Curriculum

Development
Dr. Musharraf Husain
MS,DNB,MNAMS,MRCS(Edin)
Member MEU
 Curriculum

Latin word – “race-course”

(Path to be followed and frame within which it
has to be followed)
 Definition
Syllabus:
Summary of the topics to be covered.
Curriculum:
A plan of action which incorporates
the learning outcomes to be attained
over a period of time by exposing the
learner to various learning
experiences.
 Planning the Curriculum
 Curriculum foundation

 Curriculum Components
 Curriculum Foundation

 Why a subject is being taught

 Who is being taught

 How a subject is being taught

 What is to be achieved
 Curriculum Components
 Objectives

 Materials

 Methods

 Assessment
 Objectives

Assesment Curriculum Material

Methods
Approaches to Curriculum planning

 Subject centred

 Learner centred

 Problem solving
 Steps to develop curriculum

 Problem identification
 Needs Assessment of learners
 Goals and Objectives
 Educational Strategies
 Implementation
 Evaluation and Feedback
 Innovations
 Integrated

 Problem based

 Skills training

 Affective domain
Learning objectives
Subject Systems Weightage Cognitive Psychomo Affective
tor
General 30 40 40 20
Surgery
Systemic 70 50 40 10
Surgery
Gastrointes 20
tinal
Hepatobilia 10
ry
Urology 20
Endocrine 05
Speciality 15
Aim to accomplish your goal
through various objectives
Thank You
Teaching Skills and Strategies
for Effective Lecturing

Dr. Azra S Hasan

Mind is not an empty vessel

that has to be filled

but a __________

that has to be ____________

Welcome and Rejoice
1. Appreciate the importance of teaching
skills
2. Should be able to use these skills
effectively
1. Lesson planning

2. Set induction

3. Presentation

4. Attitude

5. Listening
6. Effective questioning

7. Stimulus variation

8. Use Of A.V. Aids

9. Pupil’s reinforcement

10. Closure
1.Lesson Planning

Objectives? Content ?
Take home points?

How can you organize

your material to
accomplish your
objectives?

Student feedback
2. Set Induction

“Draw
pupil’s
attention”
 Asking few questions

 Quotations

 State objectives

 Why the topic is important ?

 3. Presentation

Making your presentation stick by chip and Dan Heath- 2008

HOW ?
S- simple
U-unexpected
C-concrete
C-credible
E-emotion
S-stories
WOW !
 The process of prioritization (find the core)

 MUST KNOW, DESIRABLE TO KNOW

 New additions
 Gap theory :
Gap in
knowledge
creates
intellectual
curiosity –
„ Velcro theory of Memory‟

 More „sensory hooks‟

CB IUS BUP SCPUN O ID A
 CBI USB UPS CPU NOIDA
 See something or experience it, to believe
it

 Use statistics – focus on relationship

between two and not the number
 It makes people care
for idea or concept

 Make people feel

something

 Empathy and horror

works
5,6- Listening and Effective
Questioning
•Involve , interact with students
•Listen to your audience 7%
( students)
– spoken and unspoken 17%

67%
And the confusion it
causes!
7.Stimulus Variation
• Changing pace of lecture by:
• By shifting emphasis
• Soliciting questions
• Jokes

• Giving directions
8. Use of Aids
 Shabaash!
Amazing!
Great Work!

Keep it
up!
10. Closure

• Summarizing

• Quotations

• Asking some questions

The FUN test is a very reliable
measure of
competence.
The only people
who have fun
skiing slopes are
those who
have the
expertise to
enjoy them
3,4.Presentation
and Attitude
how to LECTURE
 Uninterrupted rambling exposition of
apparently irrelevant information delivered
in a sleep inducing monotone for one
hour
???
 Preparation
 Presentation
 Performance
 P…
 Dr. Fox experiment
 Mathematical Game Theory
Great performance
High content Medium content Low content
(26 facts) (14 facts) (4 facts)
High seduction High seduction High seduction

Bad performance:-
High content Medium content Low content
(26 facts) (14 facts) (4 facts)
Low seduction Low seduction Low seduction
Dr. Fox : Biochemistry of Learning..
High Seduction: enthusiasm, humor, friendliness,
expressiveness

Low Seduction: monotonous, boring, angry

Who lights the lamp in your head?

“Before listening to your lecture I was confused

about this subject
Having listened to your lecture I am still confused
…………….|But on a higher level”
 I speak, you listen
“Where the notes of the lecturer
become ……….
the notes of the student
without passing through
the minds of either”
Tell them what you’re going to tell
them;
 Tell them;
Tell them what you told them.

Transition: “My next point...”,

“In conclusion...”

Emphasis: “Let me highlight this point…”

 Rate: 150 words/min; 1
slide/min

 Modulation: jocks vs.

evangelists vs. infomercials

 Volume: project; microphone

stage presence

 Direction: address each

person in the room, one
thought per person
 Anxiety, stage fright, epinephrine, arousal
◦ Use the extra energy
◦ Breathing exercises

 Humor don‟t have to be a comic, but it

helps

 Enthusiasm check your energy level

 Do whatever to create:……..
TEACHER LIVELINESS
Boring….
Angry
Or
Would
You
Rather
have me
talk?
 2 WORD DEFINITION..???
Symptoms to look out for….
Rule of thumb … PLUS…6
KISS -KEEP IT SIMPLE, STUPID
 Most people recall only 2-3 points

 Don‟t read facts, print them out

 Simplify
or focus on HEADING and
technical points
CHALK AND TALK
•Board legible from last row

•White or Yellow Chalk \ Black Marker

on White board

•Use board SYSTEMATICALLY

•Talk to AUDIENCE not the board

•NEW CONCEPT on a clean board

•PERFORMANCE is most important

Mr PP
……But
conditions
apply!
Conditions apply:-
FONT
COLOUR
BACKGROUND
6X6 RULE
◦ This is Arial 12
◦ This is Arial 16
◦ This is Arial 28
◦ This is Arial 32
◦This is Arial 44
◦This is Arial 48
 ALL CAPITAL LETTERS ARE DIFFICULT
TO READ
 Upper and lower case letters are
easier
 Underlines may signify hyperlinks
 Instead use colors to emphasize
 The 6 x 6 rule
◦ No more than 6 lines per slide
◦ No more than 6 words per line
◦ two font types per presentation
Inspire
Inform
Influence
Influence
Inspire
Inform
L- LIVELY
E- EDUCATIVE
C- CREATIVE
T- THOUGHT PROVOKING
U- UNDERSTANDABLE
R- RELEVANT
E- ENJOYABLE
 4 P‟s:
1. Performance,
2. Preparation,
What is
3. Presentation, the final P ..
the 4 th P???
◦ A picture is worth a thousand words
◦Practice makes perfect
◦ Worth saying, bears rePeating


Dr Chandra Mohan
 At the end of this session you
should be able to impart a
student the ability to:
 Identify resources,
 Design a plan for resource use,
 Make resources available, and
 Work well with teachers, peers,
and other resource persons.
 Learning resource materials are
MEANS OR VEHICLES used
EFFECTIVELY either by student or
teacher in the learning process.
 “Those human and material
resources that provide learners
with the facts, principles, and
experiences necessary to realize
meaningful learning outcomes.”
 Medical profession- Life long self
directed learning
 A good teacher aims to make
himself or herself irrelevant as he
or she imparts the students
ability to make best use of
resources
 Slotnick's staged theory of physicians'
learning
 Faculty in Class  Simulation
 Books  Manikins
 Curricular  Paramedics
Materials  Tests
 Journals
 Peers
 Senior
Colleagues
 E Books/Journals
 Websites
 Teacher to supplement the
lecture, seminar or practical or
laboratory sessions.
 Students to supplement formal or
didactic teaching.
 Students for independent
learning.
 Professionals to educate the
community, health decision
makers etc.
 A- Printed Media
 B- A-V Aids
 C- Advanced Technology
 D- Live Materials
1. Books, Journals, Handouts Etc.
2. Programmed Text ; Self
Learning Modules and Packages
3. Written Simulated Patient
Management Problem (SPMP)
1.Visual Aids
a) Non Projected
b) Projected
2.Audio-Aids
3. Audio-Visual Aids
1.Computer Assisted Learning (CAL)
2.Computer Aided Instruction (CAI)
 Synchronous (text based chat, voice and
video conferences, collaborative sessions,
etc.) and Asynchronous communication
(forums, emails, off-line messages, etc.)
 http://histology.med.umich.edu/schedule/me
dical
 himsr.org
 www.medscape.com
 www.webmd.com
 www.nlm.nih.gov/medlineplus
 www.cdc.gov
 www.who.int/en/
 www.mayoclinic.com
 www.medilexicon.com - Dictionary
 www.medicalstudent.com - Free Text Books
 www.biomedcentral.com - Free Medical Journals
 www.freemedicaljournals.com - Also: Free Medical
Books
1. Patients
2. Community
3. Teachers
4. Students
 The OBJECTIVE to be achieved.
 Who is to be taught ?
 Size of the group.
 Ability of the instructor to use a
particular aid.
 Time available for the instructors.
 Budget allotment
From Assessment to
Evaluation

Dr Satendra Singh
Medical Education Unit, UCMS & GTB Hospital,
FAIMER Faculty
Assoc Editor, RHiME
Editorial Member,
J Educ Evalv Health Prof
 It is assessment which help us distinguish
between teaching and learning

 Students learn not what you expect, but

what you inspect.

 Anything which is not evaluated is never

learnt properly
Clarify these terms?

 Measurement
 Application of tool for finding degree of
achievement
 Assessment
 Objective measurement + subjective
interpretation
 Evaluation
 Passing value judgment
Clarify these terms?

 Test
 Conventionally, refers to a written
instrument used to assess learning

 Tool
 Used to observe skills or behaviour to
assess extent of learning
Clarify these terms?

 Criterion-referenced testing

 Norm-referenced testing
 CRT –Fixed standards; only pass/fail
 NRT – Rank ordering, no fixed criteria,
how they fared in relation
Purpose of Assessment?

 Pass/fail  Measure
improvement

 Rank order the  Providing feedback to

students students

Prove Improve
 What are the types of
Assessment?
 Formative

 Summative

 Continuous Internal Assessment

 The Garden Analogy
If we think of our students as plants …

Summative assessment is the process of simply

measuring them.

Formative assessment is the equivalent of

feeding and watering the plants appropriate to
their needs - directly affecting their growth.
Chef tasting the soup – Formative
Guests tasting the soup - Summative

Assessment for learning –Formative

Assessment of learning - Summative
Assessment paradigms
Methods of assessment used drive
student learning

• Formative • Internal • Summative

•Assessment should be continuous to be

meaningful
•2:15 PM
Strengths of Internal Assessment

 Opportunity to provide corrective feedback

 Range of competencies can be tested

 Continuous assessment steer the

students’ learning
 Problems with
Internal Assessment
Problems with Internal Assessment

 Improper implementation
 How to implement? 50%?
 Lack of faculty training
 No feedback, no weightage to soft skills
 Misuse/abuse
 No longer to be added in finals
 Lack of acceptability
 Variable marking, too much power
Clarify these terms?

 Competence

 Performance
Competence vs Performance
 Competence = Capability

 Miller’s level II – Knows how – Competence

 Miller’s level III – Shows how – Competency and

Performance

 Competence is pre-requisite for performance in real

setting

 Performance = Competence x Individual influence x

External influence
Miller’s Pyramid for Assessment
Attributes of good assessment?

 Discuss in groups

 Think, Pair, Share

Attributes of good assessment?
 Validity
 Reliability
 Acceptability
 Feasibility
 Educational Impact

 Utility = V x R x A x F x EI
VALIDITY
 Measuring what it intends to measure
 Assessing intelligence of a person by looking at
his foot size.
RELIABILITY
 Refers to the consistency/reproducibility of an
assessment.
 One which consistently achieves the same
results within the same subjects under identical
conditions.
 IQ test of intelligence should give similar results
irrespective of confounding factors (tiredness,
nervousness).

The degree of confidence that we can place

in our results
Rely-ability
 Pitfalls of
conventional evaluation
 Reliability
marred by patient, examiner and student
variables
 Validity
does not measure the process, only the
end result
 Acceptability and Feasibility
average
 Educational impact ??
 Mini
Clinical
Evaluation
Ecercise
OSLER
Effective Evaluation of
Educational Programs
 Effective Evaluation of
Educational Programs
 Evaluation’s Purpose

 Determine the merit or worth of a program

 Key Questions

 1.Whose opinion matters?

 2.What would really be meaningful to them?
Evaluation approaches

 Objectives-oriented

 Process-oriented
Evaluation approaches

 Outcomes (Kirkpatrick’s model)

 Measurement method

 Instrument

 Modality
Kirkpatrick’s Model

 Level I: Evaluate Reaction

 Level II: Evaluate Learning

 Level III: Evaluate Behavior

 Level IV: Evaluate Results

Relationship Between Levels

•Level 4 - Results
Was it worth it?

•Level 3 - Behavior
KSA being used on the job?

•Level 2 - Knowledge
Did they learn anything

•Level 1 - Reaction

•Was the environment suitable for learning?

Only by assessing each level can we
yield actionable results
•Level 4 - Results •Check Requirements,
Was it worth it? Systems and Processes

•Level 3 - Behavior •Check

KSA being used on the job? Performance Environment

•Level 2 - Knowledge •Improve

Did they learn anything Knowledge/Skill transfer

•Level 1 - Reaction
•Improve
Learning Environment
•Was the environment suitable for learning?
Types of Assessments Used at Each Level

Type Form
•Level 4 - Results
Was it worth it?
Correlation of business results
Summative with other assessment results

•Level 3 - Behavior
KSA being used on the job? Summative Observation of Performance
360° Survey

•Level 2 - Knowledge Self-assessment

Did they learn anything Diagnostic
Test
Summative
•Level 1 - Reaction
Survey
Reaction
Real-time Polling
•Was the environment suitable for learning? Formative Quizzing
 Evaluation approaches

Instruments Modality
Outcome Measurement
method

I- Reaction
II-Learning MCQ Step 1,2
III-Behaviour Direct Obs. Mini-CEX Paper
IV-Results Computer
PDA
Assessment Outcomes Tasks Method to Settin
of Learning be used g the
Objectives Paper

Pediatrics
(Neonatology)

Competency -identify the Practical Viva

instruments
(Neonatal -list the indications
Resuscitation of their use
Theory MCQ/SAQ
(Recall)
-decide the need
and level of OSCE
resuscitation Practical (Application)
according to
(Application)
circumstances
-perform bag and OSCE
mask ventilation Practical (Simulator)
(Psychomotor)
Competencies
MCI Vision 2015
Key Message-1

The assessment should be

so organized that all students
are examined on identical
content by the same
examiners using
predetermined guidelines
Key Message-2

Examination should be so
organized that all
competencies are tested by
tools that evaluate the
process in an objective
manner
 MCQ - As an
Evaluation tool

Dr. Mukta Pujani,

Associate Professor,
Dept of Pathology,
HIMSR
 Advantages of MCQs
Objective, Reliable, Valid

Wider Subject Coverage

Easy to Mark- Computerised Checking
Question bank- for repeat usage

Feedback easy- amenable to audit

More scoring
Disadvantages of MCQs

Tests only Cognitive domain

Time consuming to set

Cheating Easier

Guess/ Chance factor

 Types of MCQ
Selection
type Supply type

Q. Scurvy is caused by Q. Scurvy is caused

the deficiency of by the deficiency of
which vitamin …………………
a) A
b) B
c) C
d) K
Types of MCQs- Selection type
Single Best Response
Multiple Response type
Matching type
True / False type
Problem Based
Reason Assertion Type
 Components of an MCQ

Tick the correct answer DIRECTION

Q. The drug of choice for treatment of
congestive cardiac failure is: STEM
a) Propranolol DISTRACTOR
b) Aminophylline DISTRACTOR
c) Isoptin DISTRACTOR
d) Digitalis KEY
 Which is Better?
One-Best Answer Problem Based MCQ

An otherwise healthy 33 year-old man

– Acute intermittent has mild weakness and occasional
porphyria is the episodes of steady, severe abdominal
result of a defect in pain with some cramping and no
the biosynthetic diarrhea. One aunt and a cousin have
pathway for: had similar episodes. During an
• A. collagen episode, his abdomen is distended,
and bowel sounds are decreased.
• B. corticosteroid Neurological examination shows mild
• C. fatty acid weakness in the upper arms. These
• D.heme findings suggest a defect in the
biosynthetic pathway for
A. collagen
B. corticosteroid
C. fatty acid
D. heme
 Stems
Use clear, straight forward language

Aim to write as a complete sentence

Avoid the use of negatives. If used

keep in bold eg. ALL EXCEPT

Avoid use of unnecessary content

Avoid giving clues in the question e.g an/a

 Flaws : MCQ Stems
Stem is unnecessarily complicated—too long, irrelevant
A 48-year-old woman presents to the physician with lower back
pain. She states that she has had the pain for about 2 weeks and
that it has become steadily more severe. An x-ray film shows a lytic
bone lesion in her lumbar spine. Review of systems reveals the
recent onset of mild headaches, nausea, and weakness. Her CBC
shows a normocytic anemia, and her erythrocyte sedimentation rate
is elevated. Urinalysis shows heavy proteinuria, and a serum protein
electrophoresis shows a monoclonal peak of IgG. Which of the
following is responsible for this patient’s spinal lesioins?

a.Bence-Jones protein
b.lymphoplasmacytoid proliferation
c.osteoblast activating factor
d.osteoclast activating factor
e.primary amyloidosis
 Flaws : MCQ Stems

Stem contains abbreviations that are not

clearly understood by all examinees.

A 32yo WF in her 1st trimester of pregnancy

experiences GERD 3-4x/week and c/o heartburn. She
has not responded to MOM. Which medication will
be best to treat this patient?
 Flaws : MCQ Stems

Stem contains words about quantity that

are difficult or impossible to quantify:
probably, usually, infrequently,
sometimes, in most cases, in few cases,
etc.

In most cases, men who develop prostate cancer

usually have limited dietary intake of which of
the following food groups?
 Key and Distractors
• Key should clearly be Best Choice

• Distractors should be such that only lower

ability students are distracted by them

• Distractors- same relative length as key

• In case of numerical values- options should

be in order

• Avoid ALL THE ABOVE & NONE OF THE ABOVE

 What’s wrong with this MCQ?
• The treatment of bronchogenic carcinoma is:
a) Radiotherapy
b) Chemotherapy
c) Surgery
d) Immunotherapy

Key – not clearly the best choice

Different students can give different

answers and yet be correct
 Which is a Better MCQ ?
• The average weight • The average weight of
of a normal adult a normal adult spleen
spleen in grams is: in grams is:
a) 20 a) 100
b) 150 b) 150
c) 450 c) 200
d) 750 d) 250
 Is this MCQ a good one ?
• The normal value Problems
of Hb is: • Age /sex not
a) 10-12 mentioned
b) 16-18 • Abbreviation
c) 14-16 • No unit given
d) 12-14 • Options not in order
 True/False
Two possible alternatives so fair chance of getting
the right answer…

• Some tips:
– use negatives sparingly.
– Use statements which are unequivocally true or false.

• More usually used as a basis for more complex

Assertion/Reason questions

16
 Assertion Reason (ARQs)
• Test application/analysis

Reason should be an
independent sentence

Avoid using minor

reasons. These can
result in an ambiguous
question.
17
 Example of assertion reason
Assertion A True/True
High speed is a factor Reason is correct
in car accidents explanation
B True/True
BECAUSE Reason Is NOT a
correct
Reason explanation
Most modern cars C True/False
can reach speeds in D False/True
excess of 100mph E False/False
18
 Components of a GOOD MCQ
Clearly Options
correct
Well formed answer
STEM
Plausible
distractors

Good
MCQ

+/- feedback
 ITEM ANALYSIS
• Evaluation of Effectiveness of items (MCQ s)
• Done after test has been administered and scored
• Item Analysis involves Judging:

Difficulty of the Item

Discriminating Power of the Item

Effectiveness of each Distractor

 Procedure: Item Analysis
• Eg- 30 students appeared for an MCQ exam
• Arrange the papers in order (highest marks to
Lowest marks)
• Select 1/3 with high scores (10 in no)- Upper gp
• Select 1/3 with low scores (10 in no)- Lower gp
• For each MCQ, prepare a frequency table by
counting the no of students in the upper gp who
selected each option
• Repeat same for lower gp
For Each MCQ
Alternatives No. of Responses
Upper group Lower group
A
B
C
D
No Response

Total Responses (T)

Encircle the correct answer for each MCQ

 DIFFICULTY INDEX OF MCQ
H + L X100
T
H= No. of correct responses in upper gp
L= No. of correct responses in Lower gp
T= Total no. of responses in both gps

DIFFICULT 30 40 50 60 70 EASY
Recommended
ACCEPTABLE
 DISCRIMINATION INDEX of MCQ
2x H-L
T

0 +0.15 +0.25 +0.35

DISCARD REVISE GOOD EXCELLENT
 Distractor Effectiveness
• Calculated for each distractor

• Sum of responses in the two gps x100

T

Distractor of 5% or above- Acceptable

 Checklist for constructing a Good MCQ
Select a learning objective to be tested

Write a stem (a question to be solved)

Write Key. Crosscheck its Correctness

Select plausible alternatives keeping in mind

the common mistakes made by students

Get MCQs Reviewed by Colleagues

Thank you
 OSCE
Dr Amit Sharma
Associate Professor
Forensic Medicine, HIMSR
OSCE - Objective

 All the candidates are presented with the same

test

 Specific skill modalities are tested at each station

 History taking
 Explanation
 Clinical examination
 Procedures
OSCE - Structured

 The marking scheme for each station is

structured

 Structured interaction between examiner and

student
 OSCE – Clinical Examination

 Test of performance of clinical skills

 candidates have to demonstrate their skills, not just
describe the theory
History of OSCE

OSCE was developed in Dundee , Scotland in the

early 1970’s by Dr.Harden and colleagues.
 The OSCE is now used in over 50 country world-
wide.
OSCE is a kind of exam not a test.
 OSCE
 Objective Structural Clinical Examination
 OSLER
 Objective structural Long Examination Record
 OSPE
 Objective Structural Practical Examination
 TOSCE (GOSCE)
 Team (group) Objective Structural Clinical
Examination
Advantage
 Provides a opportunity to test a student’s ability
to integrate knowledge, clinical skills, and
communication with the patient
 Provides the faculty with an assessment tool that
is custom-fit to the goals of a specific education
program
 Renders an occasion for individualized
instruction and feedback
 Offers an additional parameter by which to
evaluate student performance
Disadvantage
 Development and administration are time
consuming and costly.
 Offers opportunity for compromised test security
 Provides assessment of case-specific skills,
knowledge, and/or attitudes
What is the purpose of the OSCE?

 Provide feedback on performance

 Evaluate basic clinical skill
 Measure minimal competency
OSCE
 Format

 Purpose

 Advantages

 Writing principles

 Training observers

 Scoring considerations
Simple model of competence

Professional authenticity
Does

Shows how

Knows how

Knows
Testing formats

Professional practice
Behaviour~
attitude/skills Does
OSCEs
Shows how

Cognition~ Knows how EMQs, SEQs

knowledge
Knows MCQs
 OSCE

 Format

 Purpose

 Advantages

 Writing principles

 Training observers

 Scoring considerations
 Characteristics of assessment instruments

 Utility =
 Reliability
 Validity
 Educational impact
 Acceptability
 Feasibility
 Test characteristics

 Reliability of a test / measure

 reproducibility of scores across raters,
questions, cases, occasions

 capability to differentiate consistently

between good & poor students
 Advantages of using OSCEs in clinical assessment

 Careful specification of content = Validity

 Observation of wider sample of activities =

Reliability

 Structured interaction between examiner & student

 Structured marking schedule

 Each student has to perform the same tasks =

Acceptability
Factor leading to lower reliability
 Too few station or too little testing time
 Checklists or items that don’t discriminate (too
easy OR too hard)
 Unreliable patient or inconsistent portraits by
standard patient
 Examiners who score idiosyncratically
 Administrative problem (disorganized staff OR
noisy room)
 OSCE

 Format

 Purpose

 Advantages

 Writing principles

 Training observers

 Scoring considerations
OSCE Station Writing
 How to start

 Decide what tasks you

 want to
 can
 should
test in an OSCE format

 OSCEs test performance, not knowledge

 Constructive alignment

 Need to know the learning objectives of your

course / programme

 Map these across :

 Subject areas
 Knowledge areas
 Skill areas
Key features of success in designing OSCEs

 Feasibility

 Congruence
 Feasibility

 Is it a reasonable task to expect the

candidates to perform?

 Can the task be examined at an OSCE station?

 Can the task be performed in the time

allowed?
 Congruence

 Is it testing what you want it to test?

 Station construct: describe what station is

testing
 Congruence

 Ensure that all parts of station coordinate

 Candidate instructions

 Marking schedule

 Examiner instructions

 Simulated patient instructions

 Equipment
 Station construct

 This station tests the candidates ability

to …………………………
Number of Stations
 The number of stations in an examination refer
the time allocated for each station determines
the time required to complete the whole
examination.
 Twenty stations each of five minutes can be
completed in I hour 40 mins
 While 20 stations each of 10 minutes require 3
hrs 20 mins to complete
Duration of station
 Times ranging from 4 to 15 minutes have been
reported in different examinations and a five
minute station probably most frequently chosen.
 This times depend to some extent on the
competencies to be assessed in the
examination.
Couplet Station

Some competencies may best be assessed by

coupled or linked stations.
 The use of linked stations extends the time available
to complete a task.

Finding Treatment or
History taking
Interpretation Management
 Station Station
Station 12 10
1 Station
9

Station Station St
2 11 Station
8
8

Station
3 Station
7

Station Station Station

4 5 6

Example of 10 station OSCE accommodating 12 students

 Enter in to station

8 min

End of student interaction with SP

2 min
Exit station
1 min
Enter new examinee

Signaling station change

 Candidate instructions

 State circumstances: e.g. outpatient clinic, ward,

A & E, etc.

 Specify the task required of the candidate: e.g.

take a history, perform a neurological
examination of the legs, explain a diagnosis

 Specify tasks NOT required

 Examiner instructions

 Copy of candidate instructions

 Specific instructions appropriate to the task:

 e.g., do not prompt, managing equipment, etc
 Simulated patient instructions

 Give as much detail as possible so they can be

consistent
 try to leave as little as possible for them to ad lib!

 Give enough information to enable them to

answer questions consistently

 Be specific about affect in each role

 Specify patient demographics

 i.e., gender, age, ethnicity, social class, etc.
 Marking schedule

 Ensure marks are allocated for tasks the

candidates are asked to perform

 Decide relative importance of diagnosis vs

process (history taking, examination)

 Separate checklist for process skills

 Equipment

 Be detailed
 Think of
 Chairs + table / couch / bench
 Manikins - specify
 Medical equipment
 Stethoscope, ophthalmoscope, sphyg, suturing
materials, etc
 Designing stations

 Use your blueprint

 Be clear what you are testing: define the construct
 Check for congruence
 Pilot for feasibility
 OSCE

 Format

 Purpose

 Advantages

 Writing principles

 Training observers

 Scoring considerations
 Training observers

 Understand the principles of OSCEs

 Enhance inter-rater consistency

 Techniques

 Examiners must train together

 Videos
 ‘live’ stations

 Discussion of marking inconsistencies

 Training observers

 General training

 Station-specific training
 OSCE

 Format

 Purpose

 Advantages

 Writing principles

 Training observers

 Scoring considerations
Scoring considerations

 Global vs checklist scoring

 Weighting
 Checklist scoring
 Advantages
 Helps examiner know what the station setters are
looking for
 Helps the examiner be objective
 Facilities the use of non-expert examiners

 Disadvantages
 Can just reward process/thoroughness
 May not sufficiently reward the excellent candidate
 Ignores the examiners expertise
 Check list for assessment of a
physical finding
 Mr.C. presents with a sore swollen ankle for 6 weeks

Don’t Do

1-introduces self to patient

2-Explain to the patient what will be do
3-Demonstrate concern for patient.i.e.is not excessive
rough
4-Inspectin for any of swelling , erythema ,deformity
5-Inspection:
Standing
From anterior
Posterior
6- Inspection pt Gait
7- palpation
Sample Communication skills checklist
(rating scale)

Poor Fair Good V Good Excellence

1 2 3 4 5

1- Interpersonal skill:
Listen carefully

2-Interviwing skill:
Uses words patient can
understand
Organized
 Global scoring

 Advantages
 Utilises the expertise of the examiners
 They are in a position to make a (global) judgement
about the performance

 Disadvantages
 Examiners have to be expert examiners i.e. trained
 Examiners must be familiar with expected standards
for the level of the test
 Weighting

 In a checklist, some items may be weighted

more than others

 More complicated scoring system

 Some Tips !
 Have spare standardized patients and examiners
available for the exam as life is unpredictable.
 Have back-up equipment ,such as view box
,batteries
 Have staff available during the examination to
maintain exam security
 Make sure the bells or buzzers can be heard
from all location with closed door
 For each examination prepare an extra station
which can be setup with minimal effort
OSPE & OSCE Similarities

 Structured

 Multiple station delivery

 Variety of skills and tasks

 Observers used

 All candidates take same test

 Scoring considerations
 Advantages over Practical Exam

 Better coverage

 Less duplicated equipment

 Less preparation for each task

 Reduced cost

 Supervision easier
 OSPE can Test

 Laboratory based measurement

 Microscopy skills

 Simulated skills

 Applied medical science

 Laboratory procedures

 Special tasks
 Station Types in an OSPE

1. Microscope

2. Specimens

3. Computer

4. Laboratory equipment

5. SPs

6. X-ray, laboratory preps & results

 Station Example 1a
A

Use a sequence of annotated photomicrographs

Station Example 1b

Click to enlarge area

Use a sequence of annotated photomicrographs

Station Example 2

Specimens create several problems

 Problems with Specimens

 Duplicates are difficult

 Multiples may not be similar

 Duplicates can be costly

 If fresh, handling issues

 If fresh, survival of the tissue!

 Labelling a problem
Station Example 3

Click here for normal Click here for normal

Computers allow a complex array of illustrations

Station Example 3

Click here for normal

Computers allow an array of illustrations

Station Example 3

Computers allow an array of illustrations

Station Example 4a

Applied Anatomy

 Observer

 SP

 Examining couch

 Curtained area

 Gloves

 Hand washing
 Station Example 4b

Radiological Anatomy

A
B
C
D
E
 Station Example 5

Laboratory Investigations
 Path form
 Urine
 Blood smear
 Blood indices
 Perform tests
 Urinalysis
 Sedimentation rate
Case
 M/38
 Right shoulder contusion after fall
 PE: tenderness and swelling over his right upper
chest . No skin impingement and no external
wound found. No distal neurological deficit
elicited
Questions
 1) what is the diagnosis?
 2) what is the classification of the fracture?
 2) what is the management?
Case
 M/70
 Left shoulder contusion after history of fall
 PE: left shoulder in abducted position
 X rays of left shoulder was taken
Questions
 1) what is the diagnosis?
 2) what is the method of reduction?
Dr. Sabina Khan
Member MEU
In what may be labelled as smug
satisfaction, an amazing 94% of teachers
rate themselves above average and 68%
rate themselves in the upper quartile of
teaching performers.
How well you are teaching?

And

How might you improve?

A formal process of gathering
information over a period of
time and the application of
reasoned professional
judgement by an evaluator in
determining whether one or
more aspects of the teaching
of a teacher exceed, meet or
do not meet the teaching
standards.
 “Assume all teaching to
be ineffective till there is
evidence to
contrary”(Mager)

 “Consumer is always
right”
 Provider of  Explainer
Information  Facilitator
 Demonstrator  Supervisor
 Mentor
 Role Model
 Planner
 Assessor

Then Now
Two broad purposes;
 Evaluation for improvement, i.e. Quality
enhancement leading to development and
improvement of learning, teaching etc

 Evaluation for accountability i.e Quality

assurance regarding performance with respect
to promotion, competence, assurance for
stakeholders etc
 Quality teaching

 Professional development

Students success should always be the focus

of teacher evaluation
 The core activity of teaching – i.e planning and
preparation, the classroom environment and
instruction itself.

 Responsibilities of teachers - contribution to the

medical school development and professional
development activities.
 Formative –for teachers
To identify areas for teaching improvement

 Summative –for system and teachers

Judges the effectiveness of teaching
Teacher evaluation requires

 establishment of reference standards

 evaluation criteria to allow proper assessments
of performance.

In particular, a definition of what good teaching is

needs to be developed.
 Electronic Feedback

 Peer –review

 Self-evaluation

 Students feedback
Tape and video recordings

 Viewed by self
 Non threatening
 developed countries
 Somewhat similar to
microteaching

 Observed by senior
colleague during an
actual class
 It covers those aspects of
teaching that students are
not in a position to evaluate.

 Student and peer ratings,

viewed together, furnish a
very comprehensive picture
of teaching effectiveness.
 Prerequisite to
professional growth

 There maybe a conflict

between what you feel and
what students think.

 Self check scales

 Most important source of
obtaining feedback.

 Research has shown that

students views are
consistent with those given
by more experienced
colleagues.
 We can change the focus from

 “what is the quality of your teaching?”

To
 “how can we use evidence gathered from
student feedback and other forms of information
to improve teaching?”
 Most faculty members continue to be
enthusiastic about teaching

 Many have taken courses designed to improve

their teaching skills
 The fundamental purpose of evaluating teachers
and teaching should be to improve the quality of
medical education

 Teacher evaluation and the resulting feedback

will only work if teachers make it work.
 Create & maintain an atmosphere for learning
 Speak with loud and clear voice
 Explain relevance of the matter taught
 Arose interest/curiosity
 Explain clearly
 Provide examples
 Summarize issues before moving on
 Pose thought provoking questions
 Encourage students to share ideas
 Detect confusion and misconcepts in the class
 Provide relevant notes
 Guide for future learning