Structured Assessment using Multiple Patient Scenarios

Advanced Skill Training in Emergency Medicine: Assessment (face to face)

The AST-EM assessment process has been designed to provide a valid, reliable, logistically feasible and comprehensive process for registrars to demonstrate competence and performance that meets minimum set standards in knowledge, skills and attitudes across all applicable domains and dimensions, including safe and culturally appropriate application in the Australian setting.

Preparing for the StAMPS AST-EM assessment process

The aim of StAMPS assessment modality (Structured Assessment using Multiple Patient Scenarios) is to test higher order functions in a highly contextualised framework where candidates have the opportunity to explain what they do and demonstrate their clinical reasoning, as opposed to simply providing evidence of knowledge, listing facts or recalling protocols.

The StAMPS AST-EM assessment is essentially a viva voce examination, with no simulated patients or mannequins.

Registrars are strongly advised to consider the curriculum and prescribed reading list when preparing for the assessment, as well as familiarising themselves with the format of this assessment modality (especially if they have not previously undertaken the Primary Rural & Remote Training StAMPS assessment).

What does StAMPS assess?

1. Is the registrar a safe clinician to work unsupervised in the ED?
2. Can the registrar function effectively as a clinician at the level of a graduate of this program (Senior Medical Officer reporting to the ED Director)?
3. Does the registrar demonstrate clinical reasoning rather than simply listing knowledge?
4. Has the candidate presented their answers in the context of the set geographical and logistical environment where the exam is set?

How does it work?

Candidates are provided with the ‘Logistical Profile’ the day before the exam.  This document details the setting where the examination is deemed to be taking place and the context in which the candidate is required to answer the questions.  Each actual examination has a ‘Logistical Profile’ specific to that examination.

The examinations consist of 8 stations, each of which takes 10 minutes to complete.  The candidate remains in the same room for the duration of the examination, with the examiners moving from room to room between stations.  The stations cover a broad range of topics chosen from across the entire breadth and depth of the curriculum.

Candidates are provided with 10 minutes reading time prior to the start of the examination, when they can read the ‘candidate material’ for each of the 8 stations and make notes.

Each station consists of 2-4 core questions.  The examiner may also provide prompts where necessary to asssit the candidate.

Between each station, the candidates have 5 minutes to read the ‘candidate material’ for the next station and make notes.

The examiners assess the candidate’s performance across five categories (below) using a global assessment scale.

1. Communication
2. Define the problem systematically
3. Be flexible in response to new information
4. Develop appropriate management plan that incorporates relevant medical and rural contextual factors
5. Overall Impression

Main issues to be demonstrated are identified, however there is no one perfect answer; candidates do not necessarily need to exhaustively list information to pass; and there may be a number of different perfectly reasonable approaches to answering the questions posed.

Practice Scenario

This material is focused around a single practice scenario StAMPS AST-EM practice scenario.  Detailed notes and video footage are provided.  Candidates are advised to focus on the process of this assessment modality rather than simply the content of this single sample scenario.  As detailed above, the actual assessment involves 8 stations, each of 10 minutes duration.

Suggested time for completion of this exercise is 1 to 2 hours.

Note: The video is specifically designed to generate consideration and discussion and are not a portrayal of the ‘correct’ answer.

Practice Scenario StAMPS AST-EM

Note: The StAMPS AST-EM practice scenario video is designed to run for only 4-6 minutes; in the actual examination, each scenario runs for 10 minutes.

The format suggested for using this material is:

1. Familiarise yourself with the StAMPS AST-EM Process Rules and Regulations document.
2. Familiarise yourself with the information provided to examiners:  StAMPS AST-EM Practice Scenario: Marking Sheet (2012) and StAMPS AST-EM Practice Scenario Examiner Information Sheet.
3. Familiarise yourself with the geographic and demographic setting of this practice examination as detailed in the StAMPS AST-EM Practice Scenario Logistical Profile.  Please note: in your actual examination, this will be different.
4. Read the StAMPS AST-EM Practice Scenario Candidate Printed Information Sheet
5. Watch the video StAMPS AST-EM Practice Scenario: Version 1
6. Consider your score of this candidate using the StAMPS AST-EM Practice Scenario: Marking Sheet (2012)
7. Watch the video StAMPS AST-EM Practice Scenario Version 2
8. Consider your score of this candidate using the StAMPS AST-EM Practice Scenario: Marking Sheet (2012)
9. Compare your responses with the Key Concepts / Main Issues to be Demonstrated as detailed in the StAMPS AST-EM Practice Scenario Examiner Information Sheet.

10. Revisit each video and rescore the performance of each version referring to the Key Concepts / Main Issues to be Demonstrated. 

11. Compare your original scoring sheets with these second versions.

12. What are the main differences between your two marking efforts?

13. Reconsider how you would now answer this question.

14. If possible, discuss your thoughts with others within your learning environment.

Please note: If you require further training material, an additional training package used for the Primary Curriculum StAMPS examination of available on at: http://www.acrrm.org.au/stamps-practice-scenarios-2010-0