การประชุมเชิงปฏิบัติการ เรื่อง แนวทางการออกขอสอบเพื่อประเมินผลการเรียนการสอน เพื่อการใชยาอยางสมเหตุผล

วันที่ ๑๐ สิงหาคม ๒๕๖๐ ณ โรงแรมมิราเคิล แกรนด ถนนวิภาวดีรังสิต กรุงเทพฯ

ชัยรัตน ฉายากุล

ภาควิชาอายุรศาสตร คณะแพทยศาสตรศิริราชพยาบาล

การวัดและประเมินผล

การเรียนการสอน เรื่อง

การใชยาอยางสมเหตุผล

ในหลักสตูรสขุภาพ

The Importance of Assessment

• Fundamental to outcomes- or competency-based education

• Allows measures of individual and programmatic progress

• “Drives learning”

• Assures public that providers are competent

• Credentialing, privileging, licensure, board certification – ‘high stakes’ for practitioner and patient/society

All involve assessment of competence

Formative Summative

• The quality of basic training in pharmacotherapy for undergraduate medical students can significantly influence future prescribing.

• Rational pharmacotherapy training, linked to clinical guidelines and essential medicines lists, can help to establish good prescribing habits.

• Traditional teaching: 'drug-centered’ In clinical practice: 'reverse approach’ Training is more successful if it is problem-based, concentrates on common clinical conditions, changing from.

• The Guide to Good Prescribing describes the problem-based approach, which has been adopted in many medical schools.

Training in Rational Prescribing for Prescribers

• WHO has produced a book: Guide for Good Prescribing – a problem-based method with a Teacher’s Guide book

• Developed by Groningen University in collaboration with 15 WHO offices and professionals from 30 countries

• Widely translated and available on the WHO medicines website

• Suitable for medical students, post grads, and nurses

http://apps.who.int/medicinedocs/en/d/Jwhozip23e/

Outcome-Based Education

Rational Drug Use Assessment

• What

• Where and When

• How

1. Professional habits, attitudes,

moral, and ethics

2. Communication and

interpersonal skills

3. Scientific knowledge of medicine

4. Patient care

5. Health promotion and health

care system: individual,

community, population health

6. Continuous professional

development

Matching Ten Modules for Thai RDU to Single Competency Framework 2016

P(ersonal) – Drug Selection

Step 1: Define the patient's problem Step 2: Specify the therapeutic objective (What do you want to achieve with the treatment?)

Step 3: Verify the suitability of your P-drug treatment

efficacy safety suitability cost • Group 1 • Group 2 • Group 3

Choose a P-drug efficacy safety suitability cost

• Drug 1 • Drug 2 • Drug 3

Step 4: Start the treatment Step 5: Give information, instructions and warnings Step 6: Monitor (and stop?) treatment

Rational Drug Use Assessment

• What … Expected attributes

• Where and When

• How

Teaching/Learning Strategies for Thai RDU Curriculum 2017

• Lectures

• Learning in small groups

• Teaching in the clinical settings

• Preceptorship

• Bedside teaching

• Out-patient/Ambulatory care teaching

• Community-based learning

• E-learning/Distance learning

• Self-directed learning

• Peer-assisted learning

• Extracurricular activities

Rational Prescribing Clinical Rotation

Surgery Ambulatory

IPD, Med

Obstetrics Pediatrics

Simulation-based

Psychiatry

Critical Care

Items Matched with Specialties

Ambulatory Long-term Care

Rational Drug Use Assessment

• What … Expected attributes

• Where and When

… Formative / Summative

• How

Miller’s Pyramid of Competence

“Topic Selection" for Assessment

Clinical Pharmacology vs. Rational Drug Use

The Rational Use of Medicine requires that patients

receive medications appropriate to their clinical needs,

in doses that meet their own individual requirements,

for an adequate period of time, and at the lowest cost

to them and community.

WHO conference of experts Nairobi 1985

“Topic Selection" for Assessment

Clinical Pharmacology vs. Rational Drug Use

“Topic Selection" for Assessment

Fundamental / Essential knowledge

Professionally impact

Important questions (extent, depth)

Test level by Miller’s Pyramid

Less controversy

Sample RDU Questions • Should a drug be prescribed?

(a) What and how is the patient condition, what does he/she want?

(b) Any problem with the prior/present drug history?

(c) How could this condition be managed: drug or alternative strategies, and where is the evidence?

(d) What is the therapeutic target and expected outcome?

• Which drug should be prescribed?

(a) Efficacy: The most prudent first line choice?

(b) Safety: Contraindications to the first choice drug(s) and what alternatives should be used?

(c) Suitability: What dose and frequency, by what route and for how long?

(d) Cost effectiveness / Formulary drugs?

Sample RDU Questions • What treatment is required in addition to drug?

• How will response to treatment be assessed?

(a) How do you know if things are going wrong? - Drug adverse effects / complications - Medication errors

(b) What do you do with unsatisfactory response? - Inappropriate in type or dosage of drugs - Non-adherence / Drug-drug interaction

(c) When to stop treatment?

• How will decisions be communicated?

(a) What data should be recorded in order to support each decision?

(b) What information does the patient need, and how to inform?

(c) Who else needs to know?

การจัดทํา Short Essay Question • Keep the question short and clear, demanding a short,

precise answer

• Use explicit terms (identify, compare, define, calculate, arrange in order) rather than diffuse terms (discuss, explain)

• Make each question independent of the others

• Use maximum peer feedback possible

• Define in advance the correct answer called for by the wording of the question. If conceptually different answers are possible, reword the question

• Before the test, define the scoring procedure

• Mark the papers anonymously

• Arrange for marking by two scorers

• When scoring, stick to the agreed correct answers

ตัวอยาง Short Essay Question • Short answer question

“แพทยควรสั่งยาใหแกผูปวยโดยคํานึงถึงความคุมคา ไมเกี่ยวของกับสิทธิในการเบิกจายฯ” เกี่ยวของกับหลักเวชจริยศาสตรขอไหน

• Restricted response essay question

การท่ีแพทยสั่งยาซึ่งไมเกี่ยวของกับการเจ็บปวยปจจุบัน แตเปนไปตามคําขอของญาติท่ีมา รพ. ไมได

มคีวามเหมาะสมตามหลักเวชจริยศาสตรหรือไม อยางไร

ตัวอยาง Multiple Choice Questions

Can be everywhere!

F 65, DM HT; BP 140/80 mmHg - U. protein 2 gm/day, HbA1C 6%, eGFR 40 ml/min/1.73 m2 - Currently on glipizide 5 mg/day, enalapril 20 mg/day

(A) Replace glipizide with metformin 500 mg twice daily C.I. (dis.)

(B) Increase the dosage of enalapril to 40 mg daily Dosage

(C) Replace enalapril with lisinopril 40 mg daily Formulary

(D) Replace enalapril with losartan 100 mg daily Drug Class

(E) Add to enalapril with losartan 50 mg daily C.I. (DDI)

การจัดทํา OSCE Stations

1. ระบุสมรรถนะของทักษะทางคลินิก ท่ีตองการประเมิน เชน - Drug history taking - Communication skill - Prescription writing, etc.

2. จัดทํา Scenario ท่ีเหมาะสม และ Scoring checklist ท่ีสอดคลองกัน

3. Standardized Patient ตองแสดงบทบาทตาม scenario

อุปกรณประกอบ อ่ืนๆ ท่ีจําเปน

Today’s Work

• MCQs = 2-3

• MEQ หรือ OSCEs 1

Matched with the

- expected attributes

- learning objectives

Assessment related to Ten Thai RDU Modules

Thank you for your attention.

cshayakul@gmail.com