Libro blanco de las ACES Pediátricas 2024

Libro Blanco de las ACES Pediátricas 2024 558 ❚ European Curriculum Recommendations Oral examination A type of performance assessment using realistic patient cases with an examiner questioning the examinee/trainee. Objective • To assess clinical decision-making and the application or use of medical knowledge with realistic patients. PRM scenario Clinical scenarios that are specific to the specialty, such as asthma and respiratory infections. Method The examiner begins by presenting to the examinee with a clinical problem in the formof a patient case scenario. The examinee is asked how they wouldmanage the case. Questions probe the reasoning for requesting clinical findings, the interpretation of those findings and treatment plans. In effi- ciently designed exams, each case scenario takes 3–5min. Exams last 1.5–2.5 h with two or four separate 30- or 60-min sessions. One or two physicians serve as examiners per session. An examinee can be tested on 18–60 different clinical cases. Suggested reference • Mancall EL, Bashook PG, eds. Assessing Clinical Reasoning: The Oral Examination and Alternative Methods . Evanston, American Board of Medical • Specialties, 1995. [29] Other options: simulations and standardised patients Simulations used for assessment of clinical performance closely resemble reality and attempt to imitate, but not duplicate, real clinical problems. Objectives • To allow reasoning through a clinical problemwithminimal or no cueing • To allow life-threatening errors without hurting a patient • To provide instant feedback, such that mistakes are immediately corrected • To provide ratings on clinical problems that are otherwise difficult or impossible to evaluate PRM scenario Current uses in PRM training would commonly be the use of an acute paediatric airway intubation and difficult intubation. Future developments of avail- able formats may give a new dimension to assessments in PRM. Method Simulation formats have been developed as paper-and-pencil branching problems (patient management problems; PMPs), computerised versions of PMPs called clinical case simulations (CCX ® ), role-playing situations ( e.g . standardised patients, clinical team simulations), anatomical models or mannequins, and combinations of all three formats. Mannequins are imitations of body organs or anatomical body regions frequently using pathologi- cal findings to simulate patient disease. Themodels are constructed of vinyl or plastic sculpted to resemble human tissue with embedded electronic circuitry to allow themannequin to respond realistically to actions by the examinee. Virtual reality simulations or environments (VR) use computers, sometimes combined with anatomical models, tomimic, as much as feasible, realistic organ and surface images, and the touch sensations (computer- generated haptic responses) a physician would expect in a real patient. The VR environments allow assessment of procedural skills and other complex clinical tasks that are difficult to assess consistently by other assessment methods. Suggested reference • Scalese R, Obeso V, Issenberg SB. Simulation technology for skills training and competency assessment in medical education. Gen Intern Med 2008; 23: 46–49.