CHANGING TRENDS IN THE MEDICAL EXAMINATIONS DR.T.V.

RAO MD Methods for student assessment in medical education has changed over the past 50 years. We have moved from a standard of pen-and-paper tests of knowledge and facts toward a more complex system of evaluation. Medical students today are tested on knowledge, attitudes, and skills across multiple settings and methods, which are often triangulated to reach summative decisions. Current educational and assessment strategies include problem-based learning, computer simulations, and checklists, standardized patients, and team-based learning that we call as seminars. When we started our life in Medicine; we were few students in a Unit for training, my teachers who were always willing to spend the time in training us. Patients were poor in many Government hospitals, helpful to cooperate, and willing to answer many questions put many times with our ignorance. Medical council of India wishes that graduates should have the knowledge, skills, professional behaviours and attitudes necessary to enter the unsupervised practice of medicine in India, as Graduates must be able to diagnose and manage health problems and provide comprehensive, compassionate care to their patients. Today we teach the students on comprehensive and integrated care of the patients, as it is desired to be a competent physician as Prospective candidates should be aware that, cognitive, physical examination, management skills, communication skills, and professional behaviours are all evaluated in timed simulations of patient encounters. Doctors should be able communicators both in good and as well in critical times and student must be able to speak, to hear and to observe patients in order to effectively and efficiently elicit information, describe mood, activity and posture and perceive non-verbal communication. A student must be able to communicate effectively and sensitively with patients, families and any member of the health care team. A student must also be able to summarize coherently a patients condition and management plan verbally and in writing. To the students, we should teach to be effectually to use motor functions. A student must demonstrate sufficient motor functions to safely perform a physical examination on a patient, including palpation, auscultation and percussion. The examination must be done independently and in a timely fashion. A student must be able to use common diagnostic aids or instruments either directly or in an adaptive form (e.g. sphygmomanometer, stethoscope, otoscope and ophthalmoscope). A student must be able to execute motor movements reasonably required to provide general and emergency medical care to patients. Compassion, integrity, concern for others, interpersonal skills, interest and motivation are all personal qualities that physicians must demonstrate and are expected qualities of students. efficient motor function to safely perform a physical examination on a patient, including palpation, auscultation and percussion ability to use common diagnostic aids or instruments either directly or in an adaptive form (e.g., sphygmomanometer, stethoscope and needles)ability to execute motor movements that are reasonably required to provide general and emergency medical care to patients. Many Medical assessment examinations in India and abroad are changing to the new educational assessment for the new generation of students to eliminate the older examination system fraught with poor assessment criteria, designated as Objective Structured Clinical Examinations (OSCEs). An Objectively Structured Clinical Examination (OSCE) is a modern type of examination often used in health sciences (e.g. Midwifery, orthopaedics, optometry, medicine, chiropractic, physical therapy, radiography, nursing, pharmacy, dentistry, naturopathic medicine, Para medicine, podiatry, veterinary medicine). It is designed to test clinical skill performance and competence in skills such as communication, clinical examination, medical procedures / prescription, exercise prescription, joint mobilisation / manipulation techniques, radiographic positioning, radiographic image evaluation and interpretation of results. An OSCE usually comprises a circuit of short (the usual is 510 minutes although some use up to 15 minute) stations, in which each

candidate is examined on a one-to-one basis with one or two impartial examiner(s) and either real or simulated patients (actors or electronic dummies). Each station has a different examiner, as opposed to the traditional method of clinical examinations where a candidate would be assigned to an examiner for the entire examination. Candidates rotate through the stations, completing all the stations on their circuit. In this way, all candidates take the same stations. It is considered to be an improvement over traditional examination methods because the stations can be standardised enabling fairer peer comparison and complex procedures can be assessed without endangering patients health. Medical schools in many developed countries are increasingly relying on Objective Structured Clinical Exams as a method to evaluate their medical students' clinical skills and communications skills. As OSCE exams are now the method of the licensure examination in the USA, Canada, UK, Australia, and New Zealand and many other countries, most schools are now implementing these clinical skills assessment exams right from the first year for their medical students. OSCEs for Medical Student tend to be system oriented as you move from placement to another, like while they do their surgery clerkship, the topics will be around surgical topics, and so on. However, medical students have to keep their minds open to all possible diagnoses and explore the relevant ones as time permits. Differential diagnosis is still needed to be covered in all medical student OSCEs. The best way for a medical student to prepare for an Objective Structured Clinical Exams (OSCE Exam) is repetitive practicing following a well prepared systematic approach model. Acquire a systematic organized approach that covers clinical skills, communication skills, and differentials. Start as early as possible in your medical education and keep repeating and practicing your approach over and over for months and all through your medical school years. Make it a habit in order to master patient encounters. It will be one practicing for all your coming medical OSCE exams. Does it make sense, The OSCE is an assessment format in which the candidates rotate sequentially around a series of structured cases located in stations, at each of which specific tasks have to be performed, usually involving a clinical skill, such as history taking, examination of a patient or a practical skill. The marking scheme for each station is structured and determined in advance. There is a different examiner and a time limit for each station. The basic structure of an OSCE may be varied in timing for each station, use of checklist or rating scale for scoring, use of clinician or standardised patient as examiner, use of real patients or manikins, but the fundamental principle is that every candidate has to complete the same assignments in the same amount of time and is marked according to a structured marking schedule. Many Medical Institutions and some deemed universities are planning for a change. The DNB courses have successfully implemented many aspects of OSCE. My little experience with OSCE in a Medical College, it is far more confusing than the traditional system, for the undergraduates, I think who are implanting the system should be sound in doing the procedures or else it is confusing to the Teacher as well as taught. However Successful OSCEs are often the result of significant planning, coordination of multiple resources, commitment to large-scale testing, and judicious use of assessment data. More research is needed about the best uses of the OSCE method and how to maximize reliability and validity. Advocates of the OSCE method should continue to produce and disseminate evidence of the far-reaching impact that is seen by students and educators. Dr.T.V.Rao MD. Professor of Microbiology, Creator and Designer of e-learning resources in Microbiology and Medicine - a Freelance writer. Travancore Medical College, Kollam. Kerala the article published in the souvenir Golden Jubilee celebrations of J. N Medical College Belgaum Karnataka