British medical journal case reports

Assessment and evaluation are the foundations of learning; the former is concerned with how students perform and the latter, how successful the teaching was in reaching its objectives.
Validity concerns the accuracy of an assessment, what this means in practical terms, and how to avoid drawing unwarranted conclusions or decisions from the results. CBDs have high face validity as they focus on the role doctors perform and are, in essence, an evolution of ‘bedside oral examinations’3.
Determining the concurrent validity of CBDs is difficult as they assess the pinnacle of Miller’s triangle – what a trainee ‘does’ in clinical practice (figure1)4. CBDs have high construct validity, as the assessment is consistent with practice and appropriate for the working environment. In terms of predictive validity performance-based assessments are simulations and examinees do not behave in the same way as they would in real life3. Reliability can be defined as “the degree to which test scores are free from errors of measurement”. Rating scales are also known to hugely affect reliability – understanding of how to use these scales must be achieved by all trainee assessors in order to achieve marking consistency. CBDs are a one-to-one assessment and are not efficient; they are labour intensive and only cover a limited amount of the curriculum per assessment.
The practical advantages of CBDs are that they allow assessments to occur within the workplace and they assess both judgment and professionalism – two subjects on the curriculum which are otherwise difficult to assess1.
One method for ensuring the equality of assessments across all trainees is by providing clear information about what CBDs are, the format they take and the relevance they have to the curriculum. Formative assessments modify and enhance both learning and understanding by the provision of feedback11. For trainees to be able to improve, they must have the capacity to monitor the quality of their own work during their learning by undertaking self-assessment12. The challenge for an effective CBDis to have an open relationship between student and assessor where the trainee is able to give an honest account of their abilities and identify any areas of weakness. Evaluation of any teaching is fundamental to ensure that the curriculum is reaching its objectives14. At present there is little opportunity within the Intercollegiate Surgical Curriculum Project (ISCP) for students to provide feedback.
CBDs, like all assessments, do have limitations, but we feel that they play a vital role in development of trainees. If used appropriately, CBDs are valid, reliable and provide excellent feedback which is effective and efficient in changing practice. The above article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. From the following articleParacetamol overdose as a result of dental pain requiring medical treatment – two case reportsM. This journal is a member of and subscribes to the principles of the Committee on Publication Ethics.
Examination of the ovaries at caesarean section is a normal practice as ovarian pathology may be found. We present a case of incidental ovarian cyst found at elective caesarean section to illustrate the value of a comprehensive consenting process. A 35 year-old para 1 + 0 healthy Polish woman was admitted for elective lower segment caesarean section (LSCS) at 39 + 4 weeks gestation in view of a previous caesarean section 2 years ago for failure to progress in the first stage of labour.She was booked in a neighbouring hospital for her antenatal care where she was counselled and consented for the procedure by her consultant. Written consent for elective LSCS was obtained by the junior doctor on duty before the consultant pre-operative ward round. At the uncomplicated LSCS under spinal anaesthetic, routine inspection of the uterus and adnexa revealed a 30 x 20 x 15 mm pedunculated firm pale mass attached to the left ovary suggestive of a fibroma. The Royal College of Obstetricians and Gynaecologists (RCOG) recommend that clinicians should seek prior consent to treat any problem which might arise 4. Writing in the British Medical Journal, Dr Gillian Prue argued that HPV related diseases cause serious suffering, and made the economic case that the cost of prevention could be lower than the cost of treating such diseases. Supporting Dr Prue’s argument, several other researchers called for a gender-neutral school-age vaccination programme. When the issue was last debated in Scotland, the charity Gay Men’s Health argued strongly in favour of a gender-neutral vaccination programme. Cancer Research UK’s Senior Health Information Manager, Jessica Kirby, also spoke on the issue. Jennie Kermode is a professional journalist who also edits at Eye For Film and who has written for publications including The Independent, The New Statesman, The Press Gazette, Pink News and Mosaic. Case based discussions (CBDs) are structured, non-judgmental reviews of decision-making and clinical reasoning1. The purpose of this critical review is to assess if CBDs are effective as an assessment tool. The key elements of this assessment are learnt in medical school; thus the purpose of a CBD is easy for both trainees and assessors to validate1.

CBDs are unique in this aspect, but there may be some overlap with other work based assessments particularly in task specific skills and knowledge. The clinical skills being assessed will improve with expertise and thus there should be ‘expert-novice’ differences on marking3. Thus, CBDs are an assessment of competence (‘shows how’) but not of true clinical performance and one perhaps could deduct that they don’t assess the attitude of the trainee which completes the cycle along with knowledge and skills (‘does’)4. Feldt and Brennan describe the ‘essence’ of reliability as the “quantification of the consistency and inconsistency in examinee performance” 5. In CBD assessments, trainees should be rated against a level of completion at the end of the current stage of training (i.e.
The time taken to complete CBDs has been thought to negatively impact on training opportunities7. CBDs can be very successful in promoting autonomy and self-directed learning, which improves the efficiency of this teaching method9. The information and guidance provided for the assessment should be clear, accurate and accessible to all trainees, assessors, and external assessors. The primary function of the rating scale of a CBD is to inform the trainee and trainer about what needs to be learnt1.
Moreover, trainees must accept that their work can be improved and identify important aspects of their work that they wish to improve. This relationship currently does not exists in most CBDs, as studies by Veloski, et al8and Norcini and Burch9 who revealed that only limited numbers of trainees anticipated changing their practice in response to feedback data. CBDs have a strong summative feel: a minimum number of assessments are required and a satisfactory standard must be reached to allow progression of a trainee to the next level of training1. Student evaluation allows the curriculum to develop and can result in benefits to both students and patients. Sarah’s FREE weekly BreakFree Medicine newsletter and instantly receive her 12 page hormone guide.
The incidence of an adnexal mass found at caesarean section ranges from 1 in 123 1 to 329 2. The findings were relayed to the woman, and confirmation of consent for the ovarian cystectomy was obtained. Indeed, in its Consent Advice for caesarean section, it states that discussion of appropriate but not essential procedures, such as ovarian cystectomy at caesarean section, should take place before undertaking the procedure 5.
This may be because the clinician is unaware of the recommendations, not familiar with the potential risks or findings at surgery, or that there is simply insufficient time to document comprehensively.
These forms are available on our intranet which can be edited allowing clinicians to amend the risks and additional procedures as appropriate in each individual case. At the time when the policy was adopted, health officials argued that by vaccinating girls they could prevent the disease from spreading.
She noted that men who have sex with men (MSM) are a particular risk because they have no herd immunity, the term used to refer to the reduced risk of contracting an infection that exists when its prevalence within a group is minimised.
Chair of reform charity Trans Media Watch, Jennie is also a member of the Equality Network and the Scottish Transgender Alliance.
They are mapped directly to the surgical curriculum and “assess what doctors actually do in practice” 1.
In terms of content validity, CBDs are unique in assessing a student’s decision-making and which, is key to how doctors perform in practice. CBDs permit inferences to be drawn concerning the skills of examinees that extend beyond the particular cases included in the assessment3. Moss states that less standardized forms of assessment, such as CBDs, present serious problems for reliability6. Formalized assessment time could relieve the pressure of arranging ad hoc assessments and may improve the negative perceptions of students regarding CBDs. Moreover, CBDs can be immensely successful in improving the abilities of trainees and can change clinical practice – a feature than is not repeated by other forms of assessment8.
This minimizes the potential for inconsistency of marking practice and perceived lack of fairness7-10. Marks per see provide no learning improvement; students gain the most learning value from assessment that is provided without marks or grades12. An unwillingness to engage in formal self-reflection by surgical trainees and reluctance to voice any weaknesses may impair their ability to develop and lead to resistance in the assessment process. Summative assessment affects students in a number of different ways; it guides their judgment of what is important to learn, affects their motivation and self-perceptions of competence, structures their approaches to and timing of personal study, consolidates learning, and affects the development of enduring learning strategies and skills12-13. Given the widespread nature of subjects covered by CBDs, the variations in marking standards by assessors, and concerns with validity and reliability, an overall evaluation of the curriculum may not be possible. As a result, students do not engage fully with the assessment and evaluation process and CBDs are not being used to their full potential. Systemic review of the literature on assessment, feedback and physician’s clinical performance: BEME Guide No.

Evaluation of interprofessional education: a United Kingdom review of health and social care. You will also gain access to her FREE three part webinar series that will empower you to optimize your health! Ovarian cysts rarely develop de novo in late pregnancy, but rather persist from early pregnancy.
The woman was therefore again counselled and written consent for elective LSCS obtained for the third time now including previously omitted additional procedures that might be performed during the course of the surgery. This supports the position of the Department of Health which states that a procedure should not be performed merely because it is convenient, and that it is good practice where possible to seek the person’s consent to the proposed procedure well in advance, when there is time to respond to the person’s questions and provide adequate information 6. We believe the verified printed consent form offers legible and comprehensive documentation of the counselling process, as well as prompting clinicians to discuss key issues such as those recommended by the RCOG Consent Advice. Prevalence and natural history of adnexal pathology detected at first-trimester sonography. The virus is more likely to cause severe problems for women, as it is linked to the development of cervical cancer, but it has also been linked to increased risk in men from cancers affecting the head and neck, penis and anus.
Vaccinating boys would be beneficial for public health, and we hope that the JCVI will be able to find a way to achieve this in a practical and affordable way,” she said. However, as only six CBDs are required a year, they are unlikely to be representative of the whole curriculum.
The professional aspect of assessment can be validated by a 360 degree appraisal, as this requests feedback about a doctor’s professionalism from other healthcare professionals1. The quality of performance in one assessment can be a poor predictor of performance in another context. These types of assessment permit both students and assessors substantial latitude in interpreting and responding to situations, and are heavily reliant on assessor’s ability. While accurate ratings are critical to the success of any WBA, there may be latitude in the interpretation of these rating scales between different assessors. However, the lack of standardization of this assessment mechanism combined with the variation in training and interpretation of the rating scales between assessors may result in inequality.
CBDs have feedback is built into the process and therefore it can given immediately and orally. Improved training of assessors and removing the scoring of the CBD form may allow more accurate and honest feedback to be given to improve the student’s future performance.
Resnick and Resnick summarize this as “what is not assessed tends to disappear from the curriculum” 13. However, regular evaluation of the learning process can improve the curriculum and may lead to better student engagement with the assessment process14. The main problems with CBDs relate to the lack of formal assessor training in the use of the WBA and the lack of evaluation of the assessment process Adequate training of assessors will improve feedback and standardize the assessment process nationally. In this report, we illustrate the value of a standardised consent form which addresses the issue. We advocate the use of such standardised consent forms in improving the care of patients and supporting clinicians to deliver optimal services. Thus CBDs may have a limited content validity overall, especially if students focus on one type of condition for all assessments.
Reliability of CBDs is influenced by the quality of the rater’s training, the uniformity of assessment, and the degree of standardization in examinee. Assessors who have not received formal WBA training tend to score trainees more generously than trained assessors7-8. Verbal feedback has a significantly greater effect on future performance than grades or marks as the assessor can check comprehension and encourage the student to act upon the advice given1,11-12.
Accurate recording of CBDs is vital, as the assessment process is transient, and allows external validation and moderation. Evaluation of CBDs should improve the validity of the learning tool, enhancing the training curriculum and encouraging engagement of trainees.
Also, 4 in 5 of ovarian cysts persisting into the second trimester will also be present in the post-natal period as complex cysts such as serous cystadenomas, mature cystic teratomas, endometriomas and mucinous cystadenomas 3. Improved assessor training in the use of CBDs and spreading assessments throughout the student’s placement (i.e.
It should be specific and related to need; detailed feedback should only occur to help the student work through misconceptions or other weaknesses in performance12. A number of evaluation methods exist, but all should allow for ongoing monitoring review and further enquiries to be undertaken. Veloski, et al, suggests that systemic feedback delivered from a credible source can change clinical performance8.

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