Clinical Work Sampling

Tri Wahju Astuti

Background

In-Training Evaluation

(ITE)

Existing systems for assessing

student performance

have been criticized

Unreliable

&

Invalid

Basing performance

data on observed

behaviours

Using multiple observers & occasions

Recording data at the time of performance

Allowing for a fasible system to receive feedback

Clinical Work Sampling

• Assessment Method , developed in Canada

• Direct observation of clinical performance in the workplace (Turnbull et al.2000)

• Collection of data concerning specific patients encounters for a number of different domains (at the time of admission, during the hospital stay)

• Completed by faculty members directly observing trainee performance

Clinical Work Sampling • Tests specific skills separately ( communication, diagnostic,

investigative, health promoting )

• Number & type of team members can assess

• Blinded patient encounters

• On the spot assessment

The domains assessed, include :

• Communication skills

• Physical examination skills

• Diagnostic acumen

• Consultation skills

• Management skills

• Interpersonal behaviour

• Continued learning skills

• Health advocacy skills

Clinical Work Sampling Assessed by : • Ward nursing staff (using the multidisciplinary team rating form) • Patients (using the patient rating form) who in the care of the trainees Completed on the basis of the dirrectly observed behaviour : • Therapeutic strategies • Communication skills • Consultion with other health care proffesionals • Management of resources • Discharge planning • Interpersonal relation • Collaboration skills • Health advocacy skills • Profesionalism

Turnbull et al. 2000

This assessment method → valid & reliable

• Sufficient number of encounters are observed

• Approximately 7 encounters for a reliability of 0.7

• Diagnostic/therapeutic plan

• Differential diagnosis

• Physical examination

• Communication skills (writen & verbal)

• Overall impression

Admission Rating Form

• Diagnostic/therapeutic plan

• Communication skills

• Management of resources

• Health advoacy skills

• Interpersonal skills

• Fund of knowledge

• Overall impression

Ward Rating Form

• Diagnostic/Therapeutic plan

• Communication skills

• Consultation skills

• Management of resources

• Discharge planning

• Interpersonal skills

• Overall impression

Multidisciplinary Team Rating Form

• Communication skills

• Collaboration skills

• Health advocacy skills

• Profesionalism

• Overall impression

Patient Rating Form (conten domains:

administered through interview)

Rating scale used: 1=unsatisfactory; 2= meets expectation; 3 = good; 4 = very good and 5 = excellent Adapted from: Turnbull. J, Macfadyen. J, Barnefeld. C, Van & Norman. G (2000) Clinical work sampling: a new approach to the problem of in-training evaluation, J. Gen. Inter. Med 15: 556-561. used with authors’ permission.

Item Evaluated in Clinical Work Sampling (CWS)

Tata Laksana Pasien TB-RO

• Diagnostic: penentuan kriteria suspek (TCM)

• Therapeutic plan : STR / Individual

• Physical examination

• Communication skills (writen & verbal) : apakah pasien bersedia diterapi STR/individual

• Overall impression

Admission Rating Form

• Diagnostic : baseline (Ax, PE, Lab, EKG, audiometri)

• Therapeutic plan; STR / Individual

• Communication skills

• Management of resources: rapat Tim Ahli Klinis

• Health advocacy skills : ESO

• Interpersonal skills : Pharmacies, Nurses, Nutritionists, ENT, Cardiologist

• Fund of knowledge : BPJS

• Overall impression

Ward Rating Form

• Diagnostic/ Therapeutic plan

• Communication skills

• Consultation skills

• Management of resources

• Discharge planning

• Interpersonal skills

• Overall impression

Multidisciplinary Team Rating Form

Puskesmas, RS, DinKes

• Communication skills

• Collaboration skills

• Health advocacy skills

• Profesionalism

• Overall impression

Patient Rating Form (conten domains:

administered through interview)

PANTER

Implementasi

Divisi Infeksi

Tata Laksana

TB -RO

Tata Laksana TB-DOTS

Hospital DOTS

Linkage

Divisi Onkologi

Tata Laksana Kanker

Paru

Multi Discipline

Team

Penegakan Diagnosis: CT

Scan, FOB, FNAB

Kemoterapi

Divisi Paru Kerja &

Lingkungan

Upaya Berhenti

Merokok : a.Identifikasi

Status px, pemeriksaan fisik. b. Profil perokok

(Skor Horn ) c. Ketergantungan Nikotin(kuesioner

Fagerstroom_. d. Pengukuran kadar CO udara ekspirasi. e. tingkat motivasi.

f. Terapi

Divisi Gawat

Napas & Intervensi

RHCU

NIV

Tatalaksana Intervensi

Divisi Imunologi

ILD

Multi Discipline

Team

Divisi Asma PPOK

Spirometri

Body-

Phletysmografi