The Patient Management Problem as an Evaluative Instrument
Victor C. Vaughan III MD1
1 Senior Fellow in Medical Evaluation, National Board of Medical Examiners and Professor of Pediatrics, Temple University
The patient management problem (PMP), a device increasingly used for assessment of medical competence, has been under active development for a number of years and responds to the concern that more traditional techniques for objective evaluation, such as use of the multiple-choice question (MCQ), are often restricted in their content or scope. Though they can reliably test what is known about various aspects of health and illness, they commonly fail to evaluate realistically the process of health care.
The PMP attempts to put the student or physician (the "test-taker") figuratively into a setting recognizable as belonging to real life, and within that setting (where specified resources are available) presents a clinical problem for solution or management. Given a clearly stated problem in a defined setting, the test-taker is asked to choose among a variety of alternatives for action, some of which may be appropriate, others either not appropriate or even contraindicated. In contrast to the MCQ, which would simply have the choices scored as correct or incorrect, the PMP not only records such scores but, in addition, gives the test-taker the results of the actions selected, usually through development of a latent image embodied in invisible ink. For example, if a blood test is selected as appropriate, the test-taker who follows instructions to develop a latent image placed opposite the choice, will see the results of the test appear.
