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Glossary of Medical Terms
In medical education, it is what the learner will be able to know or do after taking part in educational activities. Objectives should result from assessment of the needs of the patient or population.
Objective Structured Clinical Examination (OSCE)
A method introduced in 1972 as a more standardized way of assessing clinical competencies. It provides a standardized means to assess physical examination and history-taking skills, communication skills with patients and family members, breadth and depth of knowledge, ability to summarize and document findings, and ability to make a differential diagnosis or plan treatment. The examiners carefully plan the tested areas and objectives of the test are identified and recorded. The clinical competency to be tested is broken down into its various components such as taking a history, auscultation of the heart, interpretation of an ECG, or making a conclusion on a basis of findings. Candidates rotate through a series of "stations", usually 12-20, and in a specified time perform a standardized task.
The format of individual OSCE varies significantly. Clinical models and standardized patients or simulated patients can be used to allow large numbers of students to be tested on the same clinical problem without causing fatigue or stress to real patients. Direct or indirect observations as well as checklists and rating scales measure the performance against predetermined standards resulting in a more objective examination than with traditional methods. This provides a more valid and more reliable examination permitting the move away from testing factual knowledge to testing a wide range of skills. The variables of the examiner and the patient are, to a large extent, removed. OSCE is particularly suited to situations where a pass/fail decision has to be taken and where a decision has to be made as to whether a student has reached a prescribed standard. It is cost-effective when many candidates are examined at once, as it is difficult to create and administer and requires resources and expertise. With succeeding examinations, less time is required and both time and effort can be reduced if a bank of objective test items and checklists is maintained.
Use of OSCE for formative assessment has great potential and value as the learners can gain insights into the elements making up clinical competencies as well as feedback on personal strengths and weaknesses. However, in the OSCE, the student's knowledge and skills are tested in compartmentalized fashion and he/she is not tested on the ability to look at a patient as a whole being. Still, OSCE may be combined with other forms of assessment, such as the clerking of cases in the wards. The previously used term for this assessment method was Multiple Station Exercises/Exam (MSE).
In this approach, medical competence is gained by focusing on one organ system at a time. It is an approach that integrates different disciplines (subjects) such as biochemistry, physiology and anatomy, and has ultimately led to the more common problem-based approach, which is currently more commonly used.
All possible demonstrable results that stem from casual factors or activities. In medical education, outcome refers to a new skill, knowledge or stimulus to improve the quality of patient care. Setting outcomes can be very useful for developing a framework of various results expected from various educational activities. Outcomes may be related to the educational process (process outcomes), to the product of undergraduate medical education (learning outcomes), or to the professional role of the physician (performance outcomes).
This approach emphasizes educational outcomes rather than the educational process and focuses on the product of medical education such as what kind of doctors will be produced, and with what professional knowledge, skills, abilities, values and attitudes. Educational outcomes must be clearly specified as they determine the curriculum content, the teaching methods, the courses offered, the assessment process and the educational environment. The scope and definition of competence and the levels of its attainment is defined in terms of student development within the natural progression in medical school. Consequently, the assessment system will ensure that the expected variation of levels of attainment is defined and assessed.
An example of such a framework is the 12-outcomes paradigm of Dundee - a model presented in the form of three-circles which describes the following:
What the doctor is able to do: clinical skills; practical procedures; patient investigations; patient management; health promotion; disease prevention and communication.
How the doctor approaches his practice: appropriate understanding of basic, social and clinical sciences and underlying principles; with appropriate attitudes and ethical understanding and legal responsibilities and with the appropriate decision-making skills and clinical reasoning and judgment.
The doctor as a professional: understanding of the doctor's role within the health system and the understanding of personal development.
In addition, some medical schools have
already incorporated advanced levels of progression in the early phases of
their curriculum such as problem-based learning programs, early clinical
exposure, and self-directed learning programs.
In the health field, this indicates the immediate result of professional or institutional health care activities, usually expressed as units of service such as patient hospital days, outpatient visits or laboratory tests performed.