What/Current status
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
How/Proposed exam design
(as per current Council guidelines)
(as per current Council guidelines)
Current local university guidelines
I found this from the NTRUHS website which was our recent previous university:
"Note
1. For conduct of exams in PG Degree/Diploma courses rules are followed as per Medical Council of India, New Delhi and the recommendations of Board of Studies/E.C Resolutions of Dr. NTR UHS, Vijayawada/Hon’ble Court Orders from time to time."
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:
"(i) Clinical examination for the subjects in Clinical Sciences shall be
conducted to test the knowledge and competence of the candidates
for undertaking independent work as a specialist/Teacher, for which
candidates shall examine a minimum one long case and two short
cases.
(ii) Practical examination for the subjects in Basic Medical Sciences
shall be conducted to test the knowledge and competence of the
candidates for making valid and relevant observations based on the
experimental/Laboratory studies and his ability to perform such
studies as are relevant to his subject.
(iii) The Oral examination shall be thorough and shall aim at assessing
the candidate knowledge and competence about the subject,
investigative procedures, therapeutic technique and other aspects of
the speciality, which form a part of the examination.
A candidate shall secure not less than 50% marks in each head of
passing which shall include
(1) Theory,
(2) Practical
including clinical
and viva voce examination."
MCI examination guidelines PDF linked below:
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
(100 + 50x2=200 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 50 points each and one long case from IPD each of 100 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.
While the above may test the candidate's cognitive competencies, to test their procedural competencies, one can in some patients get the candidates to perform certain procedures that will be anyway necessary in those patients that day or evaluate their prior recorded videos clearly showing their skills in one procedure either diagnostic such as ascitic or pleural taps as well as lumbar puncture or even drawing of ABGs and therapeutic such as intubation or central line insertions.
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://www.youtube.com/watch?v=yhXqgGpfIEo&feature=youtu.be
Viva details: (100 marks)
As visualized in the above videos other than the case presentation and discussion for 300 marks the viva is carried out by asking the candidate to speak on a chosen topic with a competency assessment goal as directed by the MCI and I quote again from the MCI link, "...The oral or viva aims at assessing the candidate's knowledge and competence about the subject, investigative procedures, therapeutic technique and other aspects of the speciality."
The viva assessments points can be further broken down by testing the candidate's skills in
1) Broad overview of the topic 30 marks
2) Searching the evidence base around efficacy of diagnostic and therapeutic interventions 15 marks
3) Critically appraising the literature especially single RCTs done to establish diagnostic and therapeutic efficacies. 15 marks
4) Sharing their original work done during the course of their theses dissertation which will be cross examined by the four member examining Team to obtain an understanding of the candidate's competency in research methodology. 20 marks
5) Log Book maintained as an online learning portfolio along with their regular reflection on cognitive and procedural competencies gained with some of their procedural videos.
Some sample E log books along with procedural competency videos can be accessed here in the link below:
Frequently asked questions FAQs
1) How will the cases be allotted?
In the morning, the PGY2 student expert conducting the exams will allot one IPD patient and 2 OPD patients each to the ten candidates such that when 5 candidates are examining their 2 OPD cases the the other 5 shall finish their IPD patients, and the IPD patients will largely be exclusively in the AMC, ICU or even wards while the external examiners after inspecting the students taking the cases into their laptops to their satisfaction will lounge in the clinical lecture hall waiting for the presentations to happen which will also be video recorded in toto by one of our PGY1s or interns.
2a) Sir one doubt.. to prepare a ppt it takes time to collect info and type it in a PowerPoint.. so we will be given cases one day before ??
2b) Should the ppt made during the examination sir or should we be ready with the power point beforehand sir?
You don't need to type the text into PPT slides. Just collect images of your clinical findings and imagings that's all. The rest you can present by reading your case notes.
The candidates may or may not collect the clinical data as text but they will definitely collect clinical images or videos as well as EcG, echo, X-ray, USG, CT, mri images and project those during the presentation.
For viva no PPT again except sharing of journal RCT data from a PDF that can be scrolled up and down.
3) Ok sir so we need our laptops to make a ppt?
Yes but not to make a PPT but to share the clinical, ecg and image data on the clinical lecture hall projector.
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