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Biomedical subjects

Brian Hodges

Publications and source records attributed to Brian Hodges.

At least 19 recordsLinked to original sources
PubMed2006

Research in medical education: balancing service and science.

Since the latter part of the 1990's, the English-speaking medical education community has been engaged in a debate concerning the types of research that should have priority. To shed light on this debate and to better understand its implications for the practice of research, 23 semi-structured interviews were conducted with "influential figures" from the community. The results were analyzed using the concept of "field" developed by the sociologist Pierre Bourdieu. The results reveal that a large majority of these influential figures believe that research in medical education continues to be of insufficient quality despite the progress that has taken place over the past 2 decades. According to this group, studies tend to be both redundant and opportunistic, and researchers tend to have limited understanding of both theory and methodological practice from the social sciences. Three factors were identified by the participants to explain the current problems in research: the working conditions of researchers, budgetary restraints in financing research in medical education, and the conception of research in the medical environment. Two principal means for improving research are presented: intensifying collaboration between PhD's and clinicians, and encouraging the diversification of perspectives brought to bear on research in medical education.

Curriculum↗
PubMed2006

Duty hours reforms in the United States, France, and Canada: is it time to refocus our attention on education?

Resident duty hours restrictions have now been instituted in many countries worldwide. Such policies have resulted in a broad-based discussion in the medical literature concerning their effects on patient care, resident education, and resident well-being. To better understand the impetuses behind these changes, the authors examine not only the duty hours mandates currently in effect in the United States, Canada, and France, but also the events influencing their independent development in these three countries. In the United States, an 80-hour resident workweek was mandated by the Accreditation Council for Graduate Medical Education out of concern for patient safety. In France, a 52.5-hour workweek was decreed by the government, reflecting the broader European Working Time Directive initiated out of concern for the negative impact of extended work hours on its population. In Canada, resident unions, whose primary interest has been one of resident well-being, have negotiated a series of reduced resident duty hours that approach those mandated in the United States. At the core of these changes are unique differences in these countries' health care and medical education systems. The resulting diversity in the origin and nature of such regulations serves to highlight the lack of evidence that has guided their development and the need to refocus on the educational elements of postgraduate training.

Canada↗
PubMed2006

Factors predicting practice location and outreach consultation among University of Toronto psychiatry graduates.

OBJECTIVE: To identify the determinants of practice location and of outreach consultation of recently graduated psychiatrists. METHODS: We surveyed 153 psychiatrists who graduated from the University of Toronto Department of Psychiatry between January 1990 and June 2002 (response rate 51%), on the basis of a self-administered mail questionnaire. The survey assessed factors that influenced practice location and outreach consultation, such as demographics, links to practice communities, and outreach experiences, including rural or northern electives as a resident. RESULTS: Professional variables were rated as the most important factors in choosing a practice location. Variables such as age or sex were not significantly associated with location. Nine percent reported working in communities of less than 100,000, and only 1% practised in Northern Ontario. Eighteen percent practised in the same location where they were born or raised. Forty-four percent had rural or northern experience as a resident but almost exclusively in the form of short, fly-in consultation electives. Twenty-four percent indicated that they provide outreach consultation. Psychiatry residents who participated in outreach electives were 10 times as likely as those who did not participate to continue outreach as a consultant. CONCLUSION: Although early exposure to rural or northern medicine leads to significantly greater continued involvement in outreach activities after graduation, our findings suggest the need for more long-term, on-site residency training opportunities in rural and remote areas.

Adult↗
PubMed2005

Ensuring global standards for medical graduates: a pilot study of international standard-setting.

Increasing physician and patient mobility has led to a move toward internationalization of standards for physician competence. The Institute for International Medical Education proposed a set of outcome-based standards for student performance, which were then measured using three assessment tools in eight leading schools in China: a 150-item multiple-choice examination, a 15-station OSCE and a 16-item faculty observation form. The purpose of this study was to empanel a group of experts to determine whether international student-level performance standards could be set. The IIME convened an international panel of experts in student education with specialty and geographic diversity. The group was split into two, with each sub-group establishing standards independently. After a discussion of the borderline student, the sub-groups established minimally acceptable cut-off scores for performance on the multiple-choice examination (Angoff and Hofstee methods), the OSCE station and global rating performance (modified Angoff method and holistic criterion reference), and faculty observation domains (holistic criterion reference). Panelists within each group set very similar standards for performance. In addition, the two independent parallel panels generated nearly identical performance standards. Cut-off scores changed little before and after being shown pilot data but standard deviations diminished. International experts agreed on a minimum set of competences for medical student performance. In addition, they were able to set consistent performance standards with multiple examination types. This provides an initial basis against which to compare physician performance internationally.

Clinical Competence↗
PubMed2005

The many and conflicting histories of medical education in Canada and the USA: an introduction to the paradigm wars.

BACKGROUND: Medical education research is a maturing field of inquiry that derives theoretical perspectives from many domains. Yet while such theoretical diversity holds the promise of rich paradigmatic writing and debate, too often medical education researchers do not place their work in a historical or cultural context, giving the impression that they have somehow unearthed universal 'truths' about medical education. METHODS: This paper introduces some of the key 'histories' of medical education from the contexts of Anglophone Canada and the USA following a review of major works in the history of medical education. RESULTS: There are many and conflicting histories of medical education in North America that can be classified according to different socio-historical paradigms. CONCLUSIONS: To avoid the error of over-generalisation, a much greater effort must be made to include historical, sociological, economic and other social science perspectives in the design, interpretation and application of medical education research.

Canada↗
PubMed2005

Educating doctors in France and Canada: are the differences based on evidence or history?

BACKGROUND: Despite many economic and political similarities between France and Canada, particularly in their health care systems, there are very significant differences in their systems of medical education. AIM: This work aims to highlight the sociohistorical values of each country that explain these differences by comparing the medical education systems of the 2 countries, including medical schools (teachers, funding), key processes (curriculum, student selection) and quality assurance methods. DISCUSSION: In France, means and processes are standardised and defined at a national level. France has almost no national system of assessment of medical schools nor of students. By contrast, Canada leaves medical schools free to design their medical curricula, select students and appoint teachers using their own criteria. In order to guarantee the homogeneity and quality of graduates, the medical profession in Canada has created independent national organisations that are responsible for accreditation and certification processes. Each country has a set of founding values that partly explain the choices that have been made. In France these include equality and the right to receive free education. In Canada, these include equity, affirmative action and market-driven tuition. CONCLUSION: Many of the differences are more easily explained by history and national values than by a robust base of evidence. There is a constant tension between a vision of education promoted by medical educators, based on contextually non-specific ideas such as those found in the medical education literature, and the sociopolitical foundations and forces that are unique to each country. If we fail to consider such variables, we are likely to encounter significant resistance when implementing reforms.

Canada↗
PubMed2004

Advancing health care education and practice through research: the University of Toronto, Donald R. Wilson Centre for Research in Education.

The vision of the Wilson Centre for Research in Education at the University of Toronto, Ontario, Canada, is "advancing health care education and practice through research." With a core staff of eight PhD researchers, five full-time administrative staff, 150 clinical faculty members, and over a dozen fellows and visiting professors from around the world, the Wilson Centre has become an international leader in health professional education research. Diversity of ideas and research methodologies, a culture of mutual support and mentorship, and strong support from both the university and a major teaching hospital have propelled the Wilson Centre. Challenges such as focusing research priorities, involving the clinical faculty more extensively, and defining productive international collaborations are among the current issues for academic planning.

Education, Medical↗
PubMed2004

Expert and trainee determinations of rhetorical relevance in referral and consultation letters.

BACKGROUND: Referral and consultation letters ferry patients among providers, negotiating co-operative care. Our study examined how "relevance" is signalled and decoded in these letters, from the perspective of both experts and trainees in three clinical specialties. METHODS: 104 letters were collected from 16 physicians representing family medicine, psychiatry and surgery. Interviews were conducted with 14 of these physicians and 13 residents from the three specialties. All documents and transcripts were analysed for emergent themes. RESULTS: Six rhetorical factors influenced expert physicians' decisions about what material is relevant: educational, professional, audience, system-institutional, medical-legal, and evaluative. Each specialty placed different emphasis on these factors. Trainees reported having no instruction regarding how to construct rhetorically relevant letters, and they demonstrated awareness of only three of the factors identified by experts--professional, audience and evaluative. Experts and trainees differed in their understanding and application of these three factors. CONCLUSIONS: This research demonstrates that six rhetorical factors influence relevance decisions in letter writing, and that experts address these factors in tacit, dynamic and discipline-specific ways. Trainees share with experts an appreciation of the rhetorical functions of referral and consultation letters, but lack a comprehensive understanding of the influential factors and do not receive instruction in them. These findings provide a framework for instruction in this domain to equip novices to meet the expectations of their professional audiences successfully.

Continuity of Patient Care↗
PubMed2004

Intravenous ethanol for the treatment of alcohol withdrawal syndrome in critically ill patients.

Critically ill patients with alcoholism are at greater risk of morbidity and mortality from alcohol withdrawal syndrome than are patients without alcoholism. Benzodiazepines are considered the drugs of choice for the prevention and treatment of alcohol withdrawal syndrome, but some studies have suggested that intravenous ethanol may be as effective as those agents, as well as being less sedating. We evaluated the evidence regarding the use of intravenous ethanol for the prevention and treatment of alcohol withdrawal syndrome in critically ill patients in order to determine its role in this patient population. Because of the paucity of well-designed clinical trials, and because of intravenous ethanol's questionable efficacy, inconsistent pharmacokinetic profile, and relatively narrow therapeutic index, routine use of this drug is not recommended in critically ill patients who have alcohol withdrawal syndrome or are at risk for it.

Adult↗
PubMed2003

Analytic global OSCE ratings are sensitive to level of training.

PURPOSE: There are several reasons for using global ratings in addition to checklists for scoring objective structured clinical examination (OSCE) stations. However, there has been little evidence collected regarding the validity of these scales. This study assessed the construct validity of an analytic global rating with 4 component subscales: empathy, coherence, verbal and non-verbal expression. METHODS: A total of 19 Year 3 and 38 Year 4 clinical clerks were scored on content checklists and these global ratings during a 10-station OSCE. T-tests were used to assess differences between groups for overall checklist and global scores, and for each of the 4 subscales. RESULTS: The mean global rating was significantly higher for senior clerks (75.5% versus 71.3%, t55 = 2.12, P < 0.05) and there were significant differences by level of training for the coherence (t55 = 3.33, P < 0.01) and verbal communication (t55 = 2.33, P < 0.05) subscales. Interstation reliability was 0.70 for the global rating and ranged from 0.58 to 0.65 for the subscales. Checklist reliability was 0.54. CONCLUSION: In this study, a summated analytic global rating demonstrated construct validity, as did 2 of the 4 scales measuring specific traits. In addition, the analytic global rating showed substantially higher internal consistency than did the checklists, a finding consistent with that seen in previous studies cited in the literature. Global ratings are an important element of OSCE measurement and can have good psychometric properties. However, OSCE researchers should clearly describe the type of global ratings they use. Further research is needed to define the most effective global rating scales.

Canada↗
PubMed2003

Validity and the OSCE.

In preparation for a celebration of '30 years of OSCEs' held during the 2002 meeting of the Association for Medical Education in Europe (AMEE), I was asked to discuss the question, 'Are OSCEs valid to assess competence?". My first instinct was to review work undertaken in ay countries by famous researchers such as Harden, Colliver, Rothman, van der Vleuten, Stillman, Tamblyn and others who have studied and written about the validity of OSCEs. I could then have reviewed the extensive literature produced in Canada by the Medical Council of Canada and in the United States by the Education Commission on Foreign Medical Graduates and National Board of Medical Examiners that has demonstrated the utility of large-scale OSCEs for certification and licensure. I might have tossed in a few papers from my own research on the validity of OSCEs in psychiatry. Indeed, it would have been relatively easy to marshal the medical education literature to answer the question 'Are OSCEs valid to assess competence' strongly in the affirmative. But the more I reflected on the question, the more I confronted concerns that have troubled me for some time. Specifically, I worry that our approaches to validity may themselves not be valid. In this paper, I review what I believe to be three serious problems with our current approaches to showing that 'the OSCE is valid' Let me begin by rethinking the question. What do we mean 'Is the OSCE valid for assessing competence' There are three important problems with this question. First, validity is a property of the application of a test, not of a test itself. Second, we cannot speak of validity without giving consideration to the context in which we use the test. And finally, the concept of validity flounders because the OSCE itself is an important agent in constructing the variables of performance that it is designed to measure. I shall consider each issue in turn.

Canada↗
PubMed2003

OSCE! Variations on a theme by Harden.

BACKGROUND: In 1979, Harden described the first objective structured clinical examination (OSCE). Harden's OSCE dramatically changed the assessment of professional competence because it used actors and choreographed scenarios to evaluate the performance of professional behaviours. ANALYSIS: Because of the intense focus on performance, OSCEs have had a powerful influence on doctor training and practice. However, the immediate psychometric characteristics of OSCEs rather than their performance effects have been the subject of most research. CONCLUSION: The time has come to undertake a sophisticated sociological investigation of how OSCEs affect medical practice, including the ways in which they shape doctor interaction with patients, families and other health professionals.

Clinical Competence↗
PubMed2002

The challenge of creating new OSCE measures to capture the characteristics of expertise.

PURPOSE: Although expert clinicians approach interviewing in a different manner than novices, OSCE measures have not traditionally been designed to take into account levels of expertise. Creating better OSCE measures requires an understanding of how the interviewing style of experts differs objectively from novices. METHODS: Fourteen clinical clerks, 14 family practice residents and 14 family physicians were videotaped during 2 15-minute standardized patient interviews. Videotapes were reviewed and every utterance coded by type including questions, empathic comments, giving information, summary statements and articulated transitions. Utterances were plotted over time and examined for characteristic patterns related to level of expertise. RESULTS: The mean number of utterances exceeded one every 10 s for all groups. The largest proportion was questions, ranging from 76% of utterances for clerks to 67% for experts. One third of total utterances consisted of a group of 'low frequency' types, including empathic comments, information giving and summary statements. The topic was changed often by all groups. While utterance type over time appeared to show characteristic patterns reflective of expertise, the differences were not robust. Only the pattern of use of summary statements was statistically different between groups (P < 0.05). CONCLUSIONS: Measures that are sensitive to the nature of expertise, including the sequence and organisation of questions, should be used to supplement OSCE checklists that simply count questions. Specifically, information giving, empathic comments and summary statements that occupy a third of expert interviews should be credited. However, while there appear to be patterns of utterances that characterise levels of expertise, in this study these patterns were subtle and not amenable to counting and classification.

Canada↗
PubMed2002

The effect of candidates' perceptions of the evaluation method on reliability of checklist and global rating scores in an objective structured clinical examination.

PURPOSE: Process-oriented global ratings, which assess "overall performance" on one or a number of domains, have been purported to capture nuances of expert performance better than checklists. Pilot data indicate that students change behaviors depending on their perceptions of how they are being scored, while experts do not. This study examines the impact of the students' orientation to the rating system on OSCE scores and the interstation reliability of the checklist and global scores. METHOD: A total of 57 third- and fourth-year medical students at one school were randomly assigned to two groups and performed a ten-station OSCE. Group 1 was told that scores were based on checklists. Group 2 was informed that performance would be rated using global ratings geared toward assessing overall competence. All candidates were scored by physician-examiners who were unaware of the students' orientations to the rating system and who used both checklists and global rating forms. RESULTS: A mixed two-factor ANOVA identified a significant interaction of rating form by group (F(1,55) = 5.5, p <.05), with Group 1 (checklist-oriented) having higher checklist scores but lower global scores than did Group 2 (oriented to global ratings). In addition, Group 1 had higher interstation alpha coefficients than did Group 2 for both global scores (0.74 versus 0.63) and checklist scores (0.63 versus 0.40). CONCLUSIONS: The interaction effect on total exam scores suggests that students adapt their behaviors to the system of evaluation. However, the lower reliability coefficients for both forms found in the process-oriented global-rating group suggest that an individual's capacity to adapt to the system of global rating forms is relatively station-specific, possibly depending on his or her expertise in the domain represented in each station.

Analysis of Variance↗