Structured assessment using multiple patient scenarios by videoconference in rural settings

Abstract

The assessment blueprint of the Australian College of Rural and Remote Medicine postgraduate curriculum highlighted a need to assess clinical reasoning. We describe the development, reliability, feasibility, validity and educational impact of an 8-station assessment tool, StAMPS (structured assessment using multiple patient scenarios), conducted by videoconference. StAMPS asks each candidate to be examined at each of 8 stations on issues relating to patient diagnosis or management. Each candidate remains located in a rural site but is examined in turn by 8 examiners who are located at a central site. Examiners were rotated through the candidates by either walking between videoconference rooms or by connecting and disconnecting the links. Reliability was evaluated using generalisability theory. Validity and educational impact were evaluated with qualitative interviews. Fourteen candidates were assessed on 82 scenarios with a reliability of G = 0.76. There was a reasonable correlation with level of candidate expertise (rho = 0.57). The videoconference links were acceptable to candidates and examiners but the walking rotation system was more reliable. Qualitative comments confirmed relevance and acceptability of the assessment tool and suggest it is likely to have a desirable educational impact. StAMPS not only reflects the content of rural and remote practice but also reflects the process of that work in that it is delivered from a distance and assesses resourcefulness and flexibility in thinking. The reliability and feasibility of this type of assessment has implications for people running any distance-based course, but the assessment could also be used in a face-to-face setting.