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Biomedical subjects

A J Speer

Publications and source records attributed to A J Speer.

15 recordsLinked to original sources
PubMed2000

Grade inflation in internal medicine clerkships: results of a national survey.

BACKGROUND: There has been a discussion among medical educators concerning grade inflation; however, little has been written about it in the medical education literature. PURPOSE: A survey was developed to determine if grade inflation exists by gathering data about grading practices and by gathering the opinions of course directors from Internal Medicine clerkships. METHODS: The survey was administered during the 1996-1997 academic year to all 125 LCME accredited medical school Internal Medicine Clerkship Directors. Grading practices for 3 separate academic years were obtained plus responses to questions about causes of and solutions for grade inflation. RESULTS: Eighty-three surveys were returned for a 66% response rate. There was a trend towards higher grades across the 3 study years, with the 1995-1996 year being statistically significant. Forty-eight percent of the clerkship directors felt that grade inflation existed in their courses, and 43% felt that some students passed who should have failed. CONCLUSION: Statistically significant grade inflation exists in Internal Medicine clerkships. Most disturbingly, 43% feel we are unable appropriately to identify incompetent students.

Clinical Clerkship↗
PubMed1999

Assessing the quality of teaching.

Although quality teaching is an integral component of the educational process, it is not easy to define or evaluate. Traditionally, teacher evaluation has focused on student surveys. Peer evaluations are more objective and seem worth the investment. They not only provide a valid and reliable assessment method but have the added advantage of easily being incorporated into faculty development by providing timely, specific feedback. Documentation of teacher accomplishments, both in quantity and quality, can be incorporated into a faculty portfolio and used for promotion, tenure, and salary decisions. Evaluating the quality of courses remains less than satisfactory. Surveying other stakeholders would provide an added perspective that might be valuable to the course. Continued research into curricular outcome measures will be important to assessing quality of courses. Until that time, a combination of student surveys and acquisition of skills will be the most logical methods.

Education, Medical↗
PubMed1999

The impact of the location and structure of an ambulatory rotation on cognitive knowledge and performance.

With the increasing shift to community-based ambulatory education, it is essential to gain a better understanding of the impact of these changes. To assess the impact of the location and structure of an ambulatory internal medicine clerkship rotation on cognitive knowledge and clinical performance, students were assigned to one of the following: (a) a multidisciplinary ambulatory clerkship (MAC), (b) the office of a community-based general internist, or (c) a university-based internal medicine ambulatory clinic. The groups were compared on the internal medicine clerkship examination and preceptor ratings controlling for introduction to clinical medicine course performance via analysis of covariance. MAC students were rated lower than the other two groups by their preceptors. There were no other statistically significant differences. The structure and location of the rotation had little impact on cognitive knowledge. The impact of the structure of the rotation on clinical performance is less clear suggesting that further research is needed.

Ambulatory Care↗
PubMed1998

Creating and evaluating an independent ambulatory internal medicine clerkship.

Patient care is shifting from an inpatient setting to an ambulatory setting. Despite this shift, most internal medicine clerkships provide the majority of medical student training in inpatient settings or in university tertiary care clinics, which are not representative of patient care in a community setting. We created a separate ambulatory clerkship that used volunteer community faculty at local and distant sites. The steps involved are described here, including finding time within the clerkship, reaching consensus within the department, defining the curriculum, identifying sites, and developing preceptors. Various parameters were measured to ensure quality in educational design. Comparisons of the 1-year pilot program, the full implementation program, and the inpatient program revealed that use of community sites does not affect cognitive knowledge acquisition but does influence students' satisfaction level.

Clinical Competence↗
PubMed1997

Setting standards and defining quality of performance in the validation of a standardized-patient examination format.

PURPOSE: To evaluate whether written standards increase the reproducibility of a physician-facilitated station in an objective structured clinical examination (OSCE) designed to assess history, physical-examination, and communication skills. METHOD: The OSCE examination at the University of Texas Medical Branch-Galveston consists of ten eight-minute stations. Six of these stations consist of three History, Physical-examination, Problem-solving, and Plan (HPPP) station pairs. Each existing clinical-problem HPPP station was given to two content experts to develop standards for faculty rating scales appropriate for the evaluation of third-year medical students. Three pairs of faculty members were used to determine interrater reliability by scoring videotapes of three HPPP stations' presentation and problem-solving components. Faculty pairs scored tapes of 15 students without using standards and tapes of 15 students using the standards developed. Differences between the reliabilities without and with the standards were tested for significance using Fisher's R to Z transformation. The reproducibility and standard error of measurement (SEM) were extrapolated for increasing amounts of testing time. The HPPP component scores were also correlated with the written examination scores and preceptors' ratings. Data were obtained from the three HPPP stations used in the 1995-96 internal medicine clerkship SP examination. RESULTS: In all, 196 students completed the OSCE examination. The standards developed improved interrater reliability and reached statistical significance (p < .01) for one HPPP station. Reproducibility for the presentation and problem-solving components of the HPPP stations were > .80 after five hours of testing. The problem-solving component correlated at .37 and .19 with written examinations and with ward grades, respectively. CONCLUSION: The data from this study suggest that standards increase the reproducibility of presentation and problem-solving components of an OSCE to a level as high as, or higher than, that associated with the history, physical-examination, and communication components of traditional standardized-patient examinations.

Clinical Clerkship↗
PubMed1997

The reliability of medical student ratings of clinical teaching.

This study estimated the interrater reliability of medical student evaluations of clinical teaching. Data consisted of 1,570 ratings evaluating 147 faculty over a 4-year period in a 3rd-year internal medicine clerkship. The number of ratings a typical faculty member receives in a year was also calculated and used to extrapolate the standard error of measurement for data typically available to evaluate faculty at different time intervals. The data available to evaluate a faculty member after 1 year was not adequate, but improved substantially at the 5- to 7-year mark, when a faculty member is typically evaluated for promotion and tenure.

Clinical Clerkship↗
PubMed1996

Dimensions of clinical competence as conceptualized by medical school faculty.

This study identified dimensions of clinical competence underlying faculty ratings of fourth-year student performance in a standardized patient examination and assessed the impact of these dimensions on faculty pass/fail decisions. Content review coupled with exploratory factor analysis was used to group 17 of 25 specific behavioral rating categories into four homogeneous clusters. Confirmatory factor analysis refined the clusters into four unidimensional scales that included 14 of the original ratings. The dimensions reflected relating to the patient, problem-solving skills, medical history skills, and physical examination skills. The factor structure was cross-validated in a separate data set. Logistic regression indicated problem solving was the only independent predictor of a student passing the exercise.

Adult↗
PubMed1994

Evaluating problem solving based on the use of history findings in a standardized-patient examination.

PURPOSE: To evaluate a novel item format for assessing clinical problem solving in a standardized-patient examination (SPE). METHOD: In 1992-93 a key-findings item format was included in two versions of three stations in an SPE (given in the style of an objective structured clinical examination) that was taken by 198 third-year students at the end of their three-month internal medicine clerkship at the University of Texas Medical Branch at Galveston. Each of the stations involved an extended matching question that listed ten to 12 findings. The students were told to select as many or as few findings as they wished that were key in leading them to their diagnosis of the standardized patient's (SP's) problem. The findings fell into three categories: (1) key to the diagnosis, (2) provided by the SP but not key to the diagnosis, and (3) not provided by the SP. RESULTS: A total of 169 students (85%) identified at least one of the findings determined to be key in each of the stations. Correctly identifying key findings was related to correctly diagnosing the SP's problem. A total of 145 students (73%) indicated at least one finding across the three cases as key to their diagnosis but not given by the SP. Selecting nonexistent findings as key to diagnosis was not found to be related to performance on the SPE. It was hypothesized that once a diagnosis was made, the students had difficulty differentiating key findings that had led them to the diagnosis from other key features of their cognitive model of illness. CONCLUSION: The students were generally able to obtain and recognize at least some of the key information they needed to formulate appropriate differential diagnoses, and the ability to identify key findings was shown to be related to identifying the most appropriate diagnosis. The key-findings item format has potential both in assessment and for gaining a better understanding of the clinical problem-solving process.

Clinical Competence↗