Transcript Rosalind Franklin University of Medicine and Science

Hands-On Workshop on Writing Patient
Vignettes and Clinical Problem-Solving
Questions
Lecia Apantaku, MD
Michael Fennewald, PhD
Sept. 16, 2015
Session Objective: to be able to construct
patient vignette and problem-solving
questions
Outline: 1. Brief intro to writing test questions
in general.
2. Intro to writing clinical vignette
questions
3. Writing the questions in small groups
4. Reviewing the questions
The Basic Rules for One-Best-Answer Items
• Each item should focus on an important concept,
typically a common or potentially catastrophic
clinical problem.
• Each item should assess application of
knowledge, not recall of an isolated fact.
• The stem of the item must pose a clear question,
and it should be possible to arrive at an answer
with the options covered.
To determine if the question is focused, cover up the
options and see if the question is clear and if the
examinees can pose an answer based only on
the stem. Rewrite the stem and/or options if
they could not.
•
All distractors (ie, incorrect options) should be
homogeneous.
• Avoid technical item flaws that provide special
benefit to testwise examinees or that pose
irrelevant difficulty.
• Do NOT write any questions of the form “Which
of the following statements is correct?” or “Each
of the following statements is correct EXCEPT.”
These questions are unfocused and have
heterogeneous options.
Guidelines for Item Content
• Test application of knowledge using experimental and
clinical vignettes
• Focus items on key concepts and principles that are
essential information (without access to references)
for all examinees to understand
• Test material that is relevant to learning in clinical
clerkships, postgraduate medical education, and
beyond
• Avoid items that only require recall of isolated facts
• Avoid esoteric or interesting topics that are not
essential
The patient vignettes may include
some or all of the following components:
• Age, Gender (eg, A 45-year-old man)
• Site of Care (eg, comes to the emergency department)
• Presenting Complaint (eg, because of a headache)
• Duration (eg, that has continued for 2 days).
• Patient History (with Family History ?)
• Physical Findings
• +/- Results of Diagnostic Studies
• +/- Initial Treatment, Subsequent Findings, etc.
Additional Templates
• A (patient description) has a (type of injury and
location). Which of the following structures is most
likely to be affected?
• A (patient description) has (history findings) and is
taking (medications). Which of the following
medications is the most likely cause of his ( history,
PE or lab finding)?
• A (patient description) has (abnormal findings).
Which [additional] finding would suggest/suggests a
diagnosis of (disease 1) rather than (disease 2)?
• A (patient description) has (symptoms and signs).
These observations suggest that the disease is a
result of the (absence or presence) of which of
the following (enzymes, mechanisms)?
Let us look at some examples of converting
recall questions into clinical vignette style
questions.
So, how can we convert a old-fashioned recall question into a modern board style
board question? Let us consider a couple of examples and then I have some
forms to help that are from the NBME(via the Santa Fe meeting, where NBME
presented)
Old:
Which of the following cells is infected by EBV?
A. B lymphocytes
B. Kupffer cells
C. Macrophages
D. Neutrophils
E. T Lymphocytes.
New: A 19 year old female presents with low grade fever, sore throat, swollen
cervical nodes, and fatigue. She is positive for the monospot test. Which of the
following cells are primarily infected in this patient?
Choices are the same.
Now, let us break into small groups to try a
and rewrite or create clinical vignette
questions.
• Old q. Believing that change will enhance my well
being defines:
• A conviction
• B Confidence
• C optimism
• D skepticism
• E. Frustration
• A 62 year old woman who weighs 300 lbs. with Type
2 diabetes believes that regular exercise and weight
loss will improve her quality of life. This is an
example of: