Physiotherapy, M ay 1986, vol 42 no 2 43 th e va lu e o f O S P E as a m e t h o d o f e v a lu a ti n g p s y c h o ­ m o t o r skills and as a c o m p l e m e n t to clinical p e r f o r m ­ ance testing. H o w ev er p r o b l e m a t i c O S P E m a y seem to be, its p o te n t ia l to satisfy the m a j o r e x a m i n a t i o n go als of object ivi ty an d efficiency is im m e n s e an d w a r r a n t s the time a n d energy sp ent on perfecting the system. References 1. Ha rde n R M, Stevenson M, Downie WW, Wilson GM. Assessment of clinical competence using objective struc­ tured clinical examination. Brit M ed J 1975; 1: 447-451. 2. Harden RM , Gleeson FA. Assessment of clinical com­ petence using an objective structured clinical exam in a­ tion (OSCE). M ed Educ 1979; 13: 41-54. 3. Stokes JF . The Clinical E xam ination (Medical Educa­ tion Booklet No. 2). Dundee: Association for the study of Medical Education, 1974. 4. Kent AP, Lazarus J. An objective medical student examination in obstetrics. S A M J 1983; 64: 388-389. 5. Wads wo rth H. Students as assessors in a performance test. Report on a pilot study. Physiotherapy 1981; 67: 364-367. The Program m e o f Clinical Experience an d Evaluation Employed a t the University o f Cape Town M. J. FUTTER SUMMARY This paper provides a brief description of the system of clinical evaluation used at the Univer­ sity of Cape Town. It gives the objectives of the clinical programme and the method of clinical supervision employed to achieve them. Some general problems of evaluation are discussed. 1.0 IN T R O D U C T IO N In o r d e r to fulfil the re q u i re m en ts for th e degree of B.Sc. P h y s i o t h e r a p y a n d e n su r e t h a t the pu bli c is p r o ­ tected, s tu de nt s have to be assessed acc u ra te ly in the clinical situ at io n so th a t thei r level o f co m p et en ce can be te s te d .1 2.0 O B J E C T IV E S O F T H E C L IN IC A L P R O G R A M M E A t the end o f the clinical p r o g r a m m e the st u d en t is M. J. Futter, B.A., Dip. (Phys), D.S.E., Assistant Lecturer, Dept, of Physiotherapy, University of Cape Town | OPSOMMING | Hierdie referaat gee 'n kort beskrywing van die ! kliniese evaluasie stelsel wat by die Universiteit i i van Kaapstad gebruik word. Die doelwitte van [ die kliniese program en die metode van kliniese 1 j toesig wat gebruik word om hulle te bereik, I word uiteengesit. Sommige algemene probleme | van evaluasie word bespreek. exp ec te d to have th e kn ow led ge, technical skills, and a tt itu de s to: 2.1 Int eg ra te an d ap pl y th eo r et i ca l kn ow led ge intelli­ gently in the clinical situa tion . 2.2 E x t r a c t th e r e l e v a n t f a c t s f r o m th e p a t i e n t ’s med ica l re co rd s an d i n t e r p r e t p e r t in e n t special inves tigations accurately. 2.3 Ev alu at e a p a ti en t co mprehensively. 2.4 Pl an an d prog re ss an a p p r o p r i a t e t r e a t m e n t p r o ­ g ram me . 2.5 P e r f o r m an effective a n d safe t r e a t m e n t a c c o r d ­ ing to h i s / h e r level o f study. 2.6 Keep a d e q u a t e d o c u m e n t a t i o n o f th e tr ea tm e nt s. 2.7 R e c o g n i s e c o m p l i c a t i o n s a s s o c i a t e d w it h th e p a t i e n t ’s c o n d it io n and avo id d a n g e r o u s practice. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 44 F isioterapie, M ei 1986, d e e l 42 no 2 AKRON Therapy products from Medical Distributors (Pty) Ltd R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) Physiotherapy, M ay 1986, vo l 42 no 2 45 2.8 T r e a t pa ti e nt s as indi vidu al s, u n d e r s t a n d i n g the influence o f social, e c o n o m i c an d psyc ho log ical fa ct or s w hic h m a y affect th e p a t i e n t ’s c o n d it io n and s u b s e q u e n t pr og re ss in t r e a tm e n t. 2.9 C o m m u n i c a t e effectively w ith the p a t i e n t , o th e r m e m b e rs o f the med ica l t e a m a n d colleagues, u n d e r s t a n d i n g the i m p o r t a n c e o f w o r k in g within the medical team. 2.10 Behave in a p r of e ss io na l m a n n e r at all times in the clinical si tua ti on. 2 . 11 Be a w a r e o f eth ical f a c t o rs invo lv ing the p a ti e n t and the medical team. 2.12 Know h i s / h e r o w n li mitations and f u r th e r h i s / h e r k no w le dg e by a d d it io na l in d e p e n d e n t s t ud y to m a x im is e th e effectiveness o f p a ti e n t tr e a tm e n t. 3 0 T H E P R O G R A M M E O F C L IN IC A L S U P E R V IS IO N E M P L O Y E D T O P R O M O T E T H E O B J E C T IV E S k T h e p u r p o s e o f clinical su p er v is i o n is to h el p the st ud en ts a c q u ir e a n d in te g ra te k n o w le d g e a n d use th ei r ju d g e m e n t in si tu at io n s w hi c h c a n n o t be achie ved by means o f lectures. It is th e m a j o r clinical t o o l 2 to assist them in using the kn ow led g e they have, to u n d e r s t a n d , a n al y s e a n d e v a l u a t e cl in ic a l c o n d i t i o n s w h il s t d e ­ vel oping quali ti es o f o b s e r v a t i o n a n d d eci si o n maki ng. By h a v in g close c o n t a c t w ith reality th ey ar e able to make c o m p a r i s o n s bet we en th e o r y an d pract ice a n d can dev elo p self-confidence in th ei r decis ion -t aki ng . T he stud en ts are also pre p ar ed for e x a m i n a ti o n ex p ec ­ tat ions . By e x pe ri en c in g clinical su p er vi so rs ob ser vi ng their t r e a tm e n ts they are placed in s it ua ti on s simi lar to those o f th e e x a m i n a t i o n s a n d ar e t h e r e fo re less likely to suffer f r o m nega ti ve levels o f a n x ie t y in th e ac tu a l e x a m i n a ti o n s i tu a t io n s .3 At the b e g in n i n g o f th e i r clinical e x p e ri e n c e st u d e n ts are p ro v i d e d w ith a g u id e to the e x p e r i e n c e th ey will receive in e a c h clinical ar ea . T h is g u id e was d r a w n up by t h e c li n i c a l p h y s i o t h e r a p i s t s a t G r o o t e S c h u u r H o sp it al an d place d in t o a p p r o p r i a t e levels o f s t ud y by the lect uri ng staff. It c o n t a i n s i n f o r m a t i o n a b o u t the -Jtheory the st ude nts are required to k no w , the c o n di t io ns 'Jfhey are likely to see, th e t r e a t m e n t s th ey s h o u l d be able to p e r f o r m a n d a n y ad m i n is tr a t iv e du ti es th a t need to be carr ied o u t in ea ch area. S tu d e n t s first c o m e in t o c o n t a c t with p a ti e n ts in the clinical s i t u a t i o n f r o m th e sec o nd q u a r t e r o f th e sec on d ye ar o f stu dy. T h ey sp en d 4'/$ h o u r s p e r week in the clinical a re a, ea ch clinical blo ck co n si sti ng o f f o u r weeks with thr ee o r f o u r s tu d en ts in e ac h g ro up . T h e ma in objectives o f seco nd y e a r clinical expe ri enc e is to in t r o d u c e the st u d e n ts to, a n d familiarise th e m with the clinical si tu at io n. S u pe rv i si on consists largely o f d e m o n s t r a t i o n s o f tr e a t m e n t s . T h e y are s h o w n h o w to e x tr a c t rele van t facts f r o m the p a t i e n t s ’ medical records and ho w to evaluate specific c on dit ion s affecting, fo r e x a m p l e , th e ch est o r knee. A ss is ta n ce is given in p la nn in g an d d o c u m e n t i n g t r e a t m e n t p r o g r a m m e s . T h e clinical su p e r v is o r acts as a role m o d e l f o r pr o f e ss i o n a l b e h a v io u r a n d c o m m u n i c a t i n g w ith th e p a ti e n t an d o t h e r m e m b e r s o f th e m ed ic al t e a m . T h e s t u d e n t s p e r ­ f o r m on ly very basic skills like m as sag e, t a p o t e m e n t , tea c hi n g bed mobi lit y exercises an d the s u p er vi so r c o m ­ pletes th e tr e at m en ts . T h i r d y e a r s t u d e n ts sp e n d 2 / 2 h o u r s p er a f t e r n o o n in ne uro lo gy , o rt h o p a e d ic s , o u tp a t ie n t s , surgery, medicine, sp o r ts injury clinic a n d the p h y s i o th e r a p y g y m n a s iu m . At this st age the objective o f clinical ex pe ri en ce is fo r the s t u d e n t to int egr at e a n d a p p ly th eor eti cal kn ow led ge in the clinical s i tu a t io n , to ev a lu a te a p a ti e n t c o m p r e ­ hensively an d to p la n a n d p ro g r es s an a p p r o p r i a t e t r e a t m e n t p ro g r a m m e . T h e y s ho ul d c o m m u n i c a t e effec­ tively with p a ti e n ts a nd p e r f o r m effective an d safe t r e a t m e n t s in a p r o f es si o na l m a n n e r . In o r d e r to ach ie ve the se ob je ct iv es th e s t u d e n t s are given 2 p e ri o d s o f clinical sup er vi si on p er week o n a o n e - t o - o n e basis f o r 30 - 45 mi n ut es . In m os t o f the clinical a r e a s e ac h s t u d e n t has tw o d if fe re n t clinical su p e r v is o r s, one being th e le ct u re r re s p on si b le fo r the lecture s o f th e p a r t i c u l a r a r e a a n d th e o t h e r a clinical s u p e r v is o r . In a d d i t i o n to thi s a g r e a t d e a l o f tim e is d e v o te d to the s t u d e n ts by th e clinical p h ys i o th e ra p i st s resp on sib le fo r th e pa ti en ts in the v ar i o u s areas. F o u r t h y e a r st u d e n ts spen d 4 h o u r s ea c h m o r n i n g in n eu r o l o g y , b u r n s , h a n d s , c a r d i o t h o r a c i c , re s p ir a t o r y int en si v e care , s p o r ts in j u ry clinic, p h y s i o t h e r a p y o u t ­ p a ti e n ts a n d ce re b r al palsy. T h e y also sp en d o n e block d o i n g a n elective at a n y recognised hosp ital in a clinical ar e a o f th ei r choice. D u r i n g th e twice-weekly clinical sup er vis io n pe ri od s th e o b je c tiv es ar e as listed in 2.0. T h e s t u d e n t s are e x p e c t e d to see th e p a t i e n t as a n i n d i v id u a l a n d to u n d e r s t a n d th e necessity o f a d a p t i n g t r e a t m e n t s t o the c h a n g i n g ci r c u m st a n c e s o r pr o b l e m s. T h e y a re assisted with p r o bl em -s ol vi ng skills a n d are ex pe c te d to p e rf o rm tr e a t m e n t s i n d e p e n d e n tl y with safety, effectiveness and proficiency. As clinical w or k is a very effective learning expe rience4 fe e d b a c k to the s t u d e n t is m o s t i m p o r t a n t . C o n t i n u e d ev a lu a ti o n , fo r e x a m p l e , ta kes place verbally d u r i n g clinical su p er v is i o n w hi c h allo ws e r r o r s in p e r f o r m a n c e to be p oi n t e d o u t im m e d i a te l y .5 T h e sy s te m o f a c q u ir in g clinical skills is very m u c h o ne o f d y n a m i c in t e r a c t i o n b e tw ee n the clinical s u p e r ­ vis or a n d th e s t u d e n t . 4 F o r this re a s o n s t u d e n t s are e n c o u r a g e d to co m p l et e f o r m s (see Fig. 1) in o r d e r to e v a lu a te e a c h clinical a r e a st a ti n g w h a t th e y f o u n d beneficial, w h a t p r o b l e m s th e y e n c o u n t e r e d a n d any suggestions they m a y hav e to im p ro v e on the ex peri ence ga ine d in th e p a r t ic u l a r clinical area. 4.0 T H E C L IN IC A L E X A M IN A T IO N A c c o r d i n g to G u i l b e r t 4 it is th e sys tem o f clinical ev a l u a t i o n t h a t es ta bli she s th e degree to which the objectives o f the clinical p r o g r a m m e have been achieved. 4.1 E n d -o f-b lo c k e x a m in a tio n s A t th e end o f ea c h clinical block tw o ex am i n er s o b se r v e th e s t u d e n t t r e a t i n g a p a ti e n t h e / s h e has n ot seen prev io usl y, fo r 30-45 mi nutes. T h e y a w a rd a m a r k o n th e basis o f th e t r e a t m e n t p e r f o r m e d by R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 46 Fisioterapie, M ei 1986, d e e l 42 no 2 E V A LU A TIO N OF C L I N I C A L BLOCK „ ^ _ PATIENT INFORMATION Y E A R ..................B L O C K .......................FROM ................T O ................... .......................................................... Y EAR: □ J □ 4 □ DATE: WHAT HAS BEE N H E L P F U L ON T H I S B LO C K ? WHAT PRO BLEM S D ID YOU ENCOUNTER ON T H IS B LO C K ? A R E A 1 . ASSESSMENT PLANNING 3 . EXECUTION GENERAL COMMENTS: S C 0 H E CAN YOU SU G G EST CHANGES THAT W IL L MAKE T H IS B LO C K MORE H E L P F U L ? EXAMINER/S SIGNATURE/S: Fig. I. Students feed b a c k fo r m . Fig. 2. End-of-block exam ination fo r m . th e s t u d e n t at the ti m e o f the e x a m i n a t i o n . This m a r k is i n d e p e n d e n t o f th e gene ral, assessed p e r ­ fo r m a n c e o f the st u d en t on the block. T h e e x a m i n a t i o n consists o f f o u r sections (see Figures 11 a n d III); assessment, pl ann in g, execut ion an d in t e rp e r s o n a l rel ationships . S tu d e n t s have to o b t a i n a t least 50% in ea ch sect ion in o r d e r to pass. If the s u b m i n i m u m is n o t achieved the stu de nt fails th e e n ti r e e x a m i n a t i o n a n d is a w a r d e d a to ta l o f 45%. At th e en d o f the f o u r t h ye a r th e s t u d e n ts have an add iti ona l clinical e xam in ati on. They assess, plan a t r e a t m e n t p r o g r a m m e a n d tr e a t a p a t i e n t f r o m a clinical a r e a t h a t has been selected at r a n d o m an h o u r before th e e x a m i n a t i o n ta kes place. 4.2 C linical e v a lu a tio n s T h e e v a l u a t i o n o f th e clinical w o r k is given by th e clinical p h y s i o th e r a p i s t s w h o h av e been re­ sp o n s ib le f o r th e s t u d e n t d u r i n g th e block. It is an ev a l u a t i o n o f th e m o s t typical p e r f o r m a n c e o f the s t u d e n t ov er the f o u r weeks. T h e gu id e to clinical ex pe ri e nc e allows the s t a ff to ex pe ct ce rt ain levels o f p e r f o r m a n c e f r o m the s t u d e n t an d enable s th em t o j u d g e t h e s t u d e n t ’s level o f p e r f o r m a n c e accordingly. T h e ass ess m ent consists o f 20 items (see Figures IV an d V) m a r k e d on a 5- po i n t scale ra n g i n g fr o m very g o o d (90%) to very p o o r (20%). Pro vi sio n is PLEASE PUT YOUR COMMENTS FOR EACH AREA ON THIS SIDE AND TRANSFER ANY SCORES TO THE FRONT SIDE A R E A K E Y W O R D S 1. ASSESSMENT Evaluating patient Comments 2. PLANNING Choosing treatment procedures Understands history Appropriate - Effective Relevant data 3. EXECITTXON Performing treatment procedures 4. INTERPERSONAL RELATIONSHIP Working with patient Objectives Priorities Effective Efficient Safe Comfort Rapport Education Max: Capacity Fig. 3. Reverse side o f end-of-block exam ination fo rm . R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) physiotherapy, May 1986, vol 42 no 2 47 m a d e to allow e v a lu a to rs to o m i t items th a t they feel u n qu al if ie d to ju d g e . A fte r ea ch section, i.e. p e r f o r m a n c e o f tr e a tm e n ts , ap p li c at i o n to w or k, at t i t u d e to p a ti en ts , a tt it ud es to colleagues and pr of es si on al be h av io u r, th er e is pro vi sio n m a d e for c o m m e n ts by the clinical p hy si oth era pi st . S t e r n b e r g 6 w a r n s th a t if these ev a lu a ti o n s are n o t t r u e reflections o f p e r f o r m a n c e , th e s tu d en ts will n o t hav e an a c c u r a t e ide a o f t h e i r level o f ability. B r o ck w ay 6 m a i n ta i n s th a t thei r m o t iv a t io n , co nf id en ce an d desi re fo r f u r t h e r f e e d b a c k will be affected by this. U N IV E R S IT Y OF C APE T O W N D E P A R T M E N T OF P H Y S IO T H E R A P Y A SSESSM ENT OF STUDENT'S CLINICAL WORK Student's N a m e ............................. Year of Study (place X in square) 2 n d Y E A R 3 r d Y E A R 4 t h Y E A R Period w orked: F r o m .................. T o . Place w o r k e d ........................................... Clinical S ta ff in Charge ....................... N o te s on C o m p le tin g th is F o rm 1. T h e re su lts o f th is a s s e s s m e n t c o u n t to w a rd s th e s tu d e n t y e a r e n d m a rk s , so c a re a nd c o n s id e ra tio n in c o m p le tin g th is fo rm w o u ld be a p p re c ia te d . A d e fin ite n u m b e r of m a rk s w ill b e a w a rd e d fo r e a c h g ra d e o f p e rfo rm a n c e . 2. D o not be a fra id to give a h ig h o r lo w m a rk w h e r e it is d e s e rv e d . Y ou h a v e a re s p o n s ib ility to discuss w ith y o u r s tu d e n ts th e ir s h o rtc o m in g s . It is W R O N G a nd U N F A IR to let s tu d e n ts d rift on in th e m is ta k e n b e lie f th a t th e y a re giving s a tis fa ctio n . I. P erform an ce o f T reatm en ts. A V e ry Good B Good C S a tis fa c to ry 0 Poor E V e ry Poor k 1. A lw a y s a p p lie s th e o re tic a l k n o w - / (edge in te llig e n tly . G e n e r a lly fa ils to a pply th e o ry in te lli­ g e n tly . 2 . C a rrie s o u t p ra c tic a l te c h n iq u e s w e ll. P ra c tic a l te c h n iq u e s p o o rly c a rrie d out. 3 . W o rk is d o n e w ith a tte n tio n to d e ta il. In s u ffic ie n t c a re g iv e n to d e ta il. 4 . P e rfo rm s tr e a tm e n ts safely . D o e s no t p e rfo rm tre a tm e n ts s afely . 5 . Is re s p o n s ib le i.e. C a n be re lie d upon to c a rry o u t in s tru c tio n s . U n r e lia b le u n le s s c lo s e ly s u p e rv is e d . 6 . Is o b s e rv a n t of th e p a tie n t in a ll re ­ spects. U n o b s e rv a n t of p a tie n t in a ll re sp e cts. 7 . Re p o rts re le v a n t fin d in g s . O m its to re p o rt r e le v a n t in fo rm a tio n . 8 . K eep s good, a c c u ra te records. R e co rd k e e p in g poor. 9 . In s u m m a ry : C a rrie s o u t tr e a tm e n ts w e ll fo r a s tu d e n t a t th is s ta g e of tra in in g . P e rfo rm s tre a t m e n t s po o rly fo r a s tu d e n t at th is s ta g e o f tra in in g . C o m m e n ts:— Fig. 4. Clinical Evaluation Form. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 48 Fisioterapie, M ei 1986, dee! 42 no 2 II. A p p lic a t io n t o W o r k A V e ry G ood 8 G ood C S a tis fa c to ry D Poor V e ry Poor 10. A k e e n a n d w illin g w o rk e r. H a lt-h e a rt e d a n d In d iffe re n t. 11. E a g e r to e x te n d th e o re tic a l k n o w ­ ledge. A p p e a rs to lack in te re s t in e x te n d in g th e o re tic a l k n o w le d g e . 1 2 . E a g e r to im p ro v e p ra c tic a l skill. A p p e a rs to lack in te re s t in im p ro vin g p ra ctic a l s kill. 1 3 S h o w s q u ic k n e s s in g ra s p in g th e im p o rta n c e o f e s s e n tia l*. O fte n fa ils to g ra sp th e im p o rta n c e of e s s e n tia ls . 14. W o rk is d o n e p ro m p tly . O fte n s lo w a n d te n d s to h old up w o rk . C o m m e n t s : — I I I. A t t i t u d e t o P a t ie n ts A V e ry G ood B G ood C S a tis fa c to ry 0 Poor V e ry Poor 1 5 . T re a ts p a tie n ts as in d ivid u a ls, not " c a s e s " . D oe s not tr e a t p a tie n ts as in d ivid u a ls. ( 16. S h o w s s o m e a b ility in g a in in g c o ­ o p e ra tio n of p a tie n ts . A s yet. lacks a b ility to g a in c o -o p e ra tio n of p a tie n ts . C o m m e n t s : — I V . A t t it u d e to C o lle a g u e s A V e ry Good B G ood C S a tis fa c to ry 0 Poor E V e ry Poor 1 7 . C o -o p e ra tiv e a n d c o n s id e ra te in d e a l­ ings w ith o th e r m e m b e rs of s ta ff a n d c o lle a g u e s . U n c o -o p e ra tiv e and in c o n s id e ra te in d e a lin g s w ith o th e r m e m b e rs of staff a n d c o lle a g u e s . 1 8 . R esp o n d s re a d ily to g u id a n c e a n d in ­ s tru c tio n . A p p e a rs re lu c ta n t to a c c e p t a d vic e or in ­ s truc tion. C o m m e n t s : — V . P ro fe s s io n a l B e h a v io u r A V e ry G ood B G ood C S a tis fa c to ry D Poor V e ry Poor 1 9 . T a kes c a re to a p p e a r n e a t a n d w e ll- g room e d. C a re le s s of a p p e a ra n c e . 2 0 . U n ru ffle d in a ll c irc u m s ta n c e s . E a s ily 'u p s e t" Comments Subjective evaluation in Percentage I % TOTAL M A R K : Date S ignature Fig. 5. Reverse side o f the Clinical Evaluation Form R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) physiotherapy, M ay 1986, vo l 42 no 2 49 4.3 A llo ca ti o n o f m a r k s Clinical w o r k fo r th e ye ar is r e ga r d ed as being satis fa cto ry if the s t u d e n t achieves the following: II Year — passes 4 o f 5 clinical blocks III Year — passes 5 o f 7 clinical blocks IV Year — passes 4 o f 6 clinical blocks. T h e m a r k s ov er th e y e a r in the m o n t h l y block e x a m i n a t i o n s and clinical e v al u a tio n s co n tr ib u t e 50% to w a r d s P h y s i o t h e r a p y A p p li c a t io n IB, IIB a n d IIIB. T h e e x a m i n a ti o n s d o n e in the final block o f the ye a r c o n tr ib u t e the r e m ai ni n g 50%. T h is sy st em o f e x a m i n a t i o n has been in o p e r a ­ tion for l ye ar an d is at pres ent u n d e rg o i n g e v a lu a ­ tio n. R es ul ts so fa r in d i ca te t h a t it is effective in i de nt if yin g p r o b l e m ar eas t h a t an y s t u d e n t m ay hav e an d th er e is a s t r o n g positive c o rr el at io n between results an d tho se o f the O S P E ’s (Objective S t r u c t u r e d P ra c t ic a l E x a m i n a t i o n ) used to test techn ica l skills fo r P h y s i o t h e r a p y T e c h n iq u e IIB an d IIIB in seco nd an d thi rd year. 5.0 P R O B L E M S A S S O C I A T E D W I T H T H E C L I N I C A L E X A M I N A T I O N S Y S T E M 5 . 1 T h e e x t r e m e c o m p l e x i t y o f t h e s k i l l s 7 t o be e v a l u a t e d in th e cl i n ic al e x a m i n a t i o n s i t u a t i o n m ak es st a n d a r d i s a t i o n very difficult. 5 . 1.1 T h e r e is a g r e a t de al o f v ari ab il it y in the c o n d i t i o n s o f in- a n d o u t- p a ti e n ts as well as in the ob se r v e rs ’ j u d g e m e n t s o f t he s t u d e n t s ’ per fo rm an ce s. 5 . 1.2 T h e e x a m i n a t i o n a n d c li n ic a l e v a l u a t i o n f o r m s a r e s t a n d a r d i s e d a n d th e s t u d e n t s ’ p e r f o r m a n c e s in v ar i o u s settings have to be tr a n sl at ed to fit the generalised fo rm at . 5 . 1.3 D iff ere nt ex am i n er s are used, even in the sa m e clinical area. 5 . 1.4 T h e r e is v a r i a ti o n in th e e x a m i n e r s ’ in t e r­ p r e t a t i o n o f the levels o f co m p e t e n c e th a t s t u d e n t s f r o m th e d i f f e r e n t y e a r s s h o u l d achieve.8 5.2 T h e re is a large degre e o f subjectivity involved in b o t h e n d -o f -b lo c k e x a m i n a t i o n s a n d clinical ev alu ­ ations. F o r this re as o n e x a m i n e r s are oft en loat he to ev alu at e st u d e n ts d i r e c tl y . 1 5.3 T h e relatively quick t u r n o v e r o f clinical st aff make s o r i e n ta t io n o f the clinical e v a lu a ti o n sys tem diffi­ cult. 5.4 Eb el8 st ates t h a t time al lo cat ed fo r e x a m i n a t i o n s is f r eq ue nt ly ins ufficient to assess th e c o m p l e x c o m ­ petencies compre hen sive ly. 5.5 M o n t h l y e x a m i n a t i o n s an d e v a lu a ti o n s are c o m ­ plicated to admi nis ter , ti m e- co n su m i n g and involve a large n u m b e r of staff, b u t as G u il b e r t4 argues, u n le s s e v a l u a t i o n s a r e c o n t i n u o u s t h e y h av e a n e g a t i v e e f f e c t a n d o n l y f u n c t i o n t o p e n a l i s e s t ud en ts an d d o n ot serve as a lea rn in g experience. 5.6 The ex am in at io n fo r m at o f two exam in ers observing a t r e a t m e n t is oft en distre ss ing for th e p a ti en t an d m a y also affect the s t u d e n t ’s level o f p e r f o r m a n c e .4 5.7 T e s t anxie ty. S a r a s o n 3 m a i n ta i n s t h a t it is n o t a m a j o r consi dera tion in allocating m a r k s to a stu d en t in an e x a m i n a ti o n situa tion . 6.0 C O N C L U S I O N In view o f the c o m p l e x n a t u r e o f th e factors th a t have to be e x a m i n e d it is very difficult to m a k e the proc es s o f clinical e v a lu a ti o n fully o b je c t iv e. 1 A lt h o u g h ther e is a large degree o f subjectivity involved in b o th en d -o f -b lo ck e x a m i n a t i o n s an d clinical e va lua tio ns , it is the o nl y m e a n s o f assessing clinical c o m p e t e n c e in th e w id e ran g e o f clinical s i t u a t i o n s 7 an d it doe s allow the ex a m i n e rs the fr e e d o m o f ex am i n in g the s tu d en ts kn ow led ge in g re a t d e p t h where necessary.8 Q ua n ti f ic a t io n o f eva lu a tio n an d p la n n in g is possible, b u t de fi n it e c ri te r ia a n d d e s cr ip tio ns o f te rm s to be m e a s u re d have to be indicated in e x e c u tio n and in ter­ p e r s o n a l re la tio n sh ip s in o r d e r to minimise th e s u b ­ je c t iv it y. 8 Eb el8 r e p o r ts th a t objectivity an d reliability are im pr ov ed by having tw o c o m p e t e n t a nd exp erienced e x a m i n e r s w h o hav e a t h o r o u g h kn ow le d ge o f the field in w hi c h they ar e ex am i n in g . F u r t h e r , v ar i o u s f o r m s o f as s ess m en t by several di ff e re n t ind ividuals is m u ch m o r e likely to be a cc u ra te t h a n assessments m a d e by one p e r s o n . 8 G u i l b e r t 4 states t h a t f r e q u e n t testing, albeit time- c o n s u m i n g has the a d v a n ta g e o f pr o v i d in g a m or e reliable basis fo r e v a l u a t i o n an d o f keep in g the lec turer a nd s t u d e n t a w a re o f the prog re ss th a t has been made. It is also an o p p o rt u n it y for valuable learning experience w he re fe ed b ac k 4 is given im m e di a te ly afte r the e x a m i ­ n a t i o n . E b e l 8 o b s e r v e s t h a t th e e x a m i n a t i o n an d aw a rd in g o f m a r k s ten d s to st imulate, dire ct a n d rew ard the efforts o f the st ude nt. References 1. Loomis J. Evaluating clinical competence of physical therapy students. Physiotherapy Canada 1985; 37: 83-98. 2. Scully R and Shepherd KF. Clinical Teaching in Physical Therapy Education. Phys Ther 1983; 63: 354. 3. S a r a s o n IG. Em pi ric al Fin di ng s and Th eor et ica l Problems in the use of Anxiety Scales. Psychological Bulletin I960: 403-415. 4. Guilbert JJ. Education H andbook o f Health Personnel. World Health Organisation, 1977: 303-345. 5. Wilson M. Supervision: New Patterns an d Processes. New York, NY: Associated Press, 1969: 19. 6. Sternberg J, Brockway B. Evaluation of Clinical Skills: an asset oriented approach. J Fam Pract 1979; 8: 1243-1245. 7. Morgan M and Irby D (Eds). Evaluating Clinical Com petence in the Health Professions. St Louis: CV Mosby, 1978. 8. Ebel RL. Essentials o f E ducational M easurement. New Jersey: Prentice-Hall, 1979: 263-271. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )