‫ارزشيابي صالحيت باليني‬
‫‪Workshop for assessing‬‬
‫‪clinical competence‬‬
‫دكتر محمدرضايوسفي‬
‫‪MD-MPH- MS.c Medical education‬‬
‫عضوهیئت علمی‬
‫مرکز مطالعات و توسعه آموزش پزشکی دانشگاه‬
‫دفترتوسعه آموزش باليني‬
‫اهداف آموزش ی‬
‫محتوای برنامه‬
‫برنامه‬
‫شیوه های تدریس و‬
‫اجرای برنامه‬
‫‪3‬‬
‫ارزشیابی‬
Evaluation is for
Improvement
Not
Provement
Professional Competence
• The habitual and judicious use of
communication, knowledge, technical skills,
evidence based decision making, emotions,
values, and reflection to improve the health
of the individual patient and the community.
‫“بههک رههری یی عردت ونههک و مدبیهنههک دهن ه مهریتهههر هیتبرطههرتی‬
‫ بهههههروینب عوهطههههه هی ههههههر و‬،‫مهریتههههههري عملهههههب هنهههههتدف‬
‫ دی هههت مهدمت بهک فهید‬،‫بر هندی ب دی فعرویت حیفکهي یو مهی‬
"‫و هرمعک‬
Epstein and Hundert, Designing and assessing professional competence. JAMA 287:226, 2002
5
What is Clinical Competency?
The ability to handle
a complex professional task by
integrating knowledge, skills and attitudes.
‫نگرش‬
‫مهارت‬
‫عملی‬
‫شناخت‬
(‫)دانش‬
‫ مهارت عملی و‬،‫تلفیق دانش‬
‫نگرش های حرفه ای در ضمن‬
‫انجام یک وظیفه بالینی‬
‫پیچیده‬
Reference
Van der Vleuten, C. The assessment of professional competence: developments,research and practical implications Advances in
Health Science Education 1996, Vol 1: 41-67
Rice et al., Competency-based objectives for clinical training. Can. J. Med. Technol. 57:136, 1995
What is the best way to evaluate
Clinical Competency?
Behavior Skills
& attitudes
Performance assessment: Masked SP
Competency assessment: OSCE
Clinical based tests: MCQ
Knowledge
Knowledge tests:
MCQs
Miller’s Pyramid of Competenc
Miller GE. The assessment of clinical skills, competence, performance Acad Med, 1990; 65(Suppl.):S63-S67.
Professional authenticity
A simple model of competence
Does
Performance
or hands on
assessment
Shows how
Knows how
Knows
Miller GE. The assessment of clinical skills/competence/performance.
Academic Medicine (Supplement) 1990; 65: S63-S7.
Written,
Oral or
Computer
based
assessment
Professional authenticity
Model of competence
Behaviour~
skills/attitudes
Cognition~
knowledge
Miller GE. The assessment of clinical skills/competence/performance.
Academic Medicine (Supplement) 1990; 65: S63-S67.
climbing the pyramid
Does
Does
Shows how
Knows how
Knows
Performance assessment in vivo:
Masked SPs, Video, Portfolio…..
Competence assessment in vitro:
OSCE, …..
(Clinical) Context based tests:
MCQ, essay type, oral…..
Factual tests:
MCQ, essay type, oral…..
Validity of testing formats
Professional practice assessment
Performance assessment: OSCEs,
long/short cases, etc
Problem-solving assessment:
PMP MCQs,..
Knowledge assessment: MCQs..
Miller’s Pyramid for Assessing
Clinical Competence
Work
Action
Does
OSCE
Performance
Shows How
PMPs
Competence
Knows How
MCQs
Knowledge
Knows
Expanding our toolbox…..
Does
Shows how
Knows
how how
Knows
Knows
Knows
Established technology
of efficient written or
computer-based high
fidelity simulations
(MCQ, Key Feature, Script
Concordance Test, MEQs….)
Expanding our toolbox…..
Does
Shows how
Knows
Knows
how how
Knows
Established technology of
structured high fidelity in
vitro simulations
requiring behavioural
performance (OSCE, SPbased testing, OSPE….)
Expanding our toolbox…..
Does
Does
Shows how
Shows how
Knows how
Knows
Emerging technology
of appraising in vivo
performance (Work-based
assessment: Clinical worksampling, Mini-CEX, Portfolio,
practice visits, case orals….)
Expanding our toolbox…..
Does
Shows how
Emerging technology
of appraising in vivo
performance (self-, peer,
co-assessment, portfolio,
multisource feedback, learning
process evaluations……)
Knows how
Knows
“Domain specific” skills
“Domain
independent”
skills
ACGME Core Competencies
(The 6 Competencies)
1.
2.
3.
4.
5.
6.
Patient Care
Medical Knowledge
Professionalism
Interpersonal & Communication Skills
Practice-Based Learning and Improvement
Systems-Based Practice
17
‫انواع آزمونها‬
‫‪ -1‬آ مونهر تکوینی ‪(Formative):‬‬
‫• ارزيابي هاي محل خدمت (‪ )Workplace‬با پس خوراند (‪ )feedback‬مناسب‬
‫درطول دوره آموزشی‬
‫• پيشرفت تحصيلی وتجربيات يادگيری دانشجو‬
‫• تمام عملكرد و رفتار يك دانشجو مورد ارزيابي قرار مي گيرد‪.‬‬
‫‪ -2‬آ مونهري تهمعی ‪)Summative( :‬‬
‫• نشانگر قبولي يا ردي از امتحان آخر ترم يا ارتقائ ساالنه دستياري مي باشد ‪.‬‬
‫• ارزيابي فقط در حيطه دانش مي باشد‪.‬‬
‫?‪What are assessment tools‬‬
‫كتبي‬
‫كوتاه پاسخ‬
‫گسترده پاسخ‬
‫‪extended‬‬
‫بسته‬
‫جور كردني‬
‫چندگزينه‌اي‬
‫انجام تكاليف ‪Assignments‬‬
‫‪Cued questions‬‬
‫صحيح‪-‬غلط‬
‫‪Uncued questions‬‬
‫باز‬
‫تشريحي‬
‫محدود پاسخ‬
‫‪restricted‬‬
‫آ مونهر رتبی‬
‫‪ ‬کاربرد‪:‬‬
‫آزمونهای کتبی‬
What are assessment tools?
Lab-based practical
PBA(Procedure – based Assessment)
DOPS
‫آزمون‌هاي عملي‬
Practical
What are assessment tools?
(Chart Stimulated Recall ) CSR ‫یا‬CBD
GRF
OSCEs
Mini-CEX
‫آزمون‌هاي باليني‬
Clinical
What are assessment tools?
Structured
‫شفاهي‬
Unstructured
‫ارزيابي هاي در محل خدمت‬
) Workplace Based Assessment)
• Mini-CEX )Clinical Evaluation Exercise)
•
•
•
•
•
•
CBD ‫يا‬CSR (Chart Stimulated Recall)
DOPS ) Direct Observation Of procedural Skills)
PBA (Procedure – based Assessment)
360° ‫) هی یربی‬Mini-PAT(
OSCE (objective structured clinical examination)
GRF(Global Rating Form )
Climbing the Pyramid
Does
Does
Showshow
how
Shows
Knowshow
how
Knows
Knows
Knows
Performance Assessment :
Video, Real patient( Mini-CEX – DOPS-…)
Competence Assessment :OSCE
(Clinical) Context Based Tests:
essay type, oral
Knowledge Tests: MCQ
‫ارزشیابی صالحیت بالینی‬
‫به وسیله آزمون بالینی ساختارمند عینی‬
‫)‪(OSCE‬‬
‫)‪(Objective Structured Clinical Examination‬‬
What’s in a name?
O
S
C
E
bjective
tructured
linical
xamination
OSCE
OSCE
Objective
Structured
Clinical
Examination
‫عینی‬
‫ساختاردار‬
‫بالینی‬
‫آزمون‬
‫ن آسووکی يووک آزمووون ارزيووابی صووالحيت بووالينی‬
‫• آزمووو ‌‬
‫اسووت کووه ب ووورت عينووی در ايسووتگاههای م تلووف‬
‫سووازماندهی شووده و تهري ووا هوور چهووار ضووابطه ي وک‬
‫آزمون عادالنه را داراست‪.‬‬
‫• همک دهوطلبین بر یك مقیرس یکنرن موید ننه‬
‫معیار ارزشیابی می شوند‪.‬‬
‫‌‬
‫• همه دانشجویان با یک‬
‫قیهی مب ییند‪.‬‬
‫‪OSCEs - Structured‬‬
‫تدهبیی و بینرمک هی هینتگر‪ ،‬نظرم دهی هنت‪.‬‬
‫• هب هیهنده ‪ ،‬یی دیهیهینتگر‪ ،‬ویژ‪ ،‬همرن هینتگر‪ ،‬تنظیم د‪ ،‬هنت‪.‬‬
‫• دیهیهینتگر‪ ،‬یک مهریت بروینی ویژ‪ ،‬مویدهی یربی قیهیمی یید‪.‬‬
‫‪ ‬مهارت هاي ويژه اي كه در هر ايستگاه مورد آزمون قرار مي گيرند‬
‫شامل موارد زير است‪:‬‬
‫‪o History taking‬‬
‫‪o Interpersonal communication‬‬
‫‪o Clinical examination‬‬
‫‪o Procedures‬‬
•
.‫آزمون توانایی انجام مهارتهای بالینی است‬OSCE
Students have to demonstrate their skills, not just
describe the theory

‫‪Clinical Examination‬‬
‫‪‬هی‬
‫یربی یفتری حیفک ه و مهریتهر هیتبرطی‬
‫• هینتگر‪ ،‬هریی بر حضوی بیمرینمر‬
‫• فیهیند یه هی یربی رنید نک محتوه یه‬
‫مثال دهن هو چگونک صحبت رید نک هینکک چک فت‪.‬‬
‫‪‬هی‬
‫یربی مهریتهر بروینی‬
‫• توهنمند دهن هو و فیهیند هنهرم مهریت یه هی یربی رنید‬
‫نک نتیهک رری یه‪.‬‬
Educational Outcomes Service Group
Educational Outcomes Service Group
Competencies:
Six
and Improvement: TheRespond
HOW YOU GET BETTER
Competencies:
The
Six Doma
Sample Behaviors Within Each
Domain
Sample Behaviors Within Each Domain
Writes leg
Interpersonal and
Consider
Sample Behaviors Within Each Domain
Skills:about patients
Gathers essential andCommunication
accurate information
Gathers
essential of
and
accurate
informationDocumen
about pa
Prioritizes
the purpose(s)
the
visit
HOW
YOU
INTERACT
Uses
effe
Interpersonal
and of the visit
Prioritizes
the purpose(s)
Makes accurate
diagnoses
WITH
OTHERS
Possesse
Makes
accurate
diagnoses
Gathers
essential
and accurate
information
about patients
Communication
Skills:
Prescribes
appropriate
therapeutic
interventions
Creates a
Prescribes
appropriate
therapeutic
Prioritizes
the
purpose(s)
of
the visit
Counsels
and
educates
patient
and familiesinterventions
HOW
YOU
INTERACT
Interpersonal
Counsels
and educates
patient
and familiesand colle
Makes
accurate
diagnoses
Incorporates
prevention
into care
planand
WITH
OTHERS
Incorporates
prevention
care
plan examCreates a
Prescribes
appropriate
therapeutic
interventions
Communication
Skills:
Conducts
an appropriate
historyinto
and
physical
families,
Conducts
an appropriate
history
and physical
exam a
Counsels
and
educates
patient
andINTERACT
families
HOW
YOU
Performs
procedures
well
Works
eff
Performs
procedures
well
Incorporates
prevention
into care
plan
Orders appropriate
diagnostic
tests
WITH
OTHERS
appropriate
diagnostic
tests exam Presents
ConductsOrders
an appropriate
history
and physical
Performs procedures well
Orders appropriate diagnostic tests
Applies knowledge to patient
care
Professionalism:
Appliesinvestigatory
knowledge
toand
patient
carethinking Respond
Demonstrates
analytic
HOW
YOU
ACT
Demonstrates
investigatory
Reliably c
Knows and
applies basic
sciences and analytic thinking
Knows
and
applies
basic
sciences
Applies
knowledge
to patient
Sees pat
Understands
a)Professionalism:
anatomy
b) care
physiology
c) biochemistry
Understands
a) anatomy
b) physiology
c) biochemis
Demonstrates
investigatory
and
analytic
thinking
Demonst
d) microbiology
e)
pathology
f)
pharmacology
g)
neurosc
HOW
YOU
ACT
microbiology
e) pathology f) pharmacology
g) n
Knows
and d)
applies
basic sciences
Demonst
Understands
psychology/behavioral
medicine
Understands
psychology/behavioral
medicine
Understands
a)
anatomy
b)
physiology
c)
biochemistry
gender, d
Understands
functionfunction
of Professionalism:
surgicalsurgical
instruments
Understands
instruments
d) microbiology
e) pathology of
f) pharmacology
g) neuroscie
Serves ef
HOW YOUmedicine
ACT
Understands psychology/behavioral
Understands
function of surgical instruments
Reads Reads
Uses information
technology
to support
own education
ho
Uses information
technology
to support
ownKnows
educatio
Locates,
evaluates
and
utilizes
evidence-based
resources
Knows
ho
Systems-Based
Practice:
Reads Locates, evaluates and utilizes evidence-based reso
Teaches
students
and
other
health
care
professionals
(facili
Understa
HOW
Teachestechnology
students
and
otherWORK
health
care professiona
Uses information
to YOU
support
own education
learning)
Bills appr
learning) andWITHIN
Locates, evaluates
utilizes evidence-based
resources
THE
SYSTEM
Systems-Based
Practice:
Engages
in continuing
medical
education
Engages
in continuing
medical
education Understa
Teaches
students
and
other
health
care professionals
(facilita
Responds
to
feedback
Able
to u
HOW
YOU
WORK
learning) Responds to feedback
Understa
WITHINSystems-Based
THE
SYSTEM
Engages in continuing
medical
education
Practice:
Practices
Responds to feedback
HOW
YOU
WORK
Ensures a
Handout prepared by
Writes legibly
Writes Lynne
legibly
Effectivel
Tomasa,
PhDTHE SYSTEM
WITHIN
Considers
literacy
level
of level
others
A more
extens
Considers
literacy
of others
520-626-7823
Uses
app
Competencies: The SIX Domains
Patient Care:
Patient Care:
WHAT YOU DO
WHAT YOU DO
Patient Care:
WHAT YOU DO
MedicalMedical
Knowledge:
Knowledge:
WHAT YOU
KNOW
WHAT YOU KNOW
Medical Knowledge:
WHAT YOU KNOW
PracticePractice
Based Learning
Based Learning
and Improvement:
and Improvement:
HOW YOU
GET
BETTER
Practice
Based
Learning
HOW
YOU
GET BETTER
and Improvement:
HOW YOU GET BETTER
Objective Structured Clinical Examination
Medical authorities & faculties
started to implement the OSCE
exams for clinical and communication
skills assessment of medical
students, clerks, interns, residents,
and graduates since the 1980s.
It is a standardized method of clinical
evaluation that eliminates bias.
www.OSCEhome.com
Objective Structured Clinical Examination
OSCE is a form of performancebased testing used to measure
candidates’ clinical competency.
During an OSCE, candidates are
observed and evaluated as they go
through a series of stations in
which they interview, examine and
treat standardized patients (SP)
who present with some type of a
medical problem.
www.OSCEhome.com
Objective Structured Clinical Examination
“The OSCE is an approach to
the assessment of clinical
competence in which the
components of competence are
assessed in a planned or
structured way with attention
being paid to the objectivity of the
examination”. Harden, 1988
www.OSCEhome.com
Objective Structured Clinical Examination
 The curriculum tells the staff what to teach...
 The OSCEs tells the students what to learn !
 And that is the point….
 What OSCE candidates should learn?
 What candidates can do rather than what they
know.
www.OSCEhome.com
Objective Structured Clinical Examination
The application of their knowledge
rather than the recall of knowledge.
The ‘WHAT’ to ask and do.
The ‘HOW’ they ask and do.
The ‘WHEN’ they ask and do.
How do they organize themselves.
How do they communicate with
patients.
www.OSCEhome.com
Objective Structured Clinical Examination
• The OSCE has offered a strikingly new
and exiting way of making valid
assessment of clinical performance of
medical student ,resident, and fellows .
What is the purpose of the
OSCE?
• Provide feedback on performance
• Evaluate basic clinical skill
• Measure minimal competency
What is OSCE?
• It is some sort of student
evaluation that examinee
will go through several
stations to be evaluated
in clinical fields by special
rating scales and
checklists.
M. Mohammadi MD
OSCE is Useful
to Evaluate:
• Clinical skill
• Practical attitudes
• Practical knowledge
OSCE =Performance-Base assessment
(Skill Based Assessment) :
Actual Performance of clinical skills
is
observed in order to adjudicate the
competence of Health professionals
What is the format
of OSCE?
What is the
format of OSCE?
• It consists of several
Stations
• (12-20 each lasting 5 to
15 minutes not more
than 30 seconds rest
between each).
‫‪OSCE‬‬
‫• نکاتی که بايد هنگام طراحی اين آزمون رعايت نمود‪:‬‬
‫– تهیه ‪:blueprint‬‬
‫• تعیين اهداف آموزش ی مهمی که باید مورد ارزیابی قرار گيرند‪.‬‬
‫– تعداد کافی ایستگاه‪:‬‬
‫• تعداد ایستگاه بیشتر از زمان هر ایستگاه اهمیت دارد‪.‬‬
‫– برنامه ریزی دقیق و منظم‬
‫– پیش بینی وقایع احتمالی‬
‫‪OSCE‬‬
‫‪ ‬نحوه برگزاری آزمون‪:‬‬
‫‪ ‬ایستگاههای پشت سر هم و در هر ایستگاه یک ‪ task‬مشخص‬
‫‪12 ‬تا ‪ 20‬ایستگاه و هر ایستگاه ‪ 5‬تا ‪ 15‬دقیقه‬
‫نقشه طرحريزي شده از ‪ 9‬ايستگاه ‪OSCE‬‬
‫‪4‬‬
‫‪3‬‬
‫‪2‬‬
‫‪1‬‬
‫‪Start‬‬
‫‪5‬‬
‫‪6‬‬
‫‪7‬‬
‫‪8‬‬
‫‪9‬‬
‫‪End‬‬
‫تعيين پروسه امتحان‬
‫‪1‬‬
‫‪2‬‬
‫‪3‬‬
‫‪4‬‬
‫‪5‬‬
‫‪6‬‬
‫‪7‬‬
‫‪8‬‬
‫‪10 9‬‬
10
9
8
7
6
5
4
3
2
1
‫ايستگاهها‪:‬‬
‫یو ‪ :‬معموف ً ‪ Observer‬ف م هنت‪.‬‬
‫نؤهفت و تفرنیی ‪Observe :‬ف م نینت‪.‬‬
‫معموف ً‬
What is the
stations’ contents?
What is the
stations’ contents?
•
•
•
•
•
Case history
Physical exam
Real patient
Standardize pt.
Simulated pt.
•
•
•
•
•
History taking
Clinical procedure
Radiographs
Slide presentation
…
‫‪OSCE‬‬
‫‪‬‬
‫محتوای ایستگاه ها‪:‬‬
‫‪‬‬
‫اخذ شرح حال‪ ،‬معاينه فيزيکی‪ ،‬مشاوره و آموزش بيمار‪ ،‬تفسير اطالعات بيمار‪،‬‬
‫پروسيجرمانندکشيدن دندانهاي قدامی فک باال و پايين وبی حسی موضعی وتنه ای‬
‫روی مانکن و‪...‬‬
‫ایستگاه های ‪manned‬‬
‫ایستگاه های ‪unmanned‬‬
‫‪‬‬
‫محتوای ایستگاه ها‪:‬‬
‫اختالالت مفصل گيجگاهی – فکی‬
‫گرافی ‪OPG‬‬
‫محتوای ایستگاه ها‪:‬‬
‫• تزريق بی حسی موضعی فک باال روي مانکن‬
‫• تزريق بی حسی تنه ايی فک پايين روي مانکن‬
‫مشاوره و آموزش بيمار‬
‫مال اکلوژن‪-‬بيماری های لثه‬
‫مال اکلوژن‬
‫گرفتن تاريخچه بيمار‬
How do you evaluate
the examinee?
How do you evaluate
the examinee?
• Checklist
• Rating scale
• Short answered
questions
•…
‫چگونگی ارزيابی ‪:‬‬
‫‪OSCE‬‬
‫– معیارهای ارزیابی از قبل و بر اساس اهداف آموزش ی تعیين می‬
‫شوند‪.‬‬
‫– از یک چک لیست استاندارد شده برای ارزیابی استفاده‬
‫شود‪.‬‬
‫می‬
Who are the
Raters?
Who are the
Raters?
•
•
•
•
•
Simulated pt.
Standardized pt.
Clinical staff
Non clinical staff
Non expert raters
‫‪OSCE‬‬
‫• ارزيابی کنندگان‪:‬‬
‫– ناظر متخصص‬
‫– ناظر غيرمتخصص‬
‫– بیمار(نما)‬
OSCE is suggested the first best method for evaluation of:
• Interviewing
•
•
•
•
•
•
•
Counseling & educating pt’s & families
Performing procedures
Physical examination
Preventive health services
Creation of therapeutic relationship with patients
Listening skills
Respectful & altruistic behaviors
• Sensitive to cultural, age, gender & disability issues
‫چند مثال براي فعاليتهايي كه مي توانيم براي ايستگاهها در‬
‫نظر بگيريم ‪:‬‬
‫‪ ‬معاينه يك بيمار واقعي‬
‫‪ ‬معاينه بيمار استاندارد شده‬
‫‪ ‬آموزش بيمار واقعي‬
‫‪ ‬انجام عمل مشاوره درباره يك موضوع با يك بيمار‬
‫واقعي يا تهليدي (تلفني يا حضوري )‬
‫‪ ‬شناسايي عوامل بيماريزا زير ميكروسكوپ‬
‫‪ EEG, EMG , ECG ‬راديوگرام‪ ،‬اسپيروگرام و ‪...‬‬
‫‪ ‬تشخيص بيماري از روي اساليد و ت وير يا فيلم‬
‫چند مثال براي فعاليتهايي كه مي توانيم براي ايستگاهها در نظر بگيريم ‪:‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫‪‬‬
‫ديدن شرح حال و آزمايشات بيمار و تشخيص بيماري‬
‫بررس ي و نهد پرونده بيماران مرخص شده‬
‫گوش كردن نوار صداهاي قلبي و تشخيص انواع صداهاي‬
‫ط يعي و غير ط يعي‬
‫انجام يك كار عملي بر روي موالژ‬
‫كار با دستگاهها و تجهيزات پزشكي‬
‫انجام يك آزمايش پاراكلينيكي‬
‫افتراق داروها و مواد شيميايي‬
‫‪ ‬تشخيص ماكروسكوپي نمونه اتوپس ي شده‬
4/13/2015
80
‫• آزمووون آسووکی يووک آزمووون ارزيووابی صووالحيت بووالينی‬
‫اسووت کووه ب ووورت عينووی در ايسووتگاههای م تلووف‬
‫سووازماندهی شووده و تهري ووا هوور چهووار ضووابطه ي وک‬
‫آزمون عادالنه را داراست‪.‬‬
‫مزايای استفاد از ‪: OSCE‬‬
‫‪.1‬‬
‫موثر است‪.‬‬
‫اين روش براي سنجش صالحيتهاي كلينيك ‌و حل مسئله ‌‬
‫‪.2‬‬
‫روش ارزيابي من فانه ايست چون‌ سواالت آن عيني است‪.‬‬
‫‪.3‬‬
‫براي ارزيابي مهارتهاي رواني – حركتي روش مناسبي است‪.‬‬
‫‪.4‬‬
‫كار واقعيش شرايط ط يعي برقر ‌ار مي كند‪.‬‬
‫اين روش بين امتحان شونده ‌و محيط ‌‬
‫‪.5‬‬
‫بازخورد آني است‪.‬‬
‫‪.6‬‬
‫در آن دخالتي ندارد‪.‬‬
‫شانس ‌‬
‫مزايای استفاد از ‪: OSCE‬‬
‫‪ -7‬طیف وسیعی از مهارت های تعداد زیادی از فراگيران در‬
‫ً‬
‫مدت نسبتا کوتاهی ارزیابی می شوند‪.‬‬
‫‪ -8‬هم بیمار و هم ارزیابی کننده برای تمام آزمون شوندگان‬
‫یکسان هستند‪.‬‬
‫‪ -9‬شرایط آزمون به شرایط واقعی نزدیک است‪.‬‬
‫‪ -10‬از روایی و پایایی خوبی برخوردار است‪.‬‬
‫محدوديتهای استفاد از ‪: OSCE‬‬
‫‪ .1‬اين امتحان بودجه‪ ،‬تداركات غني ‌و هماهنگي هاي كامل درون‬
‫ب ش ي را طلب مي كند‪.‬‬
‫ي اين روش براي تعداد زياد دانشج ‌و مشكل است‪.‬‬
‫‪ .2‬بكارگير ‌‬
‫ميسر نيست‪.‬‬
‫‌‬
‫بيمار واقعي همواره‬
‫‪ .3‬استفاده ‌از ‌‬
‫گير است‪.‬‬
‫‪ .4‬طراحي ‌و اجرا آن مشكل ‌و وقت ‌‬
‫محدوديتهای استفاد از ‪: OSCE‬‬
‫‪ -5‬مهارت ها به صورت مجزا و در ایستگاه های متفاوت ارزیابی می‬
‫شوند‪.‬‬
‫‪ -6‬برای حفظ پایایی آزمون باید تعداد ایستگاه ها زیاد باشد‪.‬‬
‫ً‬
‫• در مورد برخی مهارت ها از جمله برقراری ارتباط عمال بسیار‬
‫مشکل است‪.‬‬
‫‪ -7‬سازماندهی و اجرای آن نیازمند نيروی انسانی زیادی است‪.‬‬
‫‪ -8‬از لحاظ منابع مادی و زمان هزینه بر است‪.‬‬
GRF, 360-degree
DOPS, Mini-CEX
OSCE
MCQ