Cardiff ISCE handbook PDF

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2017-18 Year 4 ISCE

Information for students Contact Emails [email protected] Undergraduate Assessment Administration Team Year 4 Director Dr Rachel Brookes [email protected] Director of Assessment Dr Lee Coombes [email protected] Director of Clinical Skills and Simulation Professor Paul Kinnersley [email protected] Lead for Clinical Assessment Dr Liz Metcalf [email protected]

Contents ISCE- definition………………………………………………………………………………………………..………… 2 Standard setting……………………………………………………………………………………………..………… 2 Formative mini ISCE………………………………………………………………………………..………………… 3 Summative ISCE……………………………………………………………………………………………..………

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When and where, timings…………………………………………………………………………………..……… 5 Patients……………….…………………………………………………………………………………………………..… 6 Examiners…………………………………………………………………………………………………………………… 7 Student conduct……………………………………..………………………………………………………………….. 7 Extenuating circumstances and specific provisions………………………………………………………. 8 Domains of competence. …………………………………………………………………………………………

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Example formative ISCE peer marksheets ……………………………………………………………..

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Feedback……………………………………………………………………………………………………….……..…… 19 Safety alerts……………………………………………………………………………………………………………….. 20 Types of station……………………………………………………………………………………………………….. Clinical examination stations Clinical examination station: symptom presentation Acute assessment stations Psychological medicine stations Women, child and family stations e-Learning resources and Self-Directed Learning…………………………………………….…

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Year 4 clinical assessments guide 2017/18

ISCE (Integrated Structured Clinical Examination) In order to progress to Phase 3 of the undergraduate C21 curriculum, you must pass the year 4 ISCE, designed to ensure that you have acquired the necessary clinical skills for phase 3. This booklet outlines the format of the Year 4 ISCE, including detail regarding the domains of competence against which you will be assessed. This booklet should be read in conjunction with the Year 4 schedule of assessment and any queries arising should be directed to the Undergraduate Assessment Administration Team ([email protected]) who will ensure responses to frequently asked questions are made available to the whole cohort. Please note however that queries regarding the content of the ISCEs may not be answered later than one week ahead of the first day of the exams, in order to ensure fairness to all candidates. The ISCE is an examination which assesses your clinical competence and professional abilitytesting your ability to communicate and perform a range of clinical examinations and related practical clinical skills in an integrated fashion. The examination is aligned with learning outcomes up to and including phase 2 and is based upon the common clinical systems. The summative ISCE is undertaken to ensure that you have acquired the necessary clinical skills to progress to Phase 3 of the undergraduate C21 curriculum. The examination must be passed in order to progress to Phase 3. Should you fail to meet the required standard during your summative assessment you will be offered remediation and will have the opportunity to re-sit the exam at the next exam period. The re-sit examination will be equivalent in format and difficulty to the original practical examination failed.

Standard setting The examination is standard set by the borderline regression method. In order to pass the Year 4 ISCE, you must pass 10 out of the 12 stations and IN ADDITION achieve ≥50% standard set adjusted mark overall for the examination. For further information regarding the standard setting process please refer to the document on Learning Central in the Assessments, general information folder. Candidates have to meet both criteria to ensure that they have demonstrated an acceptable level of performance across a range of stations. Candidates who score highly in some stations cannot use this to compensate for poor performance in other stations. This is a standard method for examinations of clinical performance. Should you have to re-sit the ISCE you will again require a ≥50% standard set adjusted mark to pass, and you must pass 10 out of 12 stations. However, your mark will be capped at 50% for a resit (second) attempt.

Standard setting Form

Year 4 clinical assessments guide 2017/18

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Formative mini ISCE In order to give you the opportunity to practise a range of ISCE stations in the run up to your Year 4 ISCE in May 2018, you will be given the opportunity to attend a formative mini ISCE during the Reading Week in February 2018. The session is non-compulsory. The formative mini ISCE will give you the opportunity to learn more about the exam process and domain marking by completing modified domain mark sheets for your peers. Unfortunately we are unable to give any further advice regarding the stations which may come up in the summative ISCE other than what is included in this booklet- we therefore strongly advise you to attend the formative ISCE. Above all, the formative mini ISCE, and other formative clinical assessments that you undertake whilst on clinical placement, are a learning experience- a great opportunity for you to learn more about what is expected of you in the clinical assessments, to test your existing knowledge and focus your future learning to achieve your best potential in future clinical assessments. You will rotate in pairs around six 15 minute ISCE stations. You will each undertake three of the stations in full, under exam conditions, working individually and each of you will observe your peer undertaking three stations. Building upon your experiences of peer marking in the year 2 formative ISCEs, you are asked to complete a formative feedback mark sheet for your colleague. This provides another dimension to the feedback that you receive and has the added advantage of giving you good insight into the expectations of examiners, the exam process and domain marking, in the summative ISCE. There won’t be an ‘examiner’ for each station as the emphasis is on feedback from simulated patients and your peers, however floating tutors will be available to offer additional verbal feedback as necessary. This is just one opportunity for formative feedback on your clinical skills and you should be using every opportunity on clinical placement to obtain feedback from consultants and other clinicians, many of whom are examiners. The formative mini ISCE is designed to give you an idea of the types of station, timings etc. Simulated patients are experienced and specifically trained to give appropriate feedback and this model has been shown to be highly beneficial in previous years. All SLEs performed during year 3 and 4 should be thought of as a formative attempt getting feedback from a range of assessors including consultants. The marking forms for the SLEs have been devised specifically with this in mind as they mirror the domains. Senior faculty from both year 3 and 4 continuously emphasize that students should be doing many more than the minimum detailed in the handbooks. The more SLEs you do, the more feedback you get. There is no ‘global rating’ on formative feedback mark sheets, and no numerical score, however we hope feedback from your peers will support you in your final few months of preparation ahead of your summative ISCE. These sheets may be taken away on the day, but you MUST NOT remove any other paperwork from the sessions (scenarios, clinical resources etc.) Please note the formative ISCEs are not standard set and therefore you will not be told whether you have ‘passed’ or ‘failed’- instead the feedback they will receive will be aimed at helping you to identify your strengths and weaknesses in your clinical and examination technique. You will be allocated a specific time and pairing prior to the session and will be notified in advance when & where to attend.

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Year 4 clinical assessments guide 2017/18

Giving feedback to your peers: DO • • •

say what they did well say what could be done better and how (be specific) say HOW to improve (e.g. practise with patients, clinical skills lab, books, e-learning resources, etc.)

DON’T • Be so negative they feel they cannot improve • Overstate the quality of the performance (or lack of it) - the feedback should be candid

Summative ISCE In the summative year 4 ISCE, you are required to undertake twelve 15 minute ISCE stations, enabling appropriate, proportionate coverage of the key areas of the C21 practice domain learning outcomes. There will be a 3 minute gap between each station to allow you adequate time to prepare for your next station and to allow examiners and simulated patients time to give written feedback. Stations will involve a variety of tasks, for example you may be required to:     

Communicate with a patient or their relative or a colleague- for example take a history +/give an explanation or discuss a patient with a colleague Perform a clinical examination (real or simulated patients) perform a clinical procedure relating to the patient you have examined or taken a history from Interpret clinical data e.g. X-rays, ECGs and biochemistry Answer questions relating to diagnostic synthesis, clinical care, management planning and patient safety.

Each station is standardized ensuring a fair examination during which each student sees the same group of cases and is asked to perform the same clinical tasks with the same set of questions as all the other students taking the examination on your particular day, so that everyone’s examination experience is equivalent. Instructions will be on display outside each station but may be repeated/clarified by the examiners as necessary. In order to avoid overload, and to facilitate you having the best opportunity to demonstrate your knowledge and skills in all areas, the 12 stations are organised across 3 consecutive days, with each of you undertaking 4 stations per day. You will be notified ahead of the ISCEs your specific rotation timings, venues and dates via Learning Central. Six stations are based on the physical examination of ‘real’ patients. You will be expected to assess patients presenting to any speciality or to primary care. There will also be six simulated patient based stations, two of which will assess your’ ability to assess and manage patients presenting acutely, two which will assess your ability to assess and Year 4 clinical assessments guide 2017/18

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communicate with patients presenting in psychological medicine and finally two stations assessing learning outcomes and competencies based on the Women, Child and Family module. Different stations will be used for each day of examinations, in order to ensure fairness to all of you as you will be sitting the stations across different days in varying sequence. Students should expect to be corralled on the day of exams to ensure that students on different rotations/ timings on any one day do not communicate with one another, which could provide an unfair advantage to some students. Students are not permitted to use pens and paper to take notes during the ISCE stations unless it is a specific component of the station for example documenting a procedural skill result. You are being assessed on your clinical and communication skills and taking notes during stations may detract from your communication directly with the patient. When and Where The summative ISCE will be conducted in three parallel venues across three days- normally this will be the outpatients department, UHW, the Cochrane building and the sports hall, UHW. At each venue, a number of parallel circuits will run in order to accommodate everyone across the 3 days of exams. Please refer to Learning Central for specific dates of the exam. You will be informed of your allocation to a specific venue, date and time approximately 4 weeks before the examination. An example rotation is illustrated below: Student group (100 each) A B C

Tues

Wed

Thurs

Stations 1-4 OPD Stations 5-8 Cochrane Station 9-12 Sports hall

Stations 5-8 Cochrane Station 9-12 Sports hall Stations 1-4 OPD

Station 9-12 Sports hall Stations 1-4 OPD Stations 5-8 Cochrane

Timings An alarm will sound at: 0 minutes: you may begin the station • • 15 minutes: you must finish the station An alarm will also sound at 7 minutes to allow time to move you through the various stages of the station and again at 11 minutes to give you a warning that you only have 4 minutes remaining. Station sub-timings are given to guide you through the various elements of the station in order to ensure you have sufficient time to answer as many elements of the station as possible. The examiner/ station guide will normally allow you to move on to the next element of the station if you have completed the previous element, however if you the subsequently want to go back, you would not normally be permitted and would not normally be credited for answers given after the allotted time for that element of the station. 5

Year 4 clinical assessments guide 2017/18

You will have 3 minutes in-between stations in order to move between stations and read the station briefing. The examiners use this time to complete mark sheets and write formative domain linked feedback for you, in order to support further learning. Further details regarding the station timings for the various different kinds of station are detailed on pages 12-18, noting in the acute stations the station guide will be responsible for guiding you through the various elements of the station. Attendance is compulsory. You must display your University ID. Students who are either absent with good cause (as defined by the University), or who cannot take an assessment on the due date and have obtained prior approval for that absence, must take the assessment at the next available opportunity. In most cases, this means sitting the examination as a ‘first sit’ during the re-sit examination period. If this re-sit examination is missed, then the next opportunity will be the following academic year, necessitating the repeating of Year 4. If you are going to be absent from an assessment you must notify the Year coordinator on 5th floor Cochrane ASAP (who will inform the Academic Year Lead or Chair of the Exam Board) You must submit Extenuating Circumstances, together with appropriate evidence, to account for your absence. You can find further information regarding Extenuating Circumstances, including deadlines and dates for submission, on Learning Central. We do not accept self-certification or medical notes written by members of your family for absence from an assessment.

Patients Real patients Real patients are used in some stations. Please remember that many real patients will have physical signs that you are expected to identify and recognise and other patients may not have abnormal physical signs. Please also remember that patients of all ages become tired easily or may need to go to the toilet etc., and therefore you should be aware that it may be necessary for the time between stations to be extended or for you to be placed on a rest station during your circuit, should a patient become unwell during the examination and require substitution. Simulated (actor) patients Actors enable us to assess clinical competencies that would be difficult to provide in a standardized manner to all of you with real patients. All are experienced role players and some will be familiar faces from the communication skills workshops. The actors have detailed scripts for their roles and attend training sessions before the exams to go through these roles to ensure they are able to play them consistently, however there will inevitably be minor variations and these are taken into account by examiners when marking. Feedback from simulated patients themselves do not currently contribute towards the summative mark for your performance in ISCEs, but their feedback does contribute towards the formative feedback you will receive after the exam and gives you a useful insight into how you are perceived by patients in terms of your interaction with them. Year 4 clinical assessments guide 2017/18

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Examiners Examiners are required to have undergraduate medicine teaching experience for the level of the students being assessed, such that they possess an appropriate level of knowledge of the subject matter of the assessment. In addition, examiners are required to undertake regular Cardiff University School of Medicine undergraduate examiner training and provide evidence of regular Equality and Diversity training. Examiner conduct is monitored by the University through a combination of peer review, psychometric performance monitoring and by External Examiners, present during clinical assessments, ensuring fair process. On the day of each clinical assessment, examiners attend a briefing and station calibration discussion in order to ensure consistent application of marking schedule and student experience. Each ISCE station is marked by an examiner, who does not know the pass mark for the station, and is scoring objectively whether the candidate is performing the clinical skills being tested to a competent level for the appropriate level of the exam, i.e. of students at the end of Phase 2 of the course. The examiner stays with the station and marks the same station all the way through the circuit (i.e. the patient and the examiner stay put and you move from one station to the next when the alarm rings). Examiners in training may also be present observing the stations. On some stations, for example the acute stations, there is a second member of staff, the ‘station guide’ who is responsible for guiding you through the station and asking all questions, allowing the examiner who is marking the station to focus upon your demonstrated skills.

Student conduct Student conduct- please also refer to Cardiff University Registry page http://www.cardiff.ac.uk/regis/sfs/exams/ You are expected to conduct yourself in a professional manner throughout all examinations, both formative and summative. You should wear smart clothes, appropriate to a clinical environment- making sure that your name and your number are clearly displayed for the examiner and ensuring sleeves are rolled up, hair is tied back etc. You must follow all instructions given by the assessment team and invigilators. You are permitted to bring your stethoscope and a watch (EXCLUDING smart watches e.g. Apple Watches, Samsung Gear etc). All other possessions should be placed for secure handling as per instructions at the exam venue. Should calculators be required for any station, they will be provided and therefore you are not permitted to bring your own calculators to the exam. Following arrival at the exam venue (including the briefing and holding rooms and all other waiting areas), you should not attempt to communicate with other student by any means, either directly or indirectly e.g. via mobile phones or other communication devices. According to University Regulations, any communication with other students including via smartphone/computer/tablet (e-mail, sms, WhatsApp, Skype etc.) whilst in the exam venue, or the briefing/post-exam holding areas, could be interpreted as cheating and will be treated as a breach of exam security. Furthermore, you should not communicate with any other student by any means after they have taken the exam and whilst others are still waiting to take the exam as 7 Year 4 clinical assessments guide 2017/18

it will be treated as a breach of exam security.DO NOT bring valuables into your exam as the University cannot be liable for any loss incurred. It is recommended that mobile phones and all other electronic devices be left at home, however if you do choose to bring them with you, they must be switched off when you arrive and placed according to invigilator instructions in secure storage until you are permitted to leave. Any att...