A Model for Integrated Assessment of Clinical Competence

Article excerpt

An interdisciplinary group of faculty from medicine, basic sciences, physical therapy, and education developed a performance assessment tool for evaluating clinical competence. This group was assembled following the revision to integrated systems-based curricula in the school of medicine and doctor of physical therapy program. The group was challenged to measure curricular outcomes through student assessment of clinical competence as defined through integration. The Integrated Standardized Patient Examination was developed as the assessment tool. This model utilizes standardized patients, who are trained to ask questions that require the students to integrate scientific knowledge and communicate this back to the patient. The student response is graded on a rubric and averaged with a historytaking portion of the examination. This model was administered to 140 first-year medical students who were randomly assigned to either an acute low back pain case or gastroesophageal reflux disease case. Clinical faculty scored the students in the treatment room, with additional faculty scoring in the monitor room. Interrater agreement was 87% for the low back pain case and 82% for the gastroesophageal reflux disease case. These results warrant further investigation of the Integrated Standardized Patient Examination for transfer to other health care professions, in particular physical therapy. J Allied Health 2007; 36:157-164.

FACULTY IS SPENDING substantial time and energy creating and implementing new curricula and is being held accountable to ensure students acquire a minimum level of clinical competence. While curricular reform and integrated curricula are well described and implemented in the health professions, meaningful measurements of competency to test the success of curricula have yet to be described, implemented, or validated.1 Student assessment is an important aspect of any health profession curriculum. All assessment methods should be meaningful, applied consistently to all students, and linked to the intended learning outcomes.2

Traditional assessment methods have been perceived as distorting the learning process and favoring knowledge limited to recall, identification, or recognition. This report proposes a new model for assessment of clinical competence based on validation and pilot results with first-year medical students. The potential for application of this model to other health profession students is discussed.

Assessment, Integration, and Competence

Academic faculty must make conscientious decisions when choosing student assessments. Assessment drives teaching methods and learning and has powerful effects on student performance.3,4 If students are queried only for their knowledge of facts, they tend to develop a learning strategy of rote memorization. If they are assessed for their capability to integrate their knowledge, students will develop a more deeply oriented learning strategy.5 Students become more mindful and conscientious if exercises are observed and graded.6 This "steering effect" of assessment pushes students to learn best those subjects on which they expect to be rigorously examined.7

During clinical encounters, health professionals integrate knowledge from basic science and clinical courses and apply these concepts during the process. For example, when a physical therapist examines a patient with a back injury, information acquired during courses on anatomy, physiology, biomechanics, musculoskeletal, and clinical foundations must be recalled and integrated.8 Integration is a cognitive process that can be facilitated, but not guaranteed, by an integrated curriculum. The teacher provides a framework of learning opportunities, but integration of knowledge is done in the mind of the student, in the real world of clinical care.9

Clinical competence in health professions is an outcome of the curriculum and must include the integration of scientific knowledge with communication skills. …