ASSESSMENT OF ATTITUDES & PSYCHOMOTOR SKILLS Raja C. Bandaranayake.

ASSESSMENT OF ATTITUDES ASSESSMENT OF ATTITUDES & PSYCHOMOTOR SKILLS& PSYCHOMOTOR SKILLS

Raja C. BandaranayakeRaja C. Bandaranayake

DOMAINS OF LEARNINGDOMAINS OF LEARNING

• Cognitive (Knowledge)

• Psychomotor (Motor skills)

• Affective (Attitudes)

THE AFFECTIVE DOMAINTHE AFFECTIVE DOMAIN

• AwarenessAwareness [knowledge base]e.g. Reads about importance of rural health care

• ReceivingReceiving [willing to receive or attend]e.g. Acknowledges rural health care is important

• Responding Responding [actively attending]e.g. Seeks additional information about rural health needs & problems

THE AFFECTIVE DOMAIN – contd.THE AFFECTIVE DOMAIN – contd.

• ValuingValuing [‘worth’ to learner]e.g. Spends free time working in rural areas

• OrganizingOrganizing [takes steps to incorporate into one’s life]e.g. Undergoes training to deal with rural health problems

• Characterisation by value or value Characterisation by value or value complexcomplex [becomes part of one’s life]e.g. Enters a career of rural health care

PROBLEMS IN ASSESSING ATTITUDESPROBLEMS IN ASSESSING ATTITUDES

One must rely on inference

An attitude has many facets e.g. feelings, beliefs, values

An attitude has many manifestations e.g. behaviours, verbal responses

Behaviours, beliefs and feelings will not always match

An attitude can fluctuate

There is often lack of agreement on the nature or desirability of certain attitudes

ORIENTATIONS TO ATTITUDE ORIENTATIONS TO ATTITUDE ASSESSMENTASSESSMENT

Behavioural– Observation of behaviours

Psychometric– Standardized pen-and-paper tests

Counselling– One-to-one discussion

BEHAVIOURAL ORIENTATIONBEHAVIOURAL ORIENTATION

Behaviours Behaviours can be observed

Rely on observation toolsRely on observation tools– checklist, rating scale, anecdotal record

Expectations explicitExpectations explicit

Assessment consistentAssessment consistent

Inference necessaryInference necessary– many variables affect behaviour

BEHAVIOURAL ORIENTATION (contd.)BEHAVIOURAL ORIENTATION (contd.)

Change can be monitoredChange can be monitored

““Spied on” feelingSpied on” feeling

Coercive atmosphereCoercive atmosphere

IndividualIndividual event may be trivialevent may be trivial– need to observe many behaviours

BEHAVIOURAL ORIENTATIONBEHAVIOURAL ORIENTATIONWho are the observers?Who are the observers?

Trained observersTrained observers AdministratorsAdministrators TeachersTeachers PeersPeers Other professionalsOther professionals PatientsPatients ParentsParents SelfSelf

PSYCHOMETRIC ORIENTATIONPSYCHOMETRIC ORIENTATION

Pen-and-paper instrumentsPen-and-paper instruments

Validated, standardized testsValidated, standardized tests

Self reports possibleSelf reports possible

Inexpensive and objectiveInexpensive and objective

Socially desirable responses possibleSocially desirable responses possible

Situation-specificSituation-specific

Conclusions indefiniteConclusions indefinite

QUESTIONNAIRESQUESTIONNAIRES

Open-endedOpen-ended ClosedClosed[Respond in own words] [select, rank, rate]

e.g. Essay e.g. Likert scale Semantic

differentialTests of judgement

Forced-choice

LIKERT SCALELIKERT SCALE

SA A U D SDSA A U D SD

A medical history isincomplete without asocial historyThe logical leader fora health team is the doctorThe team approach tohealth care is a waste of time

SEMANTIC DIFFERENTIALSEMANTIC DIFFERENTIAL

Surgeons are:

Theoretical _ _ _ _ _ _ _ Practical

Personal _ _ _ _ _ _ _ Impersonal

Active _ _ _ _ _ _ _ Passive

Disease- _ _ _ _ _ _ _ Patient-oriented oriented

COUNSELLING ORIENTATIONCOUNSELLING ORIENTATION

Discussion between teacher and student to reveal feelings underlying behaviours

Student may be more motivated to change if understand him/her-self

Low risk environment

Counselling role not compatible with authority role

Student may manipulate or avoid giving responses

Teachers are not trained counsellors

PSYCHOMOTOR DOMAINPSYCHOMOTOR DOMAIN

1. Perception Using senses for cues to motor activity

2. SetReadiness to take a particular type of action

3. Guided responseImitating a skill; trial and error

4. MechanismResponse habitual and confident

PSYCHOMOTOR DOMAIN – contd.PSYCHOMOTOR DOMAIN – contd.

5. Complex overt responseSkillful & complex performance

6. AdaptationAble to modify movement pattern to suit particular situation

7. Origination Creating new movement pattern for a

specific purpose

OBSERVATIONS: OBSERVATIONS: Relatively Relatively UnstructuredUnstructuredComplete description of event

Participant observation (e.g. simulated patient)

Time and motion or time-sampling study

Anecdotal record

Disadvantages Sampling less Reliability low Observer influence Memory distortion

OBSERVATIONS: StructuredOBSERVATIONS: Structured

Specific plan made for making and recording observation

Investigator knows what aspects of behaviour are relevant for the purpose

Observational InstrumentsObservational Instruments

1.1. CHECKLISTCHECKLISTWhere the response is “Yes” or “No”

2. RATING SCALERATING SCALEWhere quality of performance is important

CHECKLIST: When to use?CHECKLIST: When to use?

Performance skillsPerformance skills that can be divided into a series of clearly defined steps, each of which is either “done” or “not done”e.g. steps in cardio-pulmonary resuscitation

Performance productsPerformance products that can be evaluated by noting presence (or absence) of observable characteristicse.g. patient’s medical record

CHECKLIST: CHECKLIST: STEPS IN CONSTRUCTIONSTEPS IN CONSTRUCTION

Analyse task or performance into specific sequential steps required

List common errors (of omission and commission) made by students

List actions and errors in logical order of occurrence

Provide a system for observer to record sequence of actions

CHECKLIST: CHECKLIST: Mouth-to-mouth Mouth-to-mouth resuscitationresuscitation

Done

Order #

Not done

NA

Shakes & shouts to check if unconscious

Applies chin lift to open airway

*Applies neck lift to open airway

Uses ‘look, listen, lift’ method for apnoea

Closes nose by pinching

Effects tight mouth-to-mouth seal

CHECKLIST: contd.CHECKLIST: contd.

• Gives 4 quick ventilations• Checks carotid pulse• *Checks pupils for dilatation• *Bares victim’s chest• Checks anatomical landmarks

TYPES OF RATING SCALESTYPES OF RATING SCALES

GraphicPoor rapport Excellent rapport

Graphic with anchorsPoor Fair Good Very Good Excellent

Frequency scalesNever Seldom Often Always

Behaviourally-anchored

BEHAVIOURALLY-AHCHORED RATING SCALE: BEHAVIOURALLY-AHCHORED RATING SCALE: ATTITUDESATTITUDES

Relationship with patientsRelationship with patientsA. Rapport

0: Unable to establish rapport

1: Fair rapport, but occasional lack of communication

2: Good rapport, communicates concern

3: Listens, communicates well, instills confidence

4: Convinces patient of expertise and puts patient at ease

5. Not observed

RATING SCALE: COMMUNICATIONRATING SCALE: COMMUNICATION

Participation in group discussionC. Nature of contributions

0: Does not contribute at all

1: Comments usually distract from the topic

2:

3: Comments usually pertinent, occasionally wanders from topic

4:

5: Comments always related to the topic

RATING SCALE: SKILLSRATING SCALE: SKILLS

Mouth-to-mouth resuscitationMouth-to-mouth resuscitation

A.A. Effects tight sealEffects tight seal

Cannot determineCannot determine

InadequateInadequate: Does not attempt to create a tight seal or seal is grossly inadequate

SatisfactorySatisfactory: Has leak, but adequate ventilation

ExcellentExcellent: Fully covers mouth from corner to corner, creating an airtight seal

RATING SCALE:RATING SCALE:STEPS IN CONSTRUCTIONSTEPS IN CONSTRUCTION

Define unambiguously dimension or behaviour being rated

Decide on number of rating steps– Usually 3 to 10– Uneven number better– Intervals not necessarily equidistant

Define / describe extremes and then each step in between– Try to avoid relative terms (e.g. frequently),

which could be interpreted differently

Error of leniency Error of central tendency Halo effect Logical error Error of contrast

ERRORS IN RATINGERRORS IN RATING