3/5/2014

Usingskiplogictobuildarobust
milestonesassessmenttool
BretBarrier,MD
AmandaFrevert,MPH
Turi McNamee,MD

Disclosures
TheCuratorsoftheUniversityofMissouri,the
UniversityofMissouriITDivision,the
DepartmentsofOB/GYNandMedicine,and
facultymembersBretBarrierandTuri
McNameewilleachreceiveaportionof
royaltiesfromlicensingofanAppdiscussedin
thispresentation.

LearningObjectives
Atthecompletionofthissession,participants
willbeableto:
Understandskiplogicanditspotentialrolein
residentevaluation
Beabletocreateskiplogicevaluations
relevanttotheOB/GYNmilestones
Understandhowtomapskiplogicevaluations
tomilestonereportingintheNext
AccreditationSystem

3/5/2014

Introduction
Likert scalesarepronetogradeinflationand
largevariabilityinresponses
Skiplogicisanintuitivealternative
doesnotrequireproductionofanumericalscore
presentsrespondentswithdifferentoptions
dependingonpriorresponses
ReducesbiasinherenttoLikert scaleassessment

SkipLogic
UseslogicsimilartotheChooseyourown
adventurechildrensgamebooks
Followsanintuitivelineofthought
Reliesongestaltassessmentofthelearners
capabilities
Translatesresponsesintoanumericalscore
CanbeeasilyscaledtomatchtheMilestones
competencescheme

SkipLogic
MilestonelevelsarebasedonMichaelErauts
modificationofDreyfuss5pointNoviceto
Expertmodelofskillacquisition
http://en.wikipedia.org/wiki/Dreyfus_model_of_skill_acquisition

Thisprovidesausefulframeworkfordesigning
skiplogicquestions
Convenientlytranslatesdirectlyintomilestones

Anexampleofaskiplogicassessmentcanbe
foundat:http://www.surveymonkey.com/s/XQZNXN6

3/5/2014

PracticalApplicationofSkipLogic:
RealTimeAssessmentApp

Example1:Cerclage
Novice

AdvancedBeginner

AdvancedBeginner

Abletodescribe
whatcervical
cerclage is,and,in
general,whyitis
used

Abletodescribe
indicationsand
contraindications
forcervical
cerclage
placement

Abletodescribein
detailhowa
cerclage is
performed

Partly

Partly

Score0

Score1.5

Score1

Score1.5

Score1

Evaluatorsareblindedtoassignedscore

Example1:Cerclage
Proficient

CompetentLearner

Abletoperform
cerclage under
supervisionwith
supervisor
directing Uses
correcttechnique

Expert

Wouldbeableto
performcerclage
unsupervisedin
independent
practicesetting

Abletoperform
cerclage under
supervisionwith
nosupervisor
guidance

Score5
Partly

Score2.5 Score2

Partly

Partly

Score3.5

Score3

Score4.5

Score4

Evaluatorsareblindedtoassignedscore

3/5/2014

Example2:PregnancyofUnknown
Location
Novice

AdvancedBeginner

AdvancedBeginner

Abletoprovidea
differential
diagnosisforfirst
trimesterbleeding

Abletoperforma
complete
problemfocused
historyand
physical
examination

Abletoexplain
appropriaterisein
hCG andaboutthe
discriminatory
zonefor
ultrasound

Partly

Partly

Score0

Score1.5

Score1

Score1.5

Score1

Evaluatorsareblindedtoassignedscore

Example2:PregnancyofUnknown
Location
CompetentLearner

Proficient

Abletoperform
ultrasoundand
managemedically
orsurgicallyunder
directsupervision

Abletoperform
ultrasoundand
managemedically
orsurgicallyunder
indirect
supervision

Wouldbeableto
perform
ultrasoundand
managemedically
orsurgicallyin
independent
practicesetting

Partly

Partly

Partly

Score2.5 Score2

Score3.5

Expert

Score3

Score4.5

Score5

Score4

Evaluatorsareblindedtoassignedscore

Breakout
Formsmallgroupsof34persons
Createaskiplogicdecisiontreeforevaluation
ofoneofthefollowingclinicalevents:
Managementofnormalandabnormallabor
Managementofabdominalpaininthe3rd
trimester
Managementofabnormaluterinebleeding
Managementofurinaryincontinence

3/5/2014

Framework
Fortheeventyouhavechosen,usethesupplied
worksheettodescribetheknowledgeandskill
expectedatthefollowingskilllevels:
1. Novice finalscoreis1
2. AdvancedBeginner finalscoreis2
3. CompetentLearner finalscoreis3
4.ProficientLearner finalscoreis4
5.Expert finalscoreis5
Achievingsome,butnotall,requirementsofthe
nextlevel,isscoredwithadding0.5,i.e.,2.5

Acknowledgements
BretBarrier,MD,ProgramDirectorOB/GYN,GME
Chair,UniversityofMissouri
LeadsanAppdevelopmentteamatMU

AmandaFrevert,MPH,ProgramCoordinatorfor
OB/GYN,UniversityofMissouri
Coauthor,memberoftheAppdevelopmentTeamatMU

Turi McNamee,MD,PDandViceChairofMedicine,
UniversityofMissouri
Firstconceivedofusingskiplogicfor
milestonesassessment,memberofthe
AppdevelopmentTeamatMU

ForupdatesabouttheAppmentionedinthepresentation:

milestones.missouri.edu