Tuesday, July 25, 2006

Integrated Procedural Performance Instrument

Today I took part in a Gynaecology Pilot Study, to see how one could better assess communication skills in the context of cervical screening. We were required to play the role of the doctor in three scenarios: one, involving a nervous girl attending for her first smear; another, concerning a repeat smear for an inadequate sample; and thirdly, in the context of a Muslim couple, where the husband is controlling and upset that a male doctor is performing the smear.

We filled out feedback forms on our own performance, and those watching from a video link also graded us on various aspects of the consultations, as well as practical skills. We then gave our thoughts on the whole set-up and what we thought was good and could be improved in the future.

The system is a new approach implemented by Imperial College and called Integrated Procedural Performance Instrument (IPPI), whereby instead of performing a procedure on a dummy (and pretending it's a real patient) with an examiner present, the idea is a more natural approach, allowing more freedom and avoiding the contrived circumstances currently available for assessment. One can be graded by an examiner watching from another room, which aids the candidate's ease and flow.

Experiencing the trial first hand was interesting, not least as I had the chance to reflect on the way I deal with patients, as well as how I explain things to them. But it's also exciting to be involved in the evolution of medical assessment, and I commend the direction it is taking - currently we are assessed by Objective Structured Clinical Examinations (OSCEs), in which the time limits, lack of actors and patients to interact with and the presence of examiners makes the whole affair unrealistic and false. IPPI also encourages more personality than simply 'ticking all the boxes.'


Warrior Mom said...

The senarios that you were given are ones that I encounter most days. To be honest I really enjoy doing first exams, I feel that I can set the stage, so to speak, for these young women to be less anxious in the future, therefore promoting better compliance with annual exams. I also feel that when their anxiety is relieved they can better hear when I am counseling them about self care issues.
I encounter many couples such as you described in the last senario, it does help that I am female, but it can still be a difficult exam. Many of the couples that I see in this type of situation are women that have recently immigrated to the US and do not speak english, many have never had an exam and have only recently become sexually active. Often the men have been here for a while and have had quite an indulgent lifestyle. Since there is the issue of dominance and I am female, therefore I should concede to his wishes reguarding the way the exam is conducted and the tests that I order.

I will be intersted to hear more about this. I would like to do role playing with students that I precept and new employees to evaluate empathy/counseling skills as well as clinical skills.

Anonymous said...

I think the scenarios are very interesting and usefull.
I'm inetrested if there will be another.