Competency based practical assessment timeline in MBBS Medicine university finals

 For a detailed discussion on the theory and rationale of the schematic plan below please click on 

https://medicinedepartment.blogspot.com/2021/03/final-university-mbbs-medicine.html?m=1

SCHEMATIC OF COMPETENCY BASED MBBS DEGREE EXAMINATIONS PRACTICALS & VIVA VOCE WITH MEAN EVALUATION  TIME PER STUDENT

DEPARTMENT OF GENERAL MEDICINE

S. No

Regd. No

Practical Max. Marks (100)

Viva Max Marks ( 20)

Long Case (50) 5 Minutes

Short Case (40) 4 minutes Spot case (10) 1 minute

Total Marks (100)

Approach to Patient Management  Marks (5) 2 Minutes

Therapeutics  and  Emergencies  Marks    (5)  2 Minutes

Professional Values  Attitude  Ethics  Marks  (5) 2 Minutes

Diagnostic Data interpretation    X-ray ECG etc  (5) 2 minutes

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S. No	Regd. No	Practical Max. Marks (100)				VIVA – VOCE (20)
		Long Case (50 marks) Discuss individual patient data: tests competency to capture, present and analyze data to reach at diagnosis differentials and therapeutic plan (50)	Short Case (40) +Spot case 10 marks

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Competency based final university MBBS Medicine summative assessment conduct as per available guidelines from different national and state bodies

 

What/Current status 

The final university MBBS Medicine summative assessments are the usual exit point and opportunity for medical students to ascend to a higher hierarchy in the healthcare ecosystem with many becoming practicing physicians and many going ahead for further training in organ based specialties. 

Why/Problem Statement 

In an ideal learning ecosystem driven by daily formative assessments, the students would never need a summative assessment that is often performed over few hours in a select day at the end of three years to test an individual's competencies gained over the last three years, which really sounds very imperfect when one thinks about it but then this is the real world where in most medical colleges globally, formative assessments are far from perfect and students are either too overworked to reflect and log their daily workflow with learning reflections, conceptualizations and experimentations in their prescribed web log books and maintain a steadily growing online learning portfolio or their teachers are too overworked to review those. For more around the methodology of web log books driving regular acquisition of formative learning competencies that goes into an individual's online learning portfolio please click here 

https://medicinedepartment.blogspot.com/2020/05/web-log-driven-online-learning.html?m=1

For more around how the formative assessment can be shared with the learning ecosystem again toward feedback learning please click here : 

https://medicinedepartment.blogspot.com/2021/03/2016-batch-mbbs-competency-driven.html?m=0

How/Proposed exam design 
(as per current Council guidelines) 

Current local university guidelines 

I found this from the NTRUHS website which was our recent previous university:

http://ntruhs.ap.nic.in/examinationss/index.html

And nothing yet mentioned in knruhs website which is our current university http://knruhs.telangana.gov.in/syllabus

So we deemed it best to follow the MCI examination guidlines, which is a central governing councils for medical college education in India. 

MCI guidelines for Clinical / Practical and Oral Viva examination quoted below verbatim from their website PDF document linked below:

"Practical/clinical examinations will be conducted in the laboratories and /or hospital wards. 

The objective will be to assess proficiency and skills to 

conduct experiments, interpret data and form logical conclusion. Clinical cases kept in the examination must be common conditions that the learner may encounter as a physician of first contact in the community. 

Selection of rare syndromes and disorders as examination cases is to be discouraged. Emphasis should be on candidate’s capability to elicit history, demonstrate physical signs, write a case record, analyze the case and develop a management plan.

Viva/oral examination should assess approach to patient management, emergencies, attitudinal, ethical and professional values. Candidate’s skill in interpretation of common investigative data, X-rays, identification of specimens, ECG, etc. is to be also assessed."

MCI examination guidelines PDF linked below:

https://www.google.com/url?sa=t&source=web&rct=j&url=https://www.nmc.org.in/wp-content/uploads/2020/01/Module_Competence_based_02.09.2019.pdf&ved=2ahUKEwj94c3Ojb_vAhX8yDgGHRovCTwQFjACegQIEhAC&usg=AOvVaw2Diwh7Dcm3D4xDUO2tPhd1

Finally we come to how exactly we wish to conduct the examination here locally so that 

1) There is minimal intrusion in the local patient centered workflow thus not harming patients 

2) There is maximal utilization of this additional learning in the regular workflow thus actually benefiting patients. 

We shall address points 1 and 2 above as we discuss the actual conduct of the exam in an hourly timeline below:

A)  Clinical examination competency 

testing of the students. 

1 Long case and two short cases 

and 1 spot case 

(50 + 20x2+10=100 marks)

General Medicine requires skills and competency to capture clinical data from a given patient in the form of the patient's past and present life events in the form of a history timeline followed by further data collection from the body in the form of general survey points as well as different organ system review in the form of local examination in the patient's body and this is followed by gathering all the data into a pattern that suggests the reason for the patient's symptoms and signs in terms of a physically localizable pathology as well as etiology, which is further followed by formulating a therapeutic plan based on the diagnostic model created from the patient data acquired by the student. 

The competency to do this well in both OPD (outpatient department) and IPD (inpatient department) encounters with a patient is what will be tested by a team of internal and external examiners for each candidate. 

To do this we shall provide each candidate with two short cases from the OPD of 20 points each and one long case from IPD each of 50 points (they are named short or long cases as the time needed is different to achieve closure in either type of case) and the examiners will have the choice of examining the candidates right there in the OPD or IPD or take all of them to a central location in a separate spacious demo room where the candidate can be allowed to also share the clinical data captured over a PPT projection for the convenience of focusing on the candidate's presentations with minimum hassles. 

Other than this a video of the entire examination interview of the candidates discussing their cases during their clinical competency evaluation as well videos of their ability to discuss a topic during the viva examination will be recorded for audit purposes to improve upon the current conduct of the examination. 

For a link to recent internal formative assessment videos depicting a similar clinical case and viva evaluation please click here: 

https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR

B) VIVA 20 marks:

As per NMC guidelines 

"Viva/oral examination shall assess:

Approach to patient management, 

Emergencies, 

Attitudinal, Ethical and Professional values. 

Candidate’s skill in interpretation 

of common investigative data, 

X-rays, identification of specimens, 

ECG, etc. is to be also assessed."

Competency based practical assessment vs Traditional practical assessment in Medicine

For a detailed discussion on the theory and rationale of the schematic plan below please click on https://medicinedepartment.blogspot.com/2020/05/re-final-university-md-medicine.html?m=0

FORMAT OF COMPETENCY BASED PG DEGREE EXAMINATIONS PRACTICALS & VIVA VOCE

DEPARTMENT OF GENERAL MEDICINE

S. No	Regd. No	Practical Max. Marks (200)				VIVA – VOCE (100)
		Long Case (100) Discuss individual patient data: tests competency to capture, present and analyze data to reach at diagnosis differentials and therapeutic plan (100)	Short Case (100)		Total Marks (200)	Pedagogy (Microteaching and topic recall and conceptualization competency) Marks (25)	Thesis/Dissertation (Research data collection, documentation and analysis competency) Marks (25)	Log Book /Learning Portfolio Individual clinical experiences documentation, reflection, sharing and analysis competency Marks (25)	Evidence based Medicine and critical appraisal of published data in PICO format Tests competency to read, comprehend and analyze the scientific literature toward optimizing individual patient outcomes Marks (25)	Total Marks (100)
			Case 1 Marks (50) Discuss individual patient data: tests competency to analyze visual data in the form of clinical, radiological, electrophysiological and instrumental images to quickly reach at diagnosis differentials and therapeutic plan	Case 2 Marks (50) Discuss  individual patient data: tests competency to analyze visual data in the form of clinical, radiological, electrophysiological and instrumental images to quickly reach at diagnosis differentials and therapeutic plan
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TRADITIONAL FORMAT OF PG DEGREE EXAMINATIONS PRACTICALS & VIVA VOCE

SUBJECT: GENERAL MEDICINE                

TIME ALLOTED PER CANDIDATE 90 MINUTES (SEE BELOW FOR FURTHER TIMELINE):                                                                                                                                 

S. No

Regd. No

Practical Max. Marks (200)

Viva Max Marks ( 100)

Long Case (100) 30 Minutes

Short Case (100)

Total Marks (200)

Pedagogy Marks (20) 6 Minutes

Discussion Dissertation Marks  (10) 3 Minutes

Log Book Maintenance Marks (10) 3 Minutes

Oral marks 60 (15x4)

Total Marks (100)

Case 1 Marks  (50) 15 Minutes

Case 2 Marks (50) 15 Minutes

Ext. Examiner  1 (15) 4.5 Minutes

Ext. Examiner   2 (15) 4.5 Minutes

Int. Examiner  1 (15) 4.5 Minutes

Int. Examiner  2 (15) 4.5 Minutes

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