Problem-based learning as a preparation for professional practice

Tijdschrift voor Medisch Onderwijs, Dec 2006

There is increasing pressure for professional accountability and assurance to the public that doctors are clinically competent to practise. UK medical schools, to deliver more reliable examinations which test broadly across the curriculum, have moved from traditional assessments such as long cases and orals to more ‘atomised’ formats such as the Objective Structured Clinical Examinations (OSCEs) and Multiple Choice Questions.

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Problem-based learning as a preparation for professional practice

Valerie J. Wass Problem-based learning as a preparation for professional practice in high stakes examinations: are we justified in abandoning old methodes in favour of the new? Proefschrift - Val Wass is a General Practitioner who over the years has developed an increasing interest in Medical Education and now leads the Community Based Medical Education at Manchester Medical School. She completed a Masters in International Health Professions Education at Maastricht University in the Netherlands. Research into medical school final year examinations was the subject of her PhD thesis. She has wide experience of the assessment of clinical competence for both undergraduate and postgraduate courses. There is increasing pressure for professional tery of tests was used consisting of three writaccountability and assurance to the public that ten papers, an OSCE (new) and two history tadoctors are clinically competent to practise. king long cases (traditional). The study addresUK medical schools, to deliver more reliable sed a series of research questions. examinations which test broadly across the Using multivariate generalisability theory, curriculum, have moved from traditional aswe demonstrated that careful structuring of sessments such as long cases and orals to more tests to balance the length and format of indiatomised formats such as the Objective Strucvidual tests is crucial to achieve acceptable and tured Clinical Examinations (OSCEs) and Mulmeaningful reliability. We then studied the tratiple Choice Questions. Yet there was a paucity ditional formats. No one knew how many long of published psychometric data on traditional cases would be needed to achieve a reliable methods to support this change. My thesis seihigh stakes test. We concluded that eight to ten zed the opportunity to study a final examinathirty minute HT long cases would achieve retion moving from old methodology to new. The liability consistent with a high stakes examinakey research question overarching the thesis tion. Length of testing time rather than the mewas: Have we become too atomistic in our thod used appears to reign supreme. A further approach to assessing clinical competence? study on oral examinations, another traditional The final medical school examination format under threat, confirmed this. Extending under study focused on assessing competency testing time to four 20-minute orals, each with traits: knowledge, skills and attitudes. A battwo examiners, or five orals, each with one examiner, resulted in predicted pass/fail reliabilities consistent with high stakes tests. Finally we investigated the objectivity of the OSCE. Ethnic minority students tended to perform less well. Was there a possible disadvantage either in using simulations rather than real patients or bias in the marking? Interactions on four communication stations were videoed and analysed using qualitative discourse analysis. No examiner bias was seen but the research highlighted once again the importance of ensuring tests are carefully constructed. These studies have shown that it is not the test format that matters as much as the test content i.e., as long as the examination samples widely enough, traditional formats have the same potential as new ones to provide reliable assessments of clinical competence. The trait model presents welcome opportunities to of approaching assessment expressed as domains of knowledge, skills and attitudes may be too simplistic and can create complicated tests which need careful design. No single method is flawless. The advantages of using standardised rather than real patients may not be as significant as was originally thought. The traditional assessment methods, such as the long case and orals, use a more integrated process and should not be discarded although they have a more formative rather than summative role. The current move away from examinations towards more assessment in the workplace revisit and develop these test methodologies.


This is a preview of a remote PDF: https://link.springer.com/content/pdf/10.1007%2FBF03056760.pdf

Bohn Stafleu van Loghum. Problem-based learning as a preparation for professional practice, Tijdschrift voor Medisch Onderwijs, 2006, 300, DOI: 10.1007/BF03056760