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
For more around how the formative assessment can be shared with the learning ecosystem again toward feedback learning 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:
And nothing yet mentioned in knruhs website which is our current university http://knruhs.
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:
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:
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."
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