Workplace-based Assessment Tools Research Articles

Role of Case-Based Discussion as Workplace-Based Assessment Tool in Urology and General Surgery

OBJECTIVES To determine the effectiveness of case-based discussion in terms of medical record-keeping, clinical reasoning, clinical judgment, and self-reflection in the management of patients. METHODOLOGY A multidisciplinary descriptive study was conducted in the Department of Urology Institute of Kidney Diseases, Hayatabad Medical Complex Peshawar, and Department of General Surgery, Hayatabad Medical Complex Peshawar, Pakistan, from January to December 2023. A total number of 20 postgraduate residents, ten from Urology and General Surgery, participated in the study with equal male and female participants. Case-based discussion (CBD) assessments focused on medical record-keeping, clinical Decision-making, clinical judgment, management, follow-up, and reflective writing. The data was collected on structured proforma and was analyzed on SPSS-25. RESULTSThe total number of study participants was 20, and 410 Case-Based Discussion sessions were conducted. This constitutes an average of 4.8 assessments per week. Most encounters were related to medical clinical decisions and management. The case-based discussion showed significant improvement on the Likert scale of the supervisor’s rating, which extended over four quarters on all major parameters of formative assessment (p 0.001). The multimodal regression test showed significant enhancement in learning parameters on case-based discussions. R2=0.172 F ration=25.141 n=410 (p=0.001). There was no significant difference in the gender of residents as well as training specialty of residents of urology and general surgery (p >0.05). CONCLUSION A case-based discussion is an effective tool for formative assessment of Urology and General Surgery postgraduate residents.

Implementation and Impact of an Adapted Digital Perioperative Competency-Building Tool to Enhance Teaching, Learning And Feedback in Postgraduate Competency-Based Medical Education

The purpose of this educational intervention was to introduce, iteratively adapt, and implement a digital formative assessment tool in a surgical speciality. The study also evaluated the intervention's impact on perioperative teaching, learning, feedback, and surgical competency. A participatory action research model with a mixed methods approach. This study was performed over 10 months in an institutional hospital in South Africa with a general surgery department. Twelve supervising surgical trainers/faculty and 12 surgical trainees/residents consented to participate in the intervention. The first 4 months of the intervention focused on relationship building, a multi-stakeholder contextual needs assessment and training sessions to support a shared mindset and shift in the teaching and learning culture. The final adapted perioperative competency-building tool comprised a 23-item assessment with four open-text answers (Table 1). Over the following 6-month period, 48 workplace-based competency-building perioperative evaluations were completed. Most trainees took less than 5 minutes to self-assess (67%) before most trainers (67%) took less than 5 minutes to give oral feedback to the trainee after the perioperative supervised learning encounter. On average, the digital tool took 6 minutes to complete during the bidirectional perioperative teaching and learning encounter with no negative impact on the operational flow. All trainers and trainees reported the training and implementation of the digital tool to be beneficial to teaching, learning, feedback, and the development of surgical competency. Analysis of the completed tools revealed several trainees showing evidence of progression in surgical competency for index procedures within the speciality. The focus groups and interviews also showed a change in the teaching and learning culture: more positively framed, frequent, structured, and specific feedback, improved accountability, and trainee-trainer perioperative readiness for teaching. Highlighted changes included the usefulness of trainee self-assessment before perioperative trainer feedback and the tool's value in improving competency to Kirkpatrick Level 4. Implementing an adapted digital Workplace-Based Assessment (WBA) tool using a participatory action research model has proven successful in enhancing the effectiveness of supervised perioperative teaching and learning encounters. This approach has improved teaching and feedback practices, facilitated the development of surgical competency, and ultimately impacted the overall culture to Kirkpatrick level 4. Importantly, it has positively influenced the trainee-trainer relationship dynamic. Based on these positive outcomes, we recommend using this effective method and our relationship-centred framework for implementing formative competency-building tools in future studies. By doing so, larger-scale and successful implementation of Competency-Based Medical Education (CBME) could be achieved in various contexts. This approach can potentially enhance teaching and learning encounters, promote competency development, and improve the overall educational experience for surgical trainees and trainers.

Applicability of Workplace-Based Assessment tools (Mini-CEX) for the trainee doctors of Obstetrics and Gynecology in Bangladesh

This cross-sectional study was conducted to assess the applicability of workplace-based assessment tools (Mini-CEX) for the trainee doctors of Obstetrics and Gynecology in Bangladesh. The study was conducted from January 2022 to December 2022. The Study population were trainee of selected medical college hospital and Supervisors/Teachers of selected medical college hospital. Medical colleges were selected conveniently. Respondents were selected purposively. Research instruments were Mini-CEX, questionnaire of American Board of Internal Medicine. Scores were given to each scale as: unsatisfactory=1 2 3, satisfactory =4 5 6, superior=7 8 9. Bangladesh Journal of Medical Education Vol.14(2) July 2023: 56-59

Improving Postgraduate Anaesthesiology Training in a Low-Middle Income Country by Embracing the New Trends in Medical Education.

Postgraduate medical training has increasingly adapted to competency-based medical education (CBME). In an endeavour to stay abreast with the new trends in medical education and adapt to CBME frameworks, an in-depth review and revision of the Anaesthesiology training curriculum were conducted. The authors worked on the task from December 2020 to December 2021. Learning outcomes were defined and corresponding competencies were identified and relevant teaching, learning and assessment strategies were aligned with each learning outcome. Additionally, lists were devised for topics to be covered through didactic lectures and simulation-based workshops. The revised curriculum is currently being implemented in a phased manner. Formative workplace-based assessment tools are being introduced to complement CBME. Moreover, daily clinical assessments, entrustable professional activity (EPA), simulation-based workshops and assessments have been introduced. Key Words: Anaesthesiology, Postgraduate training, Curriculum revision, Competency-based medical education, Low-middle income country, Simulation-based training.

Designing a User-Friendly Context-Specific Assessment Tool for Community-Based Teachers.

Graduate medical education (GME) programs must ensure that they are able to collect accurate information about resident competence through assessment tools that are fit for purpose. An assessment form or process is called “fit for purpose” when there is good alignment between the tool (how something is assessed) and the intent (the specific knowledge, skill, or attitude/belief that is being assessed).In our family medicine GME program, we identified that the generic workplace-based summative assessment tool provided to community-based family medicine obstetrics (FMOB) clinical teachers was not fit for purpose. As a result, these teachers were uncertain about program expectations regarding competence, the assessment form was challenging and frustrating to complete, and our program struggled to extract useful assessment data from completed assessment forms. To address this issue, we took a systematic approach to develop a workplace-based assessment tool that was specific to the clinical context of FMOB and user-friendly for clinical teachers.Our goals were to develop: (1) a fit-for-purpose workplace-based assessment tool for community-based FMOB teachers that could be used for accurate assessment without the need for faculty development, and (2) an evidence-guided process for designing similar context-specific tools in the future. We met our first goal through designing the FMOB competence rubric (FMOB-CR) tool. The FMOB-CR is comprised of 2 elements. The first is a rubric containing specific statements and examples of resident performance. The rubric clearly outlines the expected level of competence on a 3-point rating scale (“cause for concern,” “acceptable competence,” “exemplary competence”), organized by the 6 Skill Dimensions of Family Medicine (similar to CanMEDS roles).1 The second element is a simple online assessment form in which FMOB teachers specify their resident's level of competence in each Skill Dimension, guided by the statements and examples in the rubric.The FMOB-CR uses plain language and context-specific clinical examples along with a simple online assessment form to clearly communicate expectations of competence to teachers (and residents) without additional faculty development. This user-friendly tool should make it easier for FMOB clinical teachers to better identify residents who are underperforming, which will allow the program to be more effective in intervening and supporting residents in difficulty.To meet our second goal, we developed an evidence-guided process for designing workplace-based assessment tools that are fit for purpose for specific clinical contexts. Our design process included: assembling a tool development team with relevant expertise, including a resident; consultations with FMOB teachers and residents; environmental scan and review of local assessment forms and assessments used by other FMOB GME programs; a modified Delphi process with local GME program faculty to develop and refine the table of competence statements; a consensus-building process within the research team to revise the statements for the rating scale; and implementation of the assessment rubric with concurrent collection of validity evidence. For both the FMOB-CR and the development process, we collected validity evidence according to Messick's unified concept of validity.2The Table details the validity evidence collected to date. Fifteen FMOB teachers surveyed showed strong agreement across 5 items about the utility of the rubric in allowing them to accurately assess residents (overall M=3.25/4, Likert scale 1=strongly disagree to 4=strongly agree), and across 3 items about the usefulness of the rubrics in helping them to understand program expectations of resident competence (overall M=3.36/4); 14 of 15 teachers preferred the new form to the old one.We hope that the worked example of the FMOB-CR and its development process may serve as a blueprint for other institutions to develop context-specific assessment tools.

Feasibility of Implementing Mini-Clinical Evaluation Exercise (Mini-CEX) as a Formative Assessment Tool in Postgraduate Surgical Training

Background: Mini-CEX (Mini Clinical Evaluation Exercise) is extensively used in the west as a Workplace-based Assessment (WPBA) tool. However, its utility remains an infrequent in postgraduate medical training in Pakistan. Methods: Forty-eight mini-CEX sessions involving 11 faculty members and 15 postgraduate trainees were conducted over a 3‐month study period. Standardized American Board of Internal Medicine Mini‐CEX evaluation form was used to evaluate the students. The faculty and trainees were asked to provide feedback for these sessions on questionnaires consisting of close‐ and open‐ended questions. Results: Faculty satisfaction with mini-CEX was high, with all agreeing that it was an appropriate method of trainees’ assessment and teaching, and that it should be included in the curriculum. However, two-third of the faculty felt that it was not possible to assess students through mini-CEX more frequently. All trainees agreed that the sessions made them aware of their weaknesses and strengths. However, majority (73.3) complained that they were not given a chance to give reflection on their performance during the feedback session. Both residents and faculty suggested to incorporate Mini‐CEX in curriculum. Conclusion: It is feasible to use mini‐CEX for formative assessment of residents. Keywords: Workplace-based assessment, mini-clinical evaluation exercise, feedback

Preceptors' considerations when entrusting professional activities to postgraduate nursing students: A qualitative study

BackgroundNurse-preceptors regularly struggle to evaluate students' readiness to take care of patients unsupervised, even with sophisticated workplace-based assessment tools. Preceptors' gut feelings are not always captured well, but are critical for judgement of readiness for learner entrustment with care tasks. Studies in medical education report features that clinicians consider important when trusting students with clinical responsibilities that might also apply in nursing. ObjectivesTo unravel preceptors' considerations when entrusting professional activities to postgraduate nursing students. The findings may contribute to the improvement of workplace-based assessments and the training of preceptors. MethodsThematic analysis of semi-structured interviews with sixteen nurse-preceptors from three postgraduate nursing specialisations in Dutch hospitals. ResultsThree themes emerged:1)Preceptor's' expectations of students: being competent, being aware of risks and how to tackle these, being truthful, having a proactive attitude, seizing opportunities to learn and develop, and being socially and communicatively sensitive.2)Preceptor's own role in entrustment decisions: awareness of a subjective influence in assessment, shared responsibility for patient care, and imagining students as future colleagues.3)Preceptors' use of information sources to arrive at entrustment decisions: briefing and debriefing with students, direct observation, reports, and judgements of colleagues. ConclusionsFor preceptors of postgraduate nursing students, entrustment requires more than merely insight into objectively measurable competencies. Entrusting is accompanied by subjectivity related to what preceptors expected of students. These expectations are in line with suggested factors in the literature—capability, integrity, reliability, agency, and humility—considered before entrusting students with clinical responsibilities identified in medical training. Entrusting is also accompanied by what preceptors realise about their own role in entrustment decisions. Combining different information sources made assessment more transparent and the implicit more explicit.

Effect of Workplace-Based Assessment Utilization as a Formative Assessment for Learning Among Family Medicine Postgraduates at the Faculty of Medicine, Menoufia University: A Prospective Study.

Background Workplace-based assessment (WBA) is a group of assessment approaches that assesses the trainees' performance through their observation and monitoring in real clinical settings and then provides them with constructive and relevant feedback. Many WBA tools are available, including the mini-clinical evaluation exercise (mini-CEX), direct observation of procedural skills (DOPS), case-based discussions, and multisource feedback (peers, seniors, and patients). A WBAcan help medical students improve their clinical competencies and ensure that qualified physicians graduate. Methods This prospective study was done in the family medicine department at the Menoufia Faculty of Medicine in Egypt and passed through two phases. Phase I was introducing an orientation lecture for family medicine staff and a convenient sample of 21 family medicine postgraduates about WBA. Phase II was conducting a monthly mini-CEX and DOPS for the postgraduates. Finally, students' satisfaction with the WBA was assessed, and all collected data were analyzed via Statistical Package for Social Science (SPSS) version 23 (IBM Corp., Armonk, NY). Results A total of 105 feedback sheets were obtained. These feedback sheets were subdivided into 63 mini-CEX feedback sheets (21 sheets from each mini-CEX session for three sessions) and 42 DOPS feedback sheets (21 sheets from each DOPS session for two sessions), all of which were collected and analyzed. A significant improvement was detected in the mini-CEX and DOPS feedback scores of the postgraduates throughout the consecutive sessions (9.5 ± 2.7, 24.9 ± 2.5, 27.29 ± 1.5) (P < 0.001) for Mini-CEX and (6.1 ± 1.8 versus 9.0 ± 1.2) (P < 0.001) for DOPS. About 93% of the postgraduates recommended the application of WBA for their peers, and 86% of them requested to perform it again for other different clinical cases and procedures. Conclusion Workplace-based assessment in the form of Mini-CEX and DOPS revealed its ability to improve clinical knowledge and skills among family medicine postgraduates who became motivated to undergo it again in search of improving their clinical performance and reducing their stresses related to final summative and objective structured clinical examinations (OSCEs).

Understanding State-of-the-Art Literature Reviews.

Understanding State-of-the-Art Literature Reviews.

Development of workplace‐based assessment tools to support postgraduate training of provisionally registered pharmacists in Australia

AbstractThe Australian Pharmacy Council (APC) is the national accreditation authority for pharmacy education and training in Australia. In 2020, APC published revised Accreditation Standards and a new Performance Outcomes Framework (POF). The POF details expected performance for pharmacy students at the point of graduation and for pharmacy graduates on completion of postgraduate training. The APC and the pharmacist regulator, the Pharmacy Board of Australia collaborated on a project to develop workplace‐based assessment (WBA) tools for use in assessing performance of pharmacy graduates in the postgraduate training period. The objectives of the project were to; identify and develop an initial suite of WBA tools; develop accompanying guidance and supporting documentation; seek feedback from stakeholders; and pilot the WBA tools in community and hospital settings. The WBA tools were developed through consultative process overseen by a group of education experts (a Technical Working Group) and a governance group. The latter comprising members from the Pharmacy Board and APC. The Technical Working Group agreed on the tools to develop based on an available Intern Year Assessment Blueprint and the tools were then drafted by a consultant. APC held consultative forums and a pilot study to gather feedback from intern pharmacists and preceptors. The project resulted in development of a suite of three types of WBA tools; Entrustable Professional Activities (EPAs), Case Based Discussions (CbD), and In Training Assessment (ITA) activities covering six areas of focus. All types of tools that were initially agreed upon were made available for use. The WBA tools address 15 performance outcomes in the POF. Future direction will involve further evaluation of the tools in diverse practice settings and expansion of the current suite of tools to cover additional performance outcomes.

Impact of gamification techniques on surgical trainee engagement with workplace-based assessment

Engaging surgical residents and faculty with workplace-based assessment (WBA) are challenging. Gamification has helped engage trainees with simulation and online curricula but has not been used to encourage engagement with assessment. We explore the impact of gamification on engagement with WBA using the Society for Improving Medical Professional Learning (SIMPL) app. General surgery residency programs were divided into two intervention cohorts and a control cohort. The first intervention group received a weekly leaderboard of the most active residents and faculty engaged with SIMPL, while the second intervention group received leaderboards every other week. The control group did not undergo an intervention. For each cohort, resident and faculty engagement with SIMPL was measured, defined as the average number of evaluations submitted per day. Negative binomial mixed models were used to explore the mean number of evaluations completed by residents and faculty in each cohort while adjusting for program-specific factors. Nine programs were included in the weekly intervention, nine programs in the biweekly intervention, and nineteen programs in the control group. Programs receiving a weekly leaderboard increased their average daily evaluations from 5.8 to 8.0 over the course of the intervention (p < 0.01). Average daily evaluations failed to increase for the biweekly intervention (8.2 to 7.3/day, p = 0.14) and control groups (2.7 to 2.5/day, p = 0.48). Sending a weekly leaderboard of resident and faculty activity in SIMPL had a positive impact on engagement with WBA compared to biweekly or no leaderboard interventions. Strategically applying gamification may improve engagement with WBA tools.

Understanding the near-peer relationship: resident perspectives around a novel on-call workplace-based assessment.

Workplace-based assessment (WBA) is a critical component of competency-based medical education (CBME), though literature on WBA for overnight call is limited. We evaluated a WBA tool completed by supervising subspecialty trainees on paediatric residents during subspecialty overnight call, for usefulness facilitating feedback/coaching in this setting. Web-based surveys were sent to residents pre- and post-WBA tool implementation monthly for four months (August-December 2018), exploring feedback frequency, Likert-scaled opinions of tool feasibility/usefulness facilitating feedback, and qualitative experiences. Assessor comments were categorized as actionable/non-actionable. Quantitative data was summarized using descriptive statistics. Qualitative data was coded to identify themes. Total response rates averaged 41% (total 25 responses, average five respondents/12 residents on-call each month). Post-implementation (n = 16 responses), a non-sustained trend of increased Medical Expert feedback was observed. Residents were generally divided or disagreed on tool usefulness facilitating feedback and feasibility. Comments contained actionable feedback in < 10% of completed WBAs. Qualitative analysis revealed barriers to tool-facilitated coaching including: feedback quality and setting/environment, role of senior near-peer as assessor, interpersonal burden in encounters, and tool-specific issues. Increasing frequency of WBA tool completion is not sufficient to achieve CBME goals. Factors impacting feedback/coaching within the resident/near-peer dyad must be addressed.

Beyond Checking Boxes: Exploring Tensions With Use of a Workplace-Based Assessment Tool for Formative Assessment in Clerkships.

To understand the role of a workplace-based assessment (WBA) tool in facilitating feedback for medical students, this study explored changes and tensions in a clerkship feedback activity system through the lens of cultural historical activity theory (CHAT) over 2 years of tool implementation. This qualitative study uses CHAT to explore WBA use in core clerkships by identifying feedback activity system elements (e.g., community, tools, rules, objects) and tensions among these elements. University of California, San Francisco core clerkship students were invited to participate in semistructured interviews eliciting experience with a WBA tool intended to enhance direct observation and feedback in year 1 (2019) and year 2 (2020) of implementation. In year 1, the WBA tool required supervisor completion in the school's evaluation system on a computer. In year 2, both students and supervisors had WBA completion abilities and could access the form via a smartphone separate from the school's evaluation system. Thirty-five students participated in interviews. The authors identified tensions that shifted with time and tool iterations. Year 1 students described tensions related to cumbersome tool design, fear of burdening supervisors, confusion over WBA purpose, WBA as checking boxes, and WBA usefulness depending on clerkship context and culture. Students perceived dissatisfaction with the year 1 tool version among peers and supervisors. The year 2 mobile-based tool and student completion capabilities helped to reduce many of the tensions noted in year 1. Students expressed wider WBA acceptance among peers and supervisors in year 2 and reported understanding WBA to be for low-stakes feedback, thereby supporting formative assessment for learning. Using CHAT to explore changes in a feedback activity system with WBA tool iterations revealed elements important to WBA implementation, including designing technology for tool efficiency and affording students autonomy to document feedback with WBAs.

Competency-Based Medical Training in Anesthesiology: Has It Delivered on the Promise of Better Education?

Competency-Based Medical Training in Anesthesiology: Has It Delivered on the Promise of Better Education?

Development and Validation of the Family Medicine Obstetrics Assessment Tool

Timely and informative assessments during postgraduate family medicine identify gaps and strengths for residents, and help programs in identifying residents in difficulty. In our program, family medicine obstetrics (FMOB) clinical teachers faced challenges accurately assessing residents using existing tools. In this study, 1) we describe the evidence-guided process taken to develop a context-specific workplace-based assessment (WBA) tool, and 2) outline plans to collect validity evidence during the pilot.

Sexual history taking by doctors in primary care in North West province, South Africa: Patients at risk of sexual dysfunction overlooked.

BackgroundSexual history taking seldom occurs during a chronic care consultation and this research focussed on consultation interaction factors contributing to failure of screening for sexual dysfunction.AimThis study aimed to quantify the most important barriers a patient and doctor experienced in discussing sexual challenges during the consultation and to assess the nature of communication and holistic practice of doctors in these consultations.SettingThe study was done in 10 primary care clinics in North West province which is a mix of rural and urban areas.MethodsOne-hundred and fifty-five consultation recordings were qualitatively analysed in this grounded theory research. Doctors and patients completed self-administered questionnaires. A structured workplace-based assessment tool was used to assess the communication skills and holistic practice doctors. Template analysis and descriptive statistics were used for analysis. The quantitative component of the study was to strengthen the study by triangulating the data.ResultsTwenty-one doctors participated in video-recorded routine consultations with 151 adult patients living with hypertension and diabetes, who were at risk of sexual dysfunction. No history taking for sexual dysfunction occurred. Consultations were characterised by poor communication skills and the lack of holistic practice. Patients identified rude doctors, shyness and lack of privacy as barriers to sexual history taking, whilst doctors thought that they had more important things to do with their limited consultation time.ConclusionConsultations were doctor-centred and sexual dysfunction in patients was entirely overlooked, which could have a negative effect on biopsychosocial well-being and potentially led to poor patient care.

Do entrustment scales make a difference in the inter-rater reliability of the workplace-based assessment?

ABSTRACT Background A workplace-based assessment (WBA) is used to assess learners’ competencies in their workplaces. Many workplace assessment tools are available and validated to assess various constructs. The implementation of workplace-based assessment requires proper training of the staff. Objective This study aimed to explore the impact of staff training on WBA practices and evaluate the inter-rater reliability of these practices while using entrustment scales, performance descriptors, and personal judgment. Design A quasi-experimental study, in which the staff members of the orthopedic department were invited to participate in a training program on the use of entrustment scales and assessment descriptors within the WBA tools. As a response to the training, subjective judgment was replaced by entrustment scales and performance descriptors in a trauma course offered by the orthopedic department. The inter-rater reliability of the WBA was evaluated using various rating scales. Results The entrustment scales had higher inter-rater reliability of the assessment tools than performance descriptors and the personal judgment. Conclusion The inter-rater reliability was highest when using entrustment scales for WBAs, which could indicate that the entrustment scales achieve good psychometric properties as regards consistency among different raters. Thus, they decrease the confounding effect of differences in assessors. They may also give a clearer image of the actual academic level of the learners.

Reframing the O-SCORE as a Retrospective Supervision Scale Using Validity Theory.

Reframing the O-SCORE as a Retrospective Supervision Scale Using Validity Theory.

Scope of Professionalism Mini-evaluation Exercise Tool in Teaching and Assessing Professionalism among Medical Students

Medical professionalism refers to a set of values or behaviors, which eventually establishes the trust that the general population has on healthcare professionals. It will not be wrong to document that conventional assessment tools were not able to assess the complex domains of professionalism. Workplace-based assessment tools have been identified as the solution to assess professionalism among medical students during the routine clinical practice and accordingly multiple such tools have been tried under heterogeneous settings. The Professionalism Mini-Evaluation Exercise tool is an effective method to assess inter-professional skills, doctor-patient relationship, reflective abilities, and time management. In conclusion, medical professionalism plays a defining role in shaping the careers of medical students. It is the need of the hour to employ the professionalism mini-evaluation exercise tool in the field of medical education as both a learning and an assessment tool to inculcate the different aspects of professionalism among students.

Employing clinical work sampling tool for monitoring the clinical competence among medical students

The ultimate goal of medical education across heterogeneous settings is to produce a competent medical graduate. It is important to remember that this vision cannot be complete without incorporating observation, assessment, and documentation of the students' performance while they are involved in patient care throughout the duration of the course. The present review was planned to explore the utility of clinical work sampling (CWS) tool in the process of assessment of competencies. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of 15 articles were selected based upon the suitability with the current review objectives and analyzed. To ensure that the students are directly observed while at work, the use of workplace-based assessment tools has been strongly advocated owing to the high reliability, validity, feasibility, and better educational impact. CWS is an effective teaching-learning and assessment tool that involves observation and simultaneous scoring of different domains of patient interaction and management. In conclusion, the assessment method of CWS is based on the direct observation of clinical performance of the students in the workplace. Owing to the high validity and reliability of the tool, it is the need of the hour to employ the same as a part of clinical teaching and assessment in heterogeneous settings.