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Global Ratings (global + rating)

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Medical Sciences93%

Terms modified by Global Ratings

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    Selected Abstracts

    The effect of candidate familiarity on examiner OSCE scores

    MEDICAL EDUCATION, Issue 9 2007
    Ann Jefferies
    Context, Although examiners are a large source of variability in the objective structured clinical examination (OSCE), the exact causes of examiner variance remain understudied. Objective, This study aimed to determine whether examiner familiarity with candidates influences candidate scores. Methods, A total of 24 candidates from 4 neonatal-perinatal training programmes participated in a 10-station OSCE. Sixteen trainees and 7 examiners came from a single centre (site A) and 8 candidates and 5 examiners came from the other 3 centres. Examiners completed station-specific binary checklists and an overall global rating; standardised patients (SPs) and standardised health professionals (SHPs) completed 4 process ratings and the overall rating. A fixed-effect, 2-way analysis of variance was performed to ascertain whether there was interaction between examiner site and candidate site. Results, Interstation Cronbach's , was 0.80 for the examiner checklist, 0.88 for the examiner global rating and 0.88 for the SP or SHP global rating. Although the checklist scores awarded by site A examiners were significantly higher than those awarded by non-site A examiners, there was no significant interaction between examiner and candidate site (P = 0.124). Similarly, the interaction between examiner and candidate site for the global rating was not significant (P = 0.207). Global ratings awarded by SPs and SHPs were also higher in stations where site A faculty examined site A candidates, suggesting the observed differences may have been related to performance. Conclusions, Results from this small dataset suggest that examiner familiarity with candidates does not influence how examiners score candidates, confirming the objective nature of the OSCE. Confirmation with a larger study is required. [source]

    Use of a structured interview to assess portfolio-based learning

    MEDICAL EDUCATION, Issue 9 2008
    Vanessa C Burch
    Context, Portfolio-based learning is a popular educational tool usually examined by document review which is sometimes accompanied by an oral examination. This labour-intensive assessment method prohibits its use in the resource-constrained settings typical of developing countries. Objectives, We aimed to determine the feasibility and internal consistency of a portfolio-based structured interview and its impact on student learning behaviour. Methods, Year 4 medical students (n = 181) recorded 25 patient encounters during a 14-week medical clerkship. Portfolios were examined in a 30-minute, single-examiner interview in which four randomly selected cases were discussed. Six standard questions were used to guide examiners in determining the ability of candidates to interpret and synthesise clinical data gathered during patient encounters. Examiners were trained to score responses using a global rating scale. Pearson's correlation co-efficient, Cronbach's , coefficient and the standard error of measurement (SEM) of the assessment tool were determined. The number of students completing more than the required number of portfolio entries was also recorded. Results, The mean (± standard deviation [SD], 95% confidence interval [CI]) interview score was 67.5% (SD ± 10.5, 95% CI 66.0,69.1). The correlation coefficients for the interview compared with other component examinations of the assessment process were: multiple-choice question (MCQ) examination 0.42; clinical case-based examination 0.37; in-course global rating 0.08, and overall final score 0.54. Cronbach's , coefficient was 0.88 and the SEM was 3.6. Of 181 students, 45.3% completed more than 25 portfolio entries. Conclusions, Portfolio assessment using a 30-minute structured interview is a feasible, internally consistent assessment method that requires less examination time per candidate relative to methods described in published work and which may encourage desirable student learning behaviour. [source]

    The effect of candidate familiarity on examiner OSCE scores

    MEDICAL EDUCATION, Issue 9 2007
    Ann Jefferies
    Context, Although examiners are a large source of variability in the objective structured clinical examination (OSCE), the exact causes of examiner variance remain understudied. Objective, This study aimed to determine whether examiner familiarity with candidates influences candidate scores. Methods, A total of 24 candidates from 4 neonatal-perinatal training programmes participated in a 10-station OSCE. Sixteen trainees and 7 examiners came from a single centre (site A) and 8 candidates and 5 examiners came from the other 3 centres. Examiners completed station-specific binary checklists and an overall global rating; standardised patients (SPs) and standardised health professionals (SHPs) completed 4 process ratings and the overall rating. A fixed-effect, 2-way analysis of variance was performed to ascertain whether there was interaction between examiner site and candidate site. Results, Interstation Cronbach's , was 0.80 for the examiner checklist, 0.88 for the examiner global rating and 0.88 for the SP or SHP global rating. Although the checklist scores awarded by site A examiners were significantly higher than those awarded by non-site A examiners, there was no significant interaction between examiner and candidate site (P = 0.124). Similarly, the interaction between examiner and candidate site for the global rating was not significant (P = 0.207). Global ratings awarded by SPs and SHPs were also higher in stations where site A faculty examined site A candidates, suggesting the observed differences may have been related to performance. Conclusions, Results from this small dataset suggest that examiner familiarity with candidates does not influence how examiners score candidates, confirming the objective nature of the OSCE. Confirmation with a larger study is required. [source]

    Target-focused medical emergency team training using a human patient simulator: effects on behaviour and attitude

    MEDICAL EDUCATION, Issue 2 2007
    Carl-Johan Wallin
    Context, Full-scale simulation training is an accepted learning method for gaining behavioural skills in team-centred domains such as aviation, the nuclear power industry and, recently, medicine. In this study we evaluated the effects of a simulator team training method based on targets and known principles in cognitive psychology. Methods, This method was developed and adapted for a medical emergency team. In particular, we created a trauma team course for novices, and allowed 15 students to practise team skills in 5 full-scale scenarios. Students' team behaviour was video-recorded and students' attitude towards safe teamwork was assessed using a questionnaire before and after team practice. Results, Nine of 10 observed team skills improved significantly in response to practice, in parallel with a global rating of team skills. In contrast, no change in attitude toward safe teamwork was registered. Conclusion, The use of team skills in 5 scenarios in a full-scale patient simulator environment implementing a training method based on targets and known principles in cognitive psychology improved individual team skills but had no immediate effect on attitude toward safe patient care. [source]

    Standard setting in an objective structured clinical examination: use of global ratings of borderline performance to determine the passing score

    MEDICAL EDUCATION, Issue 11 2001
    Tim J Wilkinson
    Background Objective structured clinical examination (OSCE) standard-setting procedures are not well developed and are often time-consuming and complex. We report an evaluation of a simple ,contrasting groups' method, applied to an OSCE conducted simultaneously in three separate schools. Subjects Medical students undertaking an end-of-fifth year multidisciplinary OSCE. Methods Using structured marking sheets, pairs of examiners independently scored student performance at each OSCE station. Examiners also provided a global rating of overall performance. The actual scores of any borderline candidates at each station were averaged to provide a passing score for each station. The passing scores for all stations were combined to become the passing score for the whole exam. Validity was determined by making comparisons with performance on other fifth-year assessments. Reliability measures comprised interschool agreement, interexaminer agreement and interstation variability. Results The approach was simple and had face validity. There was a stronger association between the performance of borderline candidates on the OSCE and their in-course assessments than with their performance on the written exam, giving a weak measure of construct validity in the absence of a better ,gold standard'. There was good agreement between examiners in identifying borderline candidates. There were significant differences between schools in the borderline score for some stations, which disappeared when more than three stations were aggregated. Conclusion This practical method provided a valid and reliable competence-based pass mark. Combining marks from all stations before determining the pass mark was more reliable than making decisions based on individual stations. [source]

    Women with Pain due to Osteoarthritis: The Efficacy and Safety of a Once-Daily Formulation of Tramadol

    PAIN MEDICINE, Issue 6 2009
    FRCP, Walter F. Kean MB ChB
    ABSTRACT Objective., This analysis assesses the efficacy and safety of treatment with a once-daily oral formulation of tramadol for up to 12 weeks compared with placebo in women with moderate-to-severe pain due to osteoarthritis of the knee. Design., Two parallel, placebo-controlled phase III clinical trials were analyzed; patients were randomized to a fixed dosage of Tramadol Contramid® once a day (OAD) 100, 200, and 300 mg daily, or placebo. Outcome Measures., The primary efficacy end points were the percentage difference from baseline of the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) subscale scores for pain and physical function, and the patient global rating of pain relief after 12 weeks of maintenance therapy. Results., The analysis included 405 women receiving tramadol and 280 receiving placebo. At week 12, 179 of 204 women (87.7%) receiving tramadol rated their overall pain relief as effective or very effective compared with 134 of 177 (75.7%) receiving placebo. A time-weighted analysis revealed statistically significant improvements over placebo for all the WOMAC subscale scores across all three dosages. The percentage improvements from baseline of the WOMAC pain scores were significantly better than placebo for the 100-mg (58.8 ± 37.1%, P = 0.018) and 300-mg (58.9 ± 38.8%, P = 0.023) treatment arms; however, the 200-mg dosage was not significant (53.0 ± 38.5%, P = 0.175). The WOMAC physical function scores showed significant improvement for the 100 (56.9 ± 36.4%, P = 0.009), 200 (54.0 ± 33.8%, P = 0.034), and 300 mg (53.4 ± 41.4%, P = 0.043) daily dosages. Conclusion., For moderate-to-severe pain due to osteoarthritis of the knee, women experience significant analgesia and improvement of physical function over time with treatment with Tramadol Contramid® OAD. [source]

    Do early therapeutic alliance, motivation, and stages of change predict therapy change for high-risk, psychopathic violent prisoners?

    CRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 2 2010
    Devon L. L. Polaschek
    Background,Examination of the extent of offenders' engagement in change, and in rehabilitation programmes, is important to understanding success or failure following rehabilitation. In treatment programmes, the alliance between therapist and offender, and the therapy process itself appear central to progress offenders make that may reduce their criminal risk. But research with offenders seldom has measured therapeutic alliance and clinical writing suggests that it is difficult to form an alliance with those not ready to change their behaviour; especially with higher risk and psychopathic offenders. Aims and Methods,This study outlines the course of the therapeutic alliance in an 8-month treatment programme for high-risk, PCL-psychopathic violent prisoners. It examines relationships between early-treatment therapeutic alliance, therapists' global ratings of motivation to change, and initial stage of change on dynamic risk factors. In addition, it investigates which factors best predict who will complete treatment and change behaviourally during treatment. Conclusion,In this challenging, high-needs client group, early-programme stage of change, therapists' perceptions of motivation, therapeutic alliance and psychopathy did not predict how much change prisoners made. Regardless of initial levels, prisoners whose alliance increased the most over the course of treatment made the most change. Copyright © 2010 John Wiley & Sons, Ltd. [source]

    Intellectual and adaptive behaviour functioning in pantothenate kinase-associated neurodegeneration

    JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 6 2007
    K. Freeman
    Abstract Background Pantothenate kinase-associated neurodegeneration (PKAN), an extremely rare autosomal recessive disorder resulting in iron accumulation in the brain, has a diverse phenotypic expression. Based on limited case studies of one or two patients, intellectual impairment is considered part of PKAN. Investigations of cognitive functioning have utilized specific neuropsychological tests, without attention to general intellectual skills or adaptive behaviour. Methods Sixteen individuals with PKAN completed measures of global intellectual functioning, and participants or care providers completed measures of adaptive behaviour skills and day-to-day functional limitations. Clinicians provided global ratings of condition severity. Results Testing with standardized measures documented varied phenotypic expression, with general cognitive skills and adaptive behaviour ranging from high average to well below average. Age of disease onset correlated with measures of intellectual functioning, adaptive functioning and disease severity. Conclusions Findings support previously described clinical impressions of varied cognitive impairment and the association between age of onset and impairment. Further, they add important information regarding the natural history of the disease and suggest assessment strategies for use in treatment trials. [source]

    Outcome Variables and Their Assessment in Alcohol Treatment Studies: 1968-1998

    ALCOHOLISM, Issue 10 2003
    John W. Finney
    Background: This article provides a historical overview of the assessment of outcome variables in alcohol treatment studies that were first published between 1968 and 1998. The review focuses on changes over time in (1) the number of outcome variables and the number of different types of outcome variables assessed, (2) the likelihood of assessing specific types of outcome variables, (3) the methods used to assess outcome variables, and (4) the status of outcome assessment in more recent studies first published between 1990 and 1998. Methods: Reports of 357 alcohol treatment trials with two or more treatment/control groups were coded with respect to the number and types of outcome variables assessed, sources of outcome data, and methodological aspects of outcome assessment. Results: Although the number of outcome variables assessed in studies, on average, did not increase significantly over time, the number of different types of outcome variables did increase. An expected decrease in the assessment of categorical abstinence was not found, but another categorical variable, global ratings of drinking improvement, did decrease over time. More recent studies were more likely to assess such continuous variables as time abstinent, alcohol consumption, time drinking, dependence symptoms, and drinking-related problems. Physiological markers of drinking/alcohol misuse also were assessed more frequently in later years. Some aspects of outcome assessment methods exhibited improvement over time; validity data were more likely to be provided or cited, and self-reports of drinking behaviors were more likely to be corroborated in studies first published in more recent years. However, the percentages of studies that provided/cited reliability data for outcome measures, indicated that follow-up data collectors were not affiliated with treatment and were unaware of respondents' treatment conditions, and reported that respondents were alcohol-free at follow-up did not rise significantly over time. Conclusions: Although the methods of outcome assessment improved between 1968 and 1998, much room for improvement remains. [source]

    A structured communication adolescent guide (SCAG): assessment of reliability and validity

    MEDICAL EDUCATION, Issue 5 2005
    Kim Blake
    Purpose, To assess the reliability and validity of a Structured Communication Adolescent Guide (SCAG) in an undergraduate medical education setting using trained adolescent raters. Method, The SCAG is a 49-item, 6-section (A,F), protocol derived from the Calgary Cambridge Observation Guide that incorporates adolescent psychosocial data collection with the physician's communication skills. Four trained female adolescents scored 42 videotaped adolescent clinical encounters using the SCAG; a trained psychologist's rating for each videotape was used as the gold standard. Results, Agreement among adolescent raters was determined by calculating intraclass correlation coefficients (ICC). The individual SCAG item scores, combined with the global ratings for each section, resulted in an overall ICC value of 0.93, indicating very strong agreement among the 4 raters. The global rating scores for the sections (,initiating the session', ,initiating separation', ,once adolescent is alone , lifestyle' and ,closure') produced an ICC range of 0.58,0.93. However, the ICC values for the 2 remaining sections (,how was information collected' and ,gathering information') global rating scores were below 0.30, signifying low agreement. Overall agreement between the adolescent raters and the gold standard resulted in an ICC value of 0.78. This is evidence of the SCAG's criterion validity. Conclusion, The SCAG is a reasonably valid tool for use in guiding an encounter with an adolescent patient. However, 2 sections require modifications to improve their reliability and thus the SCAG's overall performance. Our results suggest that the SCAG shows promise as a potentially useful teaching resource in undergraduate medical education in adolescent medical interviewing. [source]

    Standard setting in an objective structured clinical examination: use of global ratings of borderline performance to determine the passing score

    MEDICAL EDUCATION, Issue 4 2002
    Craig Mcllhenny
    No abstract is available for this article. [source]

    Standard setting in an objective structured clinical examination: use of global ratings of borderline performance to determine the passing score

    MEDICAL EDUCATION, Issue 11 2001
    Tim J Wilkinson
    Background Objective structured clinical examination (OSCE) standard-setting procedures are not well developed and are often time-consuming and complex. We report an evaluation of a simple ,contrasting groups' method, applied to an OSCE conducted simultaneously in three separate schools. Subjects Medical students undertaking an end-of-fifth year multidisciplinary OSCE. Methods Using structured marking sheets, pairs of examiners independently scored student performance at each OSCE station. Examiners also provided a global rating of overall performance. The actual scores of any borderline candidates at each station were averaged to provide a passing score for each station. The passing scores for all stations were combined to become the passing score for the whole exam. Validity was determined by making comparisons with performance on other fifth-year assessments. Reliability measures comprised interschool agreement, interexaminer agreement and interstation variability. Results The approach was simple and had face validity. There was a stronger association between the performance of borderline candidates on the OSCE and their in-course assessments than with their performance on the written exam, giving a weak measure of construct validity in the absence of a better ,gold standard'. There was good agreement between examiners in identifying borderline candidates. There were significant differences between schools in the borderline score for some stations, which disappeared when more than three stations were aggregated. Conclusion This practical method provided a valid and reliable competence-based pass mark. Combining marks from all stations before determining the pass mark was more reliable than making decisions based on individual stations. [source]

    painACTION-Back Pain: A Self-Management Website for People with Chronic Back Pain

    PAIN MEDICINE, Issue 7 2010
    Emil Chiauzzi PhD
    Abstract Objective., To determine whether an interactive self-management Website for people with chronic back pain would significantly improve emotional management, coping, self-efficacy to manage pain, pain levels, and physical functioning compared with standard text-based materials. Design., The study utilized a pretest,posttest randomized controlled design comparing Website (painACTION-Back Pain) and control (text-based material) conditions at baseline and at 1-, 3, and 6-month follow-ups. Participants., Two hundred and nine people with chronic back pain were recruited through dissemination of study information online and at a pain treatment clinic. The 6-month follow-up rates for the Website and control groups were 73% and 84%, respectively. Measurements., Measures were based on the recommendations of the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials and included measures of pain intensity, physical functioning, emotional functioning, coping, self-efficacy, fear-avoidance, perceived improvement with treatment, self-efficacy, and catastrophizing. Results., Compared with controls, painACTION-Back Pain participants reported significantly: 1) lower stress; 2) increased coping self-statements; and 3) greater use of social support. Comparisons between groups suggested clinically significant differences in current pain intensity, depression, anxiety, stress, and global ratings of improvement. Among participants recruited online, those using the Website reported significantly: 1) lower "worst" pain; 2) lower "average" pain; and 3) increased coping self-statements, compared with controls. Participants recruited through the pain clinic evidenced no such differences. Conclusions., An online self-management program for people with chronic back pain can lead to improvements in stress, coping, and social support, and produce clinically significant differences in pain, depression, anxiety, and global rates of improvement. [source]

    Methodological considerations of measuring disability in bipolar disorder: validity of the Multidimensional Scale of Independent Functioning

    BIPOLAR DISORDERS, Issue 1-2 2007
    Stefanie Berns
    Objective:, Recent studies have highlighted the prevalence, severity and persistence of the disability associated with bipolar disorder (BPD). Reliable instruments are needed to support research into the factors associated with disability and treatment response. Contextual factors (e.g., availability of supported employment programs) can affect functionality, posing a challenge to such investigations. We present preliminary findings regarding the validity of the Multidimensional Scale of Independent Functioning (MSIF) in BPD. The MSIF provides discrete ratings of support separate from both role responsibility and performance quality in work, residential and educational environments. These distinctions allow the ,correction' for variability explained by contextual factors that allows the comparison of studies conducted in different environments and time. Methods:, Participants with BPD were administered the MSIF, the Social Adjustment Scale II (SAS-II) and an interview recording objective data regarding work, school and residential activities as part of an ongoing longitudinal study of BPD disability. Results:, Construct validity estimated using standardized Cronbach's alpha coefficient was 0.76 (n = 58). MSIF global ratings were significantly lower (reflecting higher functionality) for subjects engaged in productive activity compared with participants who were not active (t = ,3.6, p = 0.001) demonstrating external validity. Inter-rater reliability estimates ranged from 0.86 to 0.99 (n = 49). Significant, high correlations were demonstrated between comparable MSIF and SAS-II global ratings (criterion validity = 0.70,0.79) and low correlations were found between non-comparable ratings (discriminant validity = ,0.07 to ,0.35) (n = 14). Conclusion:, We conclude that the MSIF is a valid and reliable instrument optimally designed for studying determinants of disability and treatment response in BPD. [source]