In this summative e-delivered assessment students develop a case formulation in which they synthesise key aspects of a written vignette to provide a cohesive narrative of the reasons for the clinical presentation and vulnerability and strengths of the individual described in the vignette, adhering to strict character limits. Justification of differential diagnosis and description of issues which require further clarification are used to demonstrate clinical reasoning. Presentation of a concise and tailored management plan aligns with the clinical reality of the intern role after graduation.
This examination comprises 40% of the final grade for the 6-week Mental Health Placement in Year 3 of the Medical Program. We provide a case vignette in an on-line examination platform and students complete the examination in a 90-minute period. The information is confined to an A4 page of script with consistent headings: Presentation, Past Psychiatric History, Medications, Past Medical History, Drug and Alcohol use, Family Psychiatric History, Personal History, Mental Status Examination.
Students are instructed to:
- Write a bio-psycho-socio-cultural formulation for this person including presenting, precipitating, predisposing, perpetuating and protective factors as well as risk factors [30 marks]
- Write a list of the significant gaps in the history with the MOST IMPORTANT gaps identified first [15 marks]
- Write your provisional diagnosis. Do not use abbreviations [5 marks]
- List three (3) differential diagnoses (the MOST LIKELY differential diagnosis should be first). Do not use abbreviations [10 marks]
- Describe your management plan in detail assuming you are an intern working in this setting and are responsible for the patient's ongoing care [40 marks]
Details
- CLASS SIZE
- 100-500
- CLASS LEVEL
- Post-graduate
- ASSESSMENT SECURITY
- Medium security
- TIME REQUIREMENTS
- CONDITIONS
- Identity verified, Work-related, Time limited
- FEATURES
- Authentic, Online, Problem based
- TAGS
- analysis
Advantages
The impetus for the development of this assessment was the logistic problems posed with transition to a semester-based course in which teaching time was shared with cognate disciplines and assessment moved from every 8 weeks (corresponding to a clinical placement) to end-of-semester. Delivery of previous viva examinations was no longer possible in end-of-semester examinations because of the large numbers of students and the number of international students studying overseas, meaning that they would otherwise be compelled to return to UQ for assessment. We introduced this assessment in 2019 and have conducted two end-of-semester examinations and deferred and supplementary examinations.
The assessment represents a "surrogate" or approximation of the previous viva examination which was our most discriminating assessment item. In 2019 the assessment demonstrated an acceptable range in the standard of student responses similar to the previous viva examinations.
The advantages are listed below:
- The assessment writing is less time-consuming than the case development required for the previous viva examinations
- We are no longer making requests for clinical teachers to spend a morning examining in vivas (5 times per year, corresponding with the previous 8-week clinical placements) and asking professional staff to arrange the examination teams as the written examination is delivered in one location including in Ochsner
- We develop pre-determined marking criteria and rules for grading critical errors/omissions
- We do not face the type of student challenges to their grades as previously in the viva – although examiners had marking guides these were not always robustly followed and students could argue along the lines of "well I did say that, even if the examiner didn't mark that I had"
- We grade the written essays centrally and can double or triple mark easily. Marking can be done remotely as the electronic database is secure and easily accessed
- We now have the capacity to develop clear summaries for student feedback based on actual written material rather relying on sometimes rudimentary viva examination notes obtained from different examination sites. We send this feedback to clinical teachers who report that this is very helpful in guiding their teaching
- Remarks are remarks – we are able to have an independent examiner assess the original script rather than devising a new assessment
- The assessment allows us to clearly appraise the quality of writing of students– documentation is fundamental in medical practice and this in turn informs our feedback to students. In addition, the explicit instruction to not use abbreviations is important as many errors in clinical practice arise in relation to abbreviations
- Using strict character limits conveys the importance of being succinct and is in line with clinical practice in which copious notes risk not being read
- The focus on marking based on specific tailoring and prioritisation of management reflects clinical practice and embeds the importance of this in student's minds
Challenges
Marking is time consuming as is writing feedback on performance of individual students – over 200 per semester
Determining marking adjustments for critical errors is challenging and it is impossible to devise a rubric for every possible error
Use of a written examination in place of a viva means that students whose first language is not English may be at increased disadvantage
In a viva examination an examiner can prompt a student in which case a student may self-reflect and identify errors which is not possible in a written examination
We lose an opportunity for demonstration of professionalism by experienced clinicians who examined students in vivas
Tips for implementation
Use of the electronic platform is critical for success of this strategy – written student texts are challenging to mark. The electronic platform means flexibility with marking as scripts can be marked remotely
How it supports academic integrity
Examination is invigilated and student essays are uploaded to a protected electronic database.
Professor Jane Turner
jane.turner@uq.edu.au
I have worked for over 20 years in the field of Psycho-Oncology as a psychiatrist providing treatment for patients with cancer and their families, and developing a program of research focused on interventions in areas of clinical need, and translational research examining sustainable models of service delivery.
Psycho-Oncology encompasses attention to the psychological, emotional and social needs of people with cancer and their families or carers. It encompasses attention to spiritual and cultural concerns, across all phases of the cancer experience from diagnosis, through treatment, survivorship or advanced diseases. It is a relatively new discipline. The International Psycho-Oncology Society was established in 1984. As such, much of the research in this field has been descriptive and it is only in recent years that robust trials of interventions have become more common. involves attention to the psychological, emotional and social needs of people with cancer and their family or carers. Find out more