College of Medicine, University of Central Florida, Orlando, Florida.
College of Medicine, University of Central Florida, Orlando, Florida
Adv Physiol Educ. 2016 Sep;40(3):304-12. doi: 10.1152/advan.00140.2015.
Multiple-choice questions are a gold-standard tool in medical school for assessment of knowledge and are the mainstay of licensing examinations. However, multiple-choice questions items can be criticized for lacking the ability to test higher-order learning or integrative thinking across multiple disciplines. Our objective was to develop a novel assessment that would address understanding of pathophysiology and pharmacology, evaluate learning at the levels of application, evaluation and synthesis, and allow students to demonstrate clinical reasoning. The rubric assesses student writeups of clinical case problems. The method is based on the physician's traditional postencounter Subjective, Objective, Assessment and Plan note. Students were required to correctly identify subjective and objective findings in authentic clinical case problems, to ascribe pathophysiological as well as pharmacological mechanisms to these findings, and to justify a list of differential diagnoses. A utility analysis was undertaken to evaluate the new assessment tool by appraising its reliability, validity, feasibility, cost effectiveness, acceptability, and educational impact using a mixed-method approach. The Subjective, Objective, Assessment and Plan assessment tool scored highly in terms of validity and educational impact and had acceptable levels of statistical reliability but was limited in terms of acceptance, feasibility, and cost effectiveness due to high time demands on expert graders and workload concerns from students. We conclude by making suggestions for improving the tool and recommend deployment of the instrument for low-stakes summative assessment or formative assessment.
选择题是医学院中评估知识的黄金标准工具，也是执照考试的主要内容。然而，选择题可能因其缺乏测试更高阶学习或跨多个学科的综合思维的能力而受到批评。我们的目标是开发一种新的评估方法，该方法将解决对病理生理学和药理学的理解，评估应用、评估和综合的学习水平，并允许学生展示临床推理能力。评分标准评估学生对临床病例问题的书面解答。该方法基于医生传统的就诊后主观、客观、评估和计划记录。要求学生正确识别真实临床病例问题中的主观和客观发现，将病理生理和药理机制归因于这些发现，并为一系列鉴别诊断提供依据。采用混合方法评估了新评估工具的实用性，通过评估其可靠性、有效性、可行性、成本效益、可接受性和教育影响来进行评价。主观、客观、评估和计划评估工具在有效性和教育影响方面得分较高，并且具有可接受的统计可靠性水平，但由于专家评分员的时间要求高以及学生的工作量问题，在可接受性、可行性和成本效益方面受到限制。最后，我们提出了改进该工具的建议，并建议将该工具用于低风险总结性评估或形成性评估。
