Clinical Competence (clinical + competence)

Distribution by Scientific Domains


Selected Abstracts


The history of eating disorders in Norway

EUROPEAN EATING DISORDERS REVIEW, Issue 4 2001
Finn Skårderud
Abstract The history of eating disorders in Norway is described in four phases: (1) early case histories of eating disorder symptoms in the late 19th century Norwegian medical literature, (2) the pioneers of the post-World War 2 decades, (3) the 1980s when eating disorders became visible to the public and a focus of interest among professionals, and (4) the consolidation of professional networks and the emergence of a national policy for treatment. In contrast to many other countries, the official Norwegian policy is to improve clinical competence and knowledge about eating disorders at all levels of health care rather than establishing special clinics. Beside arguing for such a policy, we suggest that discussing the balance between general and specialist services is an important future issue. Copyright © 2001 John Wiley & Sons, Ltd and Eating Disorders Association. [source]


Extramural clinic in comprehensive care education

EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 2 2003
K. Petersson
In the Malmo model, the students' experience of their future professional context is a basic principle. Therefore, comprehensive care education includes one day per week in the public dental health service during the 9th and 10th semesters. There are three main objectives of this clinical module that the students should be able to, namely: ,,Further develop insights in general dentistry and its pre-requisites in Sweden. ,,Identify themselves as a member of the professional team. ,,,Think like a dentist'. A questionnaire was given to final year students and their clinical supervisors in the public dental health service. The students were asked to self-assess to which extent they had achieved the objectives and to list the most valuable experiences of their practice. The supervisors assessed the students' fulfilment of the objectives and were asked on their experience of the co-operation with the dental school and their perception of the students' clinical competence. On a 9-grade rating scale both students and supervisors rated the fulfilment of the objectives high (7,9). The supervisors rated somewhat higher than the students did. The students mentioned that it was most valuable to take full responsibility, work closely together with a dental assistant and to experience a ,real' professional context. The supervisors' most frequent comment was that the co-operation with the faculty could be improved considerably. Our conclusion is that both the dental students and their clinical supervisors considered this model for extramural clinical training most valuable. [source]


Portfolios: Possibilities for Addressing Emergency Medicine Resident Competencies

ACADEMIC EMERGENCY MEDICINE, Issue 11 2002
Patricia O'Sullivan EdD
Portfolios are an innovative approach to evaluate the competency of emergency medicine residents. Three key characteristics add to their attractiveness. First, portfolios draw from the resident's actual work. Second, they require self-reflection on the part of the resident. Third, they are inherently practice-based learning since residents must review and consider their practice in order to begin the portfolio. This paper illustrates five different applications of portfolios. First, portfolios are applied to evaluating specific competencies as part of the training of emergency physicians. While evaluating specific competencies, the portfolio captures aspects of the general competencies. Second, the article illustrates using portfolios as a way to address a specific residency review committee (RRC) requirement such as follow-ups. Third is a description of how portfolios can be used to evaluate resident conferences capturing the competency of practice-based learning and possibly other competencies such as medical knowledge and patient care. Fourth, the authors of the article designed a portfolio as a way to demonstrate clinical competence. Fifth, they elaborate as to how a continuous quality improvement project could be cast within the portfolio framework. They provide some guidance concerning issues to address when designing the portfolios. Portfolios are carefully structured and not haphazard collections of materials. Following criteria is important in maintaining the validity of the portfolio as well as contributing to reliability. The portfolios can enhance the relationship between faculty and residents since faculty will suggest cases, discuss anomalies, and interact with the residents around the portfolio. The authors believe that in general portfolios can cover many of the general competencies specified by the ACGME while still focusing on issues important to emergency medicine. The authors believe that portfolios provide an approach to evaluation commensurate with the self-evaluation skills they would like to develop in their residents. [source]


The Invisible (Inaudible) Woman: Nursing in the English Academy

GENDER, WORK & ORGANISATION, Issue 2 2005
Liz Meerabeau
Nursing is numerically a far larger academic discipline than medicine, and is situated in many more higher education institutions in England (over 50), whereas there are 21 medical schools. Like the rest of ,non medical education and training' it is purchased through a quasi-market. Despite the size of this market, however, nursing education has until recently been largely invisible in policy documents and the ambitions of nursing academics to develop their subject are seen as inappropriate. This article explores this invisibility and inaudibility, with particular reference to the 1997 Richards Report, Clinical Academic Careers and the 2001 Nuffield Trust report, A New Framework for NHS/University Relations. It draws on the work of Davies on the ,professional predicament' of nursing, to argue that, although the move of nursing education into higher education had the aim of improving its status, nursing has difficulty finding its voice within academia. As a result, issues which are salient for nursing (as for many of the health professions), such as a poor (or relatively poor) showing in the Research Assessment Exercise and the complexities of balancing research, teaching and maintaining clinical competence, are raised as high-profile issues only in medicine. [source]


The Nurse Educator's clinical role

JOURNAL OF ADVANCED NURSING, Issue 1 2005
Odette Griscti MHSc RN
Aim., This paper reports a two-phase descriptive study exploring the clinical role of the nurse educator in Malta. Background., Previous studies indicate a number of similarities and differences in the clinical role of nurse educators by country of practice. These include importance assigned to the role, factors inhibiting/facilitating the role, means to eliminate barriers to the role, and perceptions of the ideal role. Design and methods., Data were collected using both quantitative and qualitative strategies. The quantitative phase involved asking all educators to fill in a time log of their academic and clinical activities for a 2-week period. In the qualitative phase, the first author interviewed five educators, five nurses and five students about their perceptions of factors which impact the nurse educator's clinical role, as well as what the ideal clinical role of the nurse educator should be. Findings., Maltese nurse educators allot minimal time to their clinical role. Main reasons cited included workload, perceived lack of control over the clinical area, and diminished clinical competence. Nurse educators who frequented the clinical settings (who were either university or joint university and health service employees) where the study took place perceived that employment inequities among the various categories of nurse educators played an important role in the amount of time dedicated by each group to their clinical roles, and the importance individuals in these groups assigned to that role. The majority of interviewees saw the current role of nurse educators in Malta as preparing students for successful completion of the didactic sections of their programme, rather than preparing them with all the knowledge and clinical skills necessary to be competent practitioners. Participants considered that, when in clinical areas, nurse educators did focus on their students, as they should. However, they also thought that they often did not take the opportunity to forge links with professional staff. Conclusion., The clinical role of the Maltese nurse educator needs to be more multifaceted in approach. [source]


An exploratory study of web-enhanced learning in undergraduate nurse education

JOURNAL OF CLINICAL NURSING, Issue 12 2007
BSc (Hons), Elizabeth A Mitchell MSc, PG Dip Ed
Aim.,The aim of the study was to explore undergraduate nursing students' views of web-enhanced learning and to examine issues relating to their pattern of access to a rehabilitation nursing module website. Background.,As information technology is an integral component of western health care, all nurses are expected to have the necessary knowledge, skills and attitudes to be competent in its use. Methods.,In phase 1, a focus group interview was conducted with students (n = 6) who had not logged onto a similar module website. In phase 2, a questionnaire was administered to students undertaking the web-enhanced module. In phase 3, each student's (n = 231) pattern of access to the module was identified and compared with the student's performance as evidenced by their module assignment mark. Results.,Students held favourable attitudes towards web-enhanced learning but some students experienced difficulties. There was a significant positive association between the students' assignment mark and the number of times logged onto the module website. Significant negative correlations were found between mark and week of first log on, and week of first log on and number of hits onto the module site. This suggests that students who logged onto the module in the first few weeks were more likely to achieve higher marks. Conclusions.,This study's findings suggest that students who accessed the module website early and often were more likely to produce more comprehensive nursing assessments and consequently achieve higher assignment marks than their colleagues. Relevance to clinical practice.,The findings have relevance to all nurses as lifelong learning is a mandatory requirement for maintaining clinical competence and electronic learning can provide students (regardless of registration status) with the flexibility to gain access to course content at a time and place convenient to them. The role of electronic learning in promoting a more holistic nursing assessment is also discussed. [source]


Assessment of competence and progressive independence in postgraduate clinical training

MEDICAL EDUCATION, Issue 12 2009
Marja G K Dijksterhuis
Context, At present, competency-based, outcome-focused training is gradually replacing more traditional master,apprentice teaching in postgraduate training. This change requires a different approach to the assessment of clinical competence, especially given the decisions that must be made about the level of independence allowed to trainees. Methods, This study was set within postgraduate obstetrics and gynaecology training in the Netherlands. We carried out seven focus group discussions, four with postgraduate trainees from four training programmes and three with supervisors from three training programmes. During these discussions, we explored current opinions of supervisors and trainees about how to determine when a trainee is competent to perform a clinical procedure and the role of formal assessment in this process. Results, When the focus group recordings were transcribed, coded and discussed, two higher-order themes emerged: factors that determine the level of competence of a trainee in a clinical procedure, and factors that determine the level of independence granted to a trainee or acceptable to a trainee. Conclusions, From our study, it is evident that both determining the level of competence of a trainee for a certain professional activity and making decisions about the degree of independence entrusted to a trainee are complex, multi-factorial processes, which are not always transparent. Furthermore, competence achieved in a certain clinical procedure does not automatically translate into more independent practice. We discuss the implications of our findings for the assessment of clinical competence and provide suggestions for a transparent assessment structure with explicit attention to progressive independence. [source]


Patient perceptions of professionalism: implications for residency education

MEDICAL EDUCATION, Issue 1 2009
Michael N Wiggins
Objectives, The purpose of this study was three-fold: to identify which behavioural, communicative and personal presentation characteristics most closely represent patients' views of professionalism; to determine whether patients perceive resident doctors as displaying these characteristics, and to explore whether or not resident doctor professional behaviour creates an impression of clinical competence to the degree where patients perceive a decreased need for Attending Physician involvement. Methods, We carried out a descriptive, cross-sectional study at an academic centre. An anonymous, voluntary four-question survey with multiple items was administered to all adult patients or the parents of paediatric patients attending an ophthalmology clinic who were seen by a resident doctor followed by an Attending Physician. Results, A total of 133 of 148 (90%) surveys were returned. All the itemised characteristics of professionalism were reported to be important or very important to the majority of participants. The most important were: ,Pays attention to my concerns' (90%); ,Is compassionate' (83%), and ,Speaks in terms that I can understand' (83%). Although 85% of respondents reported that resident doctors demonstrated all the characteristics of professionalism listed on the survey, 83% of participants stated that it was important or very important that residents have Attending Physician involvement. Conclusions, Patient-centred components of professionalism, such as communication skills and compassion, are more important to patients than social behaviours, such as appearance and acknowledgement of family members. Resident doctors are perceived to display a high level of professionalism during patient care. Patients clearly desire direct resident doctor supervision by an Attending Physician. [source]


Reliability of the long case

MEDICAL EDUCATION, Issue 9 2008
Tim J Wilkinson
Objectives, The use of long cases for summative assessment of clinical competence is limited by concerns about unreliability. This study aims to explore the reliability of long cases and how reliability is affected by supplementation with short cases. Methods, We performed a statistical analysis of examinations held by the Royal Australasian College of Physicians in 2005 and 2006 to determine overall reliability and sources of variance in reliability according to candidate ability, case difficulty and inter-examiner differences. Results, Scores for 546 long cases in 2005 and 773 long cases in 2006 were analysed. In 2006, 38% of the total variation in long case data was explained by variation in candidate ability, with other significant contributors to variance being candidate × case and candidate × examiner interactions. Similar figures were found for the 2005 examinations. A short case is less reliable than a long case, but when examiner time is taken into account, three short cases are as reliable as one long case. Any combination of short and long cases would require 4,5 hours of testing time in order to achieve dependability > 0.7. Conclusions, Long cases can be optimised for reliability but time limits their use as the sole tool in a high-stakes examination. Further examiner training, better case selection, or greater use of short cases would have minimal impact on reliability. Reliability can be improved by either increasing examination time or including additional methods of summative assessment, such as might be provided by workplace assessment. [source]


Effects of conventional and problem-based learning on clinical and general competencies and career development

MEDICAL EDUCATION, Issue 3 2008
Janke Cohen-Schotanus
Objective, To test hypotheses regarding the longitudinal effects of problem-based learning (PBL) and conventional learning relating to students' appreciation of the curriculum, self-assessment of general competencies, summative assessment of clinical competence and indicators of career development. Methods, The study group included 2 complete cohorts of graduates who were admitted to the medical curriculum in 1992 (conventional curriculum, n = 175) and 1993 (PBL curriculum, n = 169) at the Faculty of Medicine, University of Groningen, the Netherlands. Data were obtained from student records, graduates' self-ratings and a literature search. Gender and secondary school grade point average (GPA) scores were included as moderator variables. Data were analysed by a stepwise multiple and logistic regression analysis. Results, Graduates of the PBL curriculum scored higher on self-rated competencies. Contrary to expectations, graduates of the PBL curriculum did not show more appreciation of their curriculum than graduates of the conventional curriculum and no differences were found on clinical competence. Graduates of the conventional curriculum needed less time to find a postgraduate training place. No differences were found for scientific activities such as reading scientific articles and publishing in peer- reviewed journals. Women performed better on clinical competence than did men. Grade point average did not affect any of the variables. Conclusions, The results suggest that PBL affects self-rated competencies. These outcomes confirm earlier findings. However, clinical competence measures did not support this finding. [source]


Challenges in multisource feedback: intended and unintended outcomes

MEDICAL EDUCATION, Issue 6 2007
Joan Sargeant
Context, Multisource feedback (MSF) is a type of formative assessment intended to guide learning and performance change. However, in earlier research, some doctors questioned its validity and did not use it for improvement, raising questions about its consequential validity (i.e. its ability to produce intended outcomes related to learning and change). The purpose of this qualitative study was to increase understanding of the consequential validity of MSF by exploring how doctors used their feedback and the conditions influencing this use. Methods, We used interviews with open-ended questions. We purposefully recruited volunteer participants from 2 groups of family doctors who participated in a pilot assessment of MSF: those who received high (n = 25) and those who received average/lower (n = 44) scores. Results, Respondents included 12 in the higher- and 16 in the average/lower-scoring groups. Fifteen interpreted their feedback as positive (i.e. confirming current practice) and did not make changes. Thirteen interpreted feedback as negative in 1 or more domains (i.e. not confirming their practice and indicating need for change). Seven reported making changes. The most common changes were in patient and team communication; the least common were in clinical competence. Positive influences upon change included receiving specific feedback consistent with other sources of feedback from credible reviewers who were able to observe the subjects. These reviewers were most frequently patients. Discussion, Findings suggest circumstances that may contribute to low consequential validity of MSF for doctors. Implications for practice include enhancing procedural credibility by ensuring reviewers' ability to observe respective behaviours, enhancing feedback usefulness by increasing its specificity, and considering the use of more objective measures of clinical competence. [source]


Validity of portfolio assessment: which qualities determine ratings?

MEDICAL EDUCATION, Issue 9 2006
Erik W Driessen
Context, The portfolio is becoming increasingly accepted as a valuable tool for learning and assessment. The validity of portfolio assessment, however, may suffer from bias due to irrelevant qualities, such as lay-out and writing style. We examined the possible effects of such qualities in a portfolio programme aimed at stimulating Year 1 medical students to reflect on their professional and personal development. In later curricular years, this portfolio is also used to judge clinical competence. Methods, We developed an instrument, the Portfolio Analysis Scoring Inventory, to examine the impact of form and content aspects on portfolio assessment. The Inventory consists of 15 items derived from interviews with experienced mentors, the literature, and the criteria for reflective competence used in the regular portfolio assessment procedure. Forty portfolios, selected from 231 portfolios for which ratings from the regular assessment procedure were available, were rated by 2 researchers, independently, using the Inventory. Regression analysis was used to estimate the correlation between the ratings from the regular assessment and those resulting from the Inventory items. Results, Inter-rater agreement ranged from 0.46 to 0.87. The strongest predictor of the variance in the regular ratings was ,quality of reflection' (R 0.80; R2 66%). No further items accounted for a significant proportion of variance. Irrelevant items, such as writing style and lay-out, had negligible effects. Conclusions, The absence of an impact of irrelevant criteria appears to support the validity of the portfolio assessment procedure. Further studies should examine the portfolio's validity for the assessment of clinical competence. [source]


Reliability and validity of the direct observation clinical encounter examination (DOCEE)

MEDICAL EDUCATION, Issue 3 2003
Hossam Hamdy
Context, The College of Medicine and Medical Sciences at the Arabian Gulf University, Bahrain, replaced the traditional long case/short case clinical examination on the final MD examination with a direct observation clinical encounter examination (DOCEE). Each student encountered four real patients. Two pairs of examiners from different disciplines observed the students taking history and conducting physical examinations and jointly assessed their clinical competence. Objectives, To determine the reliability and validity of the DOCEE by investigating whether examiners agree when scoring, ranking and classifying students; to determine the number of cases and examiners necessary to produce a reliable examination, and to establish whether the examination has content and concurrent validity. Subjects, Fifty-six final year medical students and 22 examiners (in pairs) participated in the DOCEE in 2001. Methods, Generalisability theory, intraclass correlation, Pearson correlation and kappa were used to study reliability and agreement between the examiners. Case content and Pearson correlation between DOCEE and other examination components were used to study validity. Results, Cronbach's alpha for DOCEE was 0·85. The intraclass and Pearson correlation of scores given by specialists and non-specialists ranged from 0·82 to 0·93. Kappa scores ranged from 0·56 to 1·00. The overall intraclass correlation of students' scores was 0·86. The generalisability coefficient with four cases and two raters was 0·84. Decision studies showed that increasing the cases from one to four improved reliability to above 0·8. However, increasing the number of raters had little impact on reliability. The use of a pre-examination blueprint for selecting the cases improved the content validity. The disattenuated Pearson correlations between DOCEE and other performance measures as a measure of concurrent validity ranged from 0·67 to 0·79. Conclusions, The DOCEE was shown to have good reliability and interrater agreement between two independent specialist and non-specialist examiners on the scoring, ranking and pass/fail classification of student performance. It has adequate content and concurrent validity and provides unique information about students' clinical competence. [source]


Empathy in medical students as related to academic performance, clinical competence and gender

MEDICAL EDUCATION, Issue 6 2002
M Hojat
Context, Empathy is a major component of a satisfactory doctor,patient relationship and the cultivation of empathy is a learning objective proposed by the Association of American Medical Colleges (AAMC) for all American medical schools. Therefore, it is important to address the measurement of empathy, its development and its correlates in medical schools. Objectives, We designed this study to test two hypotheses: firstly, that medical students with higher empathy scores would obtain higher ratings of clinical competence in core clinical clerkships; and secondly, that women would obtain higher empathy scores than men. Materials and subjects, A 20-item empathy scale developed by the authors (Jefferson Scale of Physician Empathy) was completed by 371 third-year medical students (198 men, 173 women). Methods, Associations between empathy scores and ratings of clinical competence in six core clerkships, gender, and performance on objective examinations were studied by using t -test, analysis of variance, chi-square and correlation coefficients. Results, Both research hypotheses were confirmed. Empathy scores were associated with ratings of clinical competence and gender, but not with performance in objective examinations such as the Medical College Admission Test (MCAT), and Steps 1 and 2 of the US Medical Licensing Examinations (USMLE). Conclusions, Empathy scores are associated with ratings of clinical competence and gender. The operational measure of empathy used in this study provides opportunities to further examine educational and clinical correlates of empathy, as well as stability and changes in empathy at different stages of undergraduate and graduate medical education. [source]


The assessment of poorly performing doctors: the development of the assessment programmes for the General Medical Council's Performance Procedures

MEDICAL EDUCATION, Issue 2001
Lesley Southgate
Background Modernization of medical regulation has included the introduction of the Professional Performance Procedures by the UK General Medical Council in 1995. The Council now has the power to assess any registered practitioner whose performance may be seriously deficient, thus calling registration (licensure) into question. Problems arising from ill health or conduct are dealt with under separate programmes. Methods This paper describes the development of the assessment programmes within the overall policy framework determined by the Council. Peer review of performance in the workplace (Phase 1) is followed by tests of competence (Phase 2) to reflect the relationship between clinical competence and performance. The theoretical and research basis for the approach are presented, and the relationship between the qualitative methods in Phase 1 and the quantitative methods in Phase 2 explored. Conclusions The approach is feasible, has been implemented and has stood legal challenge. The assessors judge and report all the evidence they collect and may not select from it. All their judgements are included and the voice of the lay assessor is preserved. Taken together, the output from both phases forms an important basis for remediation and training should it be required. [source]


Professional identity as a resource for talk: exploring the mentor,student relationship

NURSING INQUIRY, Issue 4 2008
Pam Shakespeare
This paper discusses a study examining how mentors in nurse education make professional judgments about the clinical competence of their pre-registration nursing students. Interviews were undertaken with nine UK students and 15 mentors, using critical incidents in practice settings as a focus. The study was undertaken for the English National Practice-Based Professional Learning Centre for Excellence in Teaching and Learning. This paper reports on the conversation analytic thread of the work. The mentor role with pre-registration nursing students is not only supportive but involves formal assessment. Central to the relationship is communication. In professional education, communication is seen as a skill to be applied and assessed in practice settings but is also the medium mentors and mentees use to talk about the relationship. Analysis of excerpts of conversation in the interviews shows that episodes of communication are used as topics of conversation to establish professional identity. It also reveals that judgments about the extent of professional capacity of both students and mentors are grounded in everyday behaviours (for example, enthusiasm, indifference and confidence) as well as professional competence. In addition to focusing on clinical issues, mentors can and do use mundane communication as a resource for judgments about competence. [source]


Poorly performing physicians: Does the script concordance test detect bad clinical reasoning?,

THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 3 2010
François Goulet MD
Abstract Introduction Evaluation of poorly performing physicians is a worldwide concern for licensing bodies. The Collège des Médecins du Québec currently assesses the clinical competence of physicians previously identified with potential clinical competence difficulties through a day-long procedure called the Structured Oral Interview (SOI). Two peer physicians produce a qualitative report. In view of remediation activities and the potential for legal consequences, more information on the clinical reasoning process (CRP) and quantitative data on the quality of that process is needed. This study examines the Script Concordance Test (SCT), a tool that provides a standardized and objective measure of a specific dimension of CRP, clinical data interpretation (CDI), to determine whether it could be useful in that endeavor. Methods Over a 2-year period, 20 family physicians took, in addition to the SOI, a 1-hour paper-and-pencil SCT. Three evaluators, blind as to the purpose of the experiment, retrospectively reviewed SOI reports and were asked to estimate clinical reasoning quality. Subjects were classified into 2 groups (below and above median of the score distribution) for the 2 assessment methods. Agreement between classifications is estimated with the use of the Kappa coefficient. Results Intraclass correlation for SOI was 0.89. Cronbach alpha coefficient for the SCT was 0.90. Agreement between methods was found for 13 participants (Kappa: 0.30, P = 0.18), but 7 out of 20 participants were classified differently in both methods. All participants but 1 had SCT scores below 2 SD of panel mean, thus indicating serious deficiencies in CDI. Discussion The finding that the majority of the referred group did so poorly on CDI tasks has great interest for assessment as well as for remediation. In remediation of prescribing skills, adding SCT to SOI is useful for assessment of cognitive reasoning in poorly performing physicians. The structured oral interview should be improved with more precise reporting by those who assess the clinical reasoning process of examinees, and caution is recommended in interpreting SCT scores; they reflect only a part of the reasoning process. [source]


A construct validity study of clinical competence: A multitrait multimethod matrix approach

THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, Issue 1 2010
Lubna Baig MBBS, PhD Managing Director, Professor of Community Medicine
Abstract Introduction: The purpose of the study was to adduce evidence for estimating the construct validity of clinical competence measured through assessment instruments used for high-stakes examinations. Methods: Thirty-nine international physicians (mean age = 41 + 6.5 y) participated in high-stakes examination and 3-month supervised clinical practice to determine the practice readiness of physicians. Three traits,doctor,patient relationship, clinical competence, and communication skills,were assessed with objective structured clinical examinations, in-training evaluation reports, and clinical assessments. These traits were intercorrelated in a multitrait multimethod matrix (MTMM). Results: The reliability of assessments ranged from moderate to high (Cronbach's ,: 0.58,0.98; Ep2 = 0.79). There is evidence for both convergent and divergent validity for clinical competence, followed by doctor,patient relationships, and communications (validity coefficients = 0.12,0.85). The correlations between the same methods but different traits indicate that there is substantial method specificity in the assessment accounting for nearly one-quarter of the variance (23.7%). Discussion: There is evidence for the construct validity of all 3 traits across 3 methods. The MTMM approach, currently underutilized, could be used to estimate the degree of evidence for validating complex constructs, such as clinical competence. [source]


Conference Attendance Does Not Correlate With Emergency Medicine Residency In-Training Examination Scores

ACADEMIC EMERGENCY MEDICINE, Issue 2009
H. Gene Hern Jr MD
Abstract Objectives:, The residency review committee for emergency medicine (EM) requires residents to have greater than 70% attendance of educational conferences during residency training, but it is unknown whether attendance improves clinical competence or scores on the American Board of Emergency Medicine (ABEM) in-training examination (ITE). This study examined the relationship between conference attendance and ITE scores. The hypothesis was that greater attendance would correlate to a higher examination score. Methods:, This was a multi-center retrospective cohort study using conference attendance data and examination results from residents in four large county EM residency training programs. Longitudinal multi-level models, adjusting for training site, U.S. Medical Licensing Examination (USMLE) Step 1 score, and sex were used to explore the relationship between conference attendance and in-training examination scores according to year of training. Each year of training was studied, as well as the overall effect of mean attendance as it related to examination score. Results:, Four training sites reported data on 405 residents during 2002 to 2008; 386 residents had sufficient data to analyze. In the multi-level longitudinal models, attendance at conference was not a significant predictor of in-training percentile score (coefficient = 0.005, 95% confidence interval [CI] = ,0.053 to 0.063, p = 0.87). Score on the USMLE Step 1 examination was a strong predictor of ITE score (coefficient = 0.186, 95% CI = 0.155 to 0.217; p < 0.001), as was female sex (coefficient = 2.117, 95% CI = 0.987 to 3.25; p < 0.001). Conclusions:, Greater conference attendance does not correlate with performance on an individual's ITE scores. Conference attendance may represent an important part of EM residency training but perhaps not of ITE performance. [source]


Simulation in Graduate Medical Education 2008: A Review for Emergency Medicine

ACADEMIC EMERGENCY MEDICINE, Issue 11 2008
Steve McLaughlin MD
Abstract Health care simulation includes a variety of educational techniques used to complement actual patient experiences with realistic yet artificial exercises. This field is rapidly growing and is widely used in emergency medicine (EM) graduate medical education (GME) programs. We describe the state of simulation in EM resident education, including its role in learning and assessment. The use of medical simulation in GME is increasing for a number of reasons, including the limitations of the 80-hour resident work week, patient dissatisfaction with being "practiced on," a greater emphasis on patient safety, and the importance of early acquisition of complex clinical skills. Simulation-based assessment (SBA) is advancing to the point where it can revolutionize the way clinical competence is assessed in residency training programs. This article also discusses the design of simulation centers and the resources available for developing simulation programs in graduate EM education. The level of interest in these resources is evident by the numerous national EM organizations with internal working groups focusing on simulation. In the future, the health care system will likely follow the example of the airline industry, nuclear power plants, and the military, making rigorous simulation-based training and evaluation a routine part of education and practice. [source]


Developments in molecular genetics and electrophysiology in inherited retinal disorders

ACTA OPHTHALMOLOGICA, Issue 2 2006
Sten Andréasson
Abstract. Retinitis pigmentosa is said to be the most frequent reason for severe visual handicap among young people in Scandinavia today. Developments in the fields of electrophysiology and molecular genetics have increased our understanding of the pathophysiology of these disorders and have also improved our clinical competence, leading to a better understanding of the patient's visual handicap and his or her prognosis. This represents the first step towards fulfilling our plan for the future, which is ultimately to cure blindness caused by the different forms of hereditary retinal degeneration. This review is based on 20 years of research at the Department of Ophthalmology in Lund. [source]