Transcript Modified essay question

Summative assessment
tools for undergraduate
students
EURACT 15th INTERNATIONAL
COURSE LEARNING AND
TEACHING ABOUT COMORBIDITY
IN GENERAL/FAMILY PRACTICE.
Group 3:
Jaime Correia de Sousa
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Darinka Klančar
Gerry Wheeler
Igor Švab
Marko Kocijan
Matilda Vojnović
Nathalie Bentov
Nena Kopčavar-Guček
VlastaVodopivec-Jamšek
Vojislav Ivetić
AIMS
• To devise summative assessment
tools for final year medical students.
• To assess students’ competence in
using an holistic approach for
managing comorbidity.
TOOLS
• MEQ (Modified Essay Question)
• OSCE
(Objective Structured Clinical
Examination)
MEQ
QUESTION 1
A 64 year old woman who has recently
remarried, has moved to the area. She
comes to visit you for the first time. She
complains of dysuria for 3 days. She also
tells you that she has had Type 2 Diabetes
Mellitus since the birth of the last of her 3
children 25 years ago.
A
B
What symptoms and signs will you ask
for?
(Limit your answer to a maximum of 20
items).
What examinations and investigations
MEQ MARKING GRID
TOTAL MARKS
AVAILABLE
100 POINTS
PASS MARK
50 POINTS
MEQ 1A. Marking Schedule -SYMPTOMS AND
SIGNS (ACUTE- 40 POINTS)
* Essentials.
ITEMS
points
1*
Lower abdominal Pain
5
2*
Frequency
5
3*
Fever
5
4
Urgency
5
5
Flank pain
5
6
Recurrence
4
7
Urine colour change
3
8
Incontinence
3
9
Vaginal discharge
3
10
Dyspareunia
2
MEQ 1A. (BACKGROUND25 POINTS).
ITEMS
POINTS
1
LIFE STYLE (DM DIET)
5
2
DRUGS (DM)
5
3*
DIABETIC MONITORING (LAST
BLOOD TESTS)
DIABETIC REFERRALS (EYE,
OTHERS)
LAST GYNAECOLOGIST VISIT
5
4
5
*essential
5
5
MEQ 1B. EXAMINATION,
INVESTIGATIONS AND REFERRALS
(20 POINTS)
ITEMS
1 * URINE TESTS (DIPSTICK)
POINT
S
5
2 * PHYSICAL EXAMINATION ( ABDOMINAL +
FLANK PERCUSION)
3 TEMPERATURE
5
4
URINE CULTURE
3
5
CONSIDER BLOOD TESTS (CBC)
2
6
BLOOD PRESSURE
2
3
MEQ 1C. PLAN (15 POINTS)
ITEMS
1 * ANTIBIOTICS
POINT
S
5
2 * ARANGE FOLLOW UP VISIT
5
3
DRINKING
2
4
COMPLEMENTARY THERAPY (ANALGESICS, 2
CRANBERRY)
CONSIDER REFERRAL (UROLOGIST1
HEMATURIA + FEVER, GYNAECOLOGISTVAGINAL DISCHARGE CHRONIC
5
MEQ
QUESTION 2
You invite her for a double time consultation a week
later. When she returns, her symptoms have
cleared. She now admits to urinary incontinance
for 10 years and dyspareunia since her recent
remarriage.
She brings her file which shows:
• HbA1C 6.9
• BP 130/80
• ECG Normal
• Eye examination; no retinopathy
A. What issues will you address today?
B. Outline your management plan for the next 3
months
MEQ
Question 3
On her next visit, she tells you that she is
worried about her 30 year-old son, who
has moved in with her and her
husband. She confesses to difficulties
with her husband.
List the factors that might be impacting
on their relationship.
OSCE
Information for the candidate (student)
You are Dr. B, a GP/FP in a practice / health centre.
Mrs. A is a 75 year old woman that has recently
registered with you.
You haven’t seen her previously and you have a
blank clinical file in front of you. Mrs. A’s previous
file has not yet been transferred to you. All you
have is her name, age and address.
Your task will be to interview this patient, write
SOAP notes on the consultation and deal with her
problems and requests.
OSCE
Information for the role player (patient)
Mrs A, a 75 year old woman has recently registered with Dr. B.
Dr.B doesn’t know much about Mrs. A’s previous health problems. When Mrs. A enters the
consulting room coughing, she informs her family physician (FP) that she would like to have her
celecoxib prescription renewed and, by the way, “could you also write down my other usual
prescriptions”? She gives the doctor a paper with the list of regular medication.
Mrs. A, when asked, informs Dr. B. that she has chronic low back pain, was seen by an orthopaedist
in the emergency service two weeks ago and was prescribed celecoxib. This new drug is helping
her.
If asked, Mrs. A. should confess that she sometimes takes both diclofenac and celecoxib.
When asked, Mrs.A. will inform the Dr. that she has been taking paroxetine during her husband’s
terminal disease and since his death she feels lonely and sad. Her feelings are alleviated somewhat
by the paroxetine and she is sleeping better. The only thing she complains about is her weight loss
of about 5 kg in the last month which she attributes to her sadness and depression.
When Dr. B. asks Mrs. A about the reasons for taking salmeterol she will inform her that she was
given that for her COPD and that she feels much better from using it. She was seen by a lung
specialist 3 months ago and had a chest X-ray and everything was OK.
If asked, she will confess smoking 20 cigarettes a day and she has thought about quitting but it is
OSCE
Information for the examiner
The student is expected to write SOAP notes on the consultation. The
different elements of these notes will be used for the assessment of the
OSCE station. The consultation will be video recorded. The observers will
use a classification form to mark the student’s performance.
During the interview, the doctor should review the medication together
with the patient and the reasons why she’s taking them.
There will be marks for:
A.Identification of the problems
B.Management and prioritisation
C.Follow-up
D.Empathy
OSCE APPENDIX 1
OBJECTIVE (EXAMINATION)
Blood pressure
Pulse
Cardiac auscultation
Pulmonary
auscultation
Lasseque/
straight leg raising
Bragard
Temperature
135/70
72
Normal
Normal
Normal
Negative
36.8oC
OSCE APPENDIX 2
LIST OF MEDICATION
SALMETEROL
500mcg
2 puffs bd
PAROXETINE 20 mg 1 daily
DICLOFENAC 75 mg 1 bd
OSCE APPENDIX 3
LAB tests
CBC
normal
CRP
low
Complete biochemistry
tests
normal
Urine analysis
normal
OSCE
Information for the candidate (student)
You are Dr. B, a GP/FP in a practice / health centre.
Mrs. A is a 75 year old woman that has recently registered with
you.
You haven’t seen her previously and you have a blank clinical file
in front of you. Mrs. A’s previous file has not yet been transferred
to you. All you have is her name, age and address.
Your task will be to interview this patient, write SOAP notes on the
consultation and deal with her problems and requests.
OSCE Marking Schedule
TOTAL MARKS
AVAILABLE
30 POINTS
PASS MARK
16 POINTS
OSCE Marking Schedule
A. Identification of the problems
(10 points; from SOAP written by the
student)
Item
Weight loss
Bereavement
Point
s
3
2
Smoking
2
Depression
1
Low back pain
1
Cough
1
OSCE Marking Schedule
B. Management and prioriatisation
(10 points; from video observation)
Item
Points
Discussion of weight loss
3
Discussion concerning diclofenac
3
Discussion concerning smoking
3
Review of salmuterol and other
medications
1
OSCE Marking Schedule
C. FOLLOW UP (5 points; from SOAP)
Follow up advice
5
D. CANDIDATE’S ATTITUDE (5 points;
from video)
Empathy
5