To be effective, an Integrated curriculum needs integrated assessment. This brief talk captures the essence of integrated evaluation carried out in Malaysia using a hybrid curriculum modelled after the British curricula. Harden's 11-step ladder of integration forms the basis of the talk.

1. Integrated Assessment
in Medical Education

2. Objectives for this brief session
• Consider integration as a continuum
– from Isolation to Trans-disciplinary holism
• Share personal experience in Integrated
assessment in a hybrid UG curriculum
• Consider various tools for integrated
assessment of competencies especially for
postgraduate residencies

3. Intro…
– “Learning is by connecting things. If you can not
connect, you can not learn.”
– Lord Chesterton (paraphrased)
• Integration as an educational strategy
• Medical Teachers are polarized (For/Against)
• Ronald Harden described a 11-step ladder
between the two extremes.

4. From Isolation
to Authentic T-L
- in 11 steps
(Harden et al)
Fragmentation | Anarchy
Connection | Consultation
infusion
concurrent teaching
Integrate !
joint teaching
concomitant program
mixed program
contributory
monolithic
Immersion | authentic

5. Integrated Curriculum needs
Integrated Assessment
I Year Integrated MBBS
MCBM = Molecular and
Cellular Basis of Medicine
HBM = Human Basis of
Medicine
II Year Integrated MBBS
Systems-based approach

6. Year 1 – Concurrent “Slice of Pie”
Model of Assessment
• Molecular & Cellular Basis of Medicine
– Paper-1 – Structure & Function (Anat-Physiol)
– Paper-2 – Biochemical & Gen Pharma
– Paper-3 – Gen-Path, Immunology, Microbiology
• Human Basis of Medicine
– Paper-4 – Epidemiology, Basic statistics etc
– Paper-5 – Ethics, Bio-psycho-social approach etc
• Integrated 24 station OSPE

7. Year 2 – Multi-Disciplinary Model
• Systems based Theory papers (n=6)
– LAQ – SAQ – MCQ
• With “Slice-of-Pie” division among departments
• Integrated OSCE in 2 sessions
– 18 to 24 station performance (5-10-min stations) +
– 40 to 50 items for response (3 min per item)
– This avoids duplication of skills across subjects

8. Years 3 & 4 – Purposive Outcomes
Oriented Integrated OSCE
• Theory Papers (isolated & Subject based )
– LAQ/SAQ/MCQ
• Outcomes based integrated OSCE
– Clinical skills: Paeds OG & Forensic in Year-3
– Clinical skills: Med – Surgery – Com-Med (year-4)
– 15 to 20 station performance (5-10-min stations) +
– 40 to 50 items for response (3 min per item)
– This avoids duplication of skills across subjects

9. Final Exams in Year-5
• Theory – multi-disciplinary papers (n=2)
– Medical specialties | Surgical specialties
• Clinical Exam – Integrated
– Long case: 1 of 4 (Med/Sur-Ortho/Paed/OG)
– Short case: other 3 of 4 (joint vs. concurrent)
– OSCE: 24 station Integrated OSCE
• 12 each for Medical & Surgical specialties
• History – physical exam – Dx tests – Rx advice –
counseling on diet/life-style etc

10. Assessment during PG Residency
In-training formative assessment by
• Clinical Skills Exam (CHEX)
• DOPS (direct observation of procedural skills)
• Self evaluation using e-Portfolio
• Peer assessment
• Multi-source / 360o evaluation
• Tools: Check list / Rating scale / Rubric
Haldane T. “Portfolios” as a method of assessment in medical education”
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017561/ (accessed on 9-9-2015)

11. Rubric – more explicit than
Rating Scale
• Rubrics have 4 parts:
– 1- description of the task = Check-list
– 2- the scale to be used = Rating scale
– 3- the dimensions of the task
– 4- the description of each dimension on the scale.
• The Development of a Competency Based Assessment Rubric to
Measure Resident Milestones - DOI: 10.4300/01.01.0008

12. Many
requirements of
task are missing
All requirements of
task done; partial
understanding
All requirements o
task done with full
understanding
Most requirements
of task are done;
some understanding

13. Rubrics for Outcomes
1. Measure outcomes based on real-life criteria
2. Specify graded performance indicators
3. Permit assessment of outcome level achieved
in a specific competency
4. Ensure coherent and consistent assessment
5. Improve the quality of assessment
6. A collage of rubrics may permit integrated
assessment of professional behaviour

14. Be a Trail-blazer
• One more trail to blaze:
• Making rubrics for effective assessment of
specialty training to suit your training objectives
• Will you do it soon to enhance the quality of
assessment ?
• Strive for Success – Best wishes…