions to have students actually recall the answer rather than merely select it from a set of alternatives. As the answers must be constructed, it is reasonable to assume that there is little chance of guessing correctly. The questions are therefore cued-recall measures of memory for course material whereas multiple-choice questions require only recognition. Although the stem (question) could be the same in both exam formats and the answer could be quite short, even a single word, the short-answer version is likely to be more difficult than the multiple-choice version. Because the short-answer questions require students to construct answers, they provide more information about the students' knowledge than the selection of a multiple-choice alternative. The disadvantage of this form of exam is related to grading. Question vagueness can yield interpretive problems, and even with quite clear questions, scoring requires assessors with relevant knowledge, judgment and time.


Simulated Patient (SP)
Simulated patients are healthy persons who have been trained to reliably reproduce the history and/or physical findings of typical clinical cases. Sometimes actors are used to accomplish this goal but more often, health care providers are used. Use of an SP is designed to assess students' clinical skills while making the examination as objective as possible. Note that teaching an SP to simulate a new clinical problem takes eight to ten hours.


Simulations and Models
Tools for assessment of clinical performance in an environment closely resembling reality and imitating real clinical problems to rate the examinees' performance on clinical problems that are difficult or even impossible to evaluate effectively without harming a real patient. They permit examinees to make life-threatening errors and provide instant feedback so examinees can correct a mistaken action.

Models are mannequins constructed to respond realistically to actions, allowing examinees to reason through a clinical problem without risk to a real patient.

Simulation formats have been developed as paper-pencil patient management problems (PMP), computerized versions of PMP called clinical case simulations (CCX), role-playing situations, e.g., standardized patients (SP), clinical team simulations, anatomical models or mannequins, and combinations of all of the above formats.

Virtual reality simulations (VR) use computers sometimes combined with anatomical models to mimic realistic organ and surface images and the touch sensations a physician would expect examining a real patient. Written and computerized simulations have been used to assess clinical reasoning, diagnostic plans and treatment for a variety of clinical disciplines. They are expensive to create.

Skill
The ability to perform a task well, usually gained by training or experience; a systematic and coordinated pattern of mental and/or physical activity.


Small Group Teaching
A very popular form of instruction since it permits the working through of learning material, not just in terms of knowledge but also in terms of attitudes. Within a small group, participants are more likely to exchange opinions and feelings. Usually such sessions are structured with the help of specific exercises such as patient interviews or discussion topics.


Standard
Refers to a model, example or rule for the measure of quantity, weight, extent, value, or quality, established by authority, custom or general consent. It is also defined as a criterion, gauge or yardstick by which judgments or decisions may be made. A meaningful standard should offer a realistic prospect of determining whether or not one actually meets it.

Standards may be mandatory (required by law), voluntary (established by private and professional organizations and available for use), or de facto (generally accepted by custom or convention, such as standards of dress, manners, or behavior).


Standard in Education
A model design or formulation related to various aspects of medical education and presented in a manner that enables the assessment of graduates' performance in compliance with generally accepted professional requirements. They are set up by consent of experts or by decision of educational authority. Three types of interrelated educational standards can be envisaged:
 

Content standards or curriculum standards describe skills, knowledge, attitudes and values; what teachers are supposed to "teach" and students are expected to learn. Thus the content standards define what is to be taught and learned. Content standards can be also defined as "essential (core) requirements" that the medical curriculum should meet to equip physicians with the knowledge, skills and attitudes necessary at the time of graduation.

Performance or assessment standards define degrees of attainment of content standards and level of competencies in compliance with the professional requirements. Performance standards describe how well content has been learned.

Process or opportunity-to-learn standards define availability of staff and other resources necessary for the medical school so that students will be able to meet content and performance standards.

A standard can be also classified four ways:

An absolute standard refers to the knowledge and skills a student must possess in order to pass a given course. An absolute standard stays the same over multiple administrations relative to the content specifications of the test. The failure rate may vary due to changes in the group's ability, from one administration to the other.

A relative standard can be set at the mean performances of the candidates, or by defining the units of standard deviation from the mean. A relative standard may vary from year to year due to shifts in the ability of the group and may result in a fixed annual percentage of failing students, if the scores maintain a normal distribution across administrations.

A norm-referenced standard is a standard based on the representative group of the candidates' population. Credentialing organizations may use norm-referenced orientation, in which the standard is based on the performance of an external large representative sample (norm group) equivalent to the candidates taking the test. The norm-referenced standard will be somewhat unstable and will shift according to the performance of the norm group, as large as it may be. Shift of the standard over time is a concern.

A criterion-referenced standard   is a fixed standard that may undergo periodic re-evaluation in view of shifts or trends in candidates' performance over time. The criterion reference orientation links the standard to the content of the level of competence.

Standardized Oral Examination (SOE)
A performance assessment using realistic patient cases with a trained physician examiner questioning an examinee in a standardized manner. These exams assess clinical decision-making and the application or use of medical knowledge with realistic patients. The exam begins with the presentation of a clinical problem in the form of a patient case scenario with a request to the examinee to manage the case. An examinee can be tested on a selection of different clinical cases. The examiners need to be trained in how to provide patient data for each scenario, how to question the examinee, and how to evaluate and score the examinee's responses. To create such an exam, extensive resources and expertise are required.


Standardized Patient (SP)
Individuals who have been trained to reliably reproduce the history and/or physical findings of typical clinical cases. They can be real patients who have been "standardized" or they can be simulated patients, i.e. persons who are not sick but take on a patient's history and role. Sometimes health care providers or actors are used to accomplish this goal. This tool is designed to make examination and assessment of a student's clinical skills as objective as possible. To teach a standardized patient to simulate a new clinical problem takes eight to ten hours.


Standardized Patient Examination (SPE)
An exam used to assess history-taking and physical examination skills, communication skills, differential diagnosis, laboratory utilization, and treatment. A standardized patient examination consists of multiple standardized patients, each presenting a different condition in a 10-12 minute encounter. The examinee performs a history-taking and physical examination, orders tests, provides diagnosis, develops a treatment plan, and counsels the patient. Using a checklist or rating form, the examiner or the Standardized Patient evaluates the student's performance and behavior. Reproducible scores are readily obtained for history-taking, physical examination, and communication skills. Thorough training of raters, whether they are physicians, patients or other types of observers, is critical to obtaining reliable scores. Development of such an examination is often time consuming.


Subject-Based Teaching
A method of teaching in which each subject area of curriculum is addressed separately. In the past, this model had been very prominent in basic science education. Now, however, it is gradually being replaced with a problem-based learning (PBL) where knowledge and skills unfold as elements in cases that illustrate real life situations.