Biomedical subjects

C Ringsted

Publications and source records attributed to C Ringsted.

At least 19 recordsLinked to original sources

PubMed2006

Person-task-context: a model for designing curriculum and in-training assessment in postgraduate education.

Structured curricula for senior house officers have often been lacking. The aim of this study was to trial a person-task-context model in designing a curriculum and in-training assessment (ITA) programme for SHOs in internal medicine. A working group designed the programme based on triangulation of information from interviews with trainees and programme directors, analysis of patient case mix and national quality assurance data. The interview data showed that the main difference currently between trainee levels was in expected degree of responsibility for patient management rather than in actual tasks. Key learning needs were how to take a structured approach to the tasks and get an overview of situations. SHOs expressed a need for explicit learning goals and standards of performance. SHOs requested formal teaching in non-medical aspects of competence such as communication, interpersonal skills and professionalism. This article points out how consideration of the type of trainees involved, the tasks they must do and learn, and the context in which they work are important in designing postgraduate curricula. The person-task-context model can be used to tailor curricula and ITA that support learning and may be especially beneficial in promoting learning in non-dominant areas of a specialty.

Curriculum↗

PubMed2004

Educational impact of in-training assessment (ITA) in postgraduate medical education: a qualitative study of an ITA programme in actual practice.

OBJECTIVES: To investigate the experiences and opinions of programme directors, clinical supervisors and trainees on an in-training assessment (ITA) programme on a broad spectrum of competence for first year training in anaesthesiology. How does the programme work in practice and what are the benefits and barriers? What are the users' experiences and thoughts about its effect on training, teaching and learning? What are their attitudes towards this concept of assessment? METHODS: Semistructured interviews were conducted with programme directors, supervisors and trainees from 3 departments. Interviews were audiotaped and transcribed. The content of the interviews was analysed in a consensus process among the authors. RESULTS: The programme was of benefit in making goals and objectives clear, in structuring training, teaching and learning, and in monitoring progress and managing problem trainees. There was a generally positive attitude towards assessment. Trainees especially appreciated the coupling of theory with practice and, in general, the programme inspired an academic dialogue. Issues of uncertainty regarding standards of performance and conflict with service declined over time and experience with the programme, and departments tended to resolve practical problems through structured planning. DISCUSSION: Three interrelated factors appeared to influence the perceived value of assessment in postgraduate education: (1) the link between patient safety and individual practice when assessment is used as a licence to practise without supervision rather than as an end-of-training examination; (2) its benefits to educators and learners as an educational process rather than as merely a method of documenting competence, and (3) the attitude and rigour of assessment practice.

Anesthesiology↗

PubMed2003

Implementation of a formal in-training assessment programme in anaesthesiology and preliminary results of acceptability.

BACKGROUND: A new reform on postgraduate education in Denmark requires a formal in-training assessment in all specialties. The aim of this study was to survey the implementation and acceptability of the first example of a nation-wide in-training assessment programme for first-year trainees in anaesthesiology developed by a working group under the Danish Society of Anaesthesiology and Intensive Care Medicine. METHODS: A questionnaire about the implementation of the programme in practice and the characteristics of the trainees was sent to the educational responsible consultant (ERC) in each of the 26 anaesthetic departments in the country with first-year trainees in anaesthesiology. Standard evaluations of the assessment programme were regularly collected from trainees. RESULTS: Twenty-five (96%) departments returned the questionnaire. In total the departments reported on 100 trainees and 83 of these had been enrolled in the programme. Thirteen departments reported in total on 27 trainees who had completed their first year of training and these departments had applied a median 21 (range 17-21) of the 21 tests included in the entire programme. Time constraints and resistance among senior clinicians were the most frequently cited barriers to implementation. Evaluations from trainees showed a generally positive attitude towards most of the programme. They especially praised the programme's effect on structuring training and having a positive effect on learning. CONCLUSION: The in-training assessment programme has been widely implemented across the country. The majority of the programme was acceptable to trainees and had a positive effect on structuring training and on fostering learning.

Anesthesiology↗

PubMed2003

Embracing the new paradigm of assessment in residency training: an assessment programme for first-year residency training in anaesthesiology.

Assessment of clinical competence is facing a paradigm shift in more than one sense. The shift relates to test content, which increasingly covers a broader spectrum of competences than mere medical expertise, and to test methods, with an increasing focus on testing performance in realistic settings. Also there is a shift in the concept of assessment in that instruction and assessment are no longer seen as being separate in time and purpose, but as integral parts of the learning process. The nature of the new paradigm for assessment is well described but the challenge to programme directors is to specify the evaluation situations and develop appropriate methods. This paper describes the intrinsic rational validation process in outlining an assessment programme for first-year anaesthesiology residency training according to the new paradigm. The applicability to other residency programmes and higher-level training in anaesthesiology is discussed.

Anesthesiology↗

PubMed2003

A feasibility study comparing checklists and global rating forms to assess resident performance in clinical skills.

This study evaluated the feasibility of two different scoring forms for assessing the clinical performance of residents in anaesthesiology. One of the forms had a checklist format including task-specific items and the other was a global rating form with general dimensions of competence including 'clinical skills', 'communication skills' and 'knowledge'. Thirty-two clinicians representing 25 (83%) of the 30 training hospitals in the country participated in the study. The clinicians were randomized into two groups, each of which used one of the scoring formats to assess a resident's performance in four simulated clinical scenarios on videotape. Clinicians' opinions about the appropriateness of the scoring forms were rated on a scale of 1-5. The checklist format was rated significantly higher compared with the global rating form (mean 4.6, 0.5 vs. mean 3.5, 1.4, p < 0.001). The inter-rater agreement regarding pass/fail decisions was poor irrespective of the scoring form used. This was explained by clinicians' leniency as assessors rather than by lack of vigilance in the observations or disagreements on standards for good performance.

Anesthesiology↗

PubMed2002

Consultants' opinion on a new practice-based assessment programme for first-year residents in anaesthesiology.

BACKGROUND: Assessment in postgraduate education is moving towards using a broad spectrum of practice-based assessment methods. This approach was recently introduced in first-year residency in anaesthesiology in Denmark. The new assessment programme covers: clinical skills, communication skills, organizational skills and collaborative skills, scholarly proficiencies and professionalism. Eighteen out of a total of 21 assessment instruments were used for pass/fail decisions. The aim of this study was to survey consultants' opinions of the programme in terms of the representativeness of competencies tested, the suitability of the programme as a basis for pass/fail decisions and the relevance and sufficiency of the content of the different assessment instruments. METHODS: A description of the assessment programme and a questionnaire were sent to all consultants of anaesthesiology in Denmark. The questionnaire consisted of items, to be answered on a five-point scale, asking the consultants' opinions about representativeness, suitability and content of the programme. RESULTS: The response rate was 251/382 (66%). More than 75% of the respondents agreed that the assessment programme offered adequate coverage of the competencies of a first-year resident and was appropriate for making pass/fail decisions. There was strong agreement that the content of the 18 tests used for pass/fail decisions was relevant and sufficient for pass/fail decisions. CONCLUSION: Judging from the consultants' opinions, the assessment programme for first-year residency in anaesthesiology appears to be appropriate regarding the range of competencies assessed, the appropriateness as a basis for pass/fail decisions, and regarding the content of the tests used for pass/fail decisions. Further studies are needed to assess the feasibility and acceptability of the programme in practice.

Anesthesiology↗

PubMed1992

Anaesthetic practice and postoperative pulmonary complications.

The aim of this study was to identify risk factors associated with postoperative pulmonary complications. The influence of the anaesthetic technique was evaluated (i.e. general contra regional anaesthesia and long contra intermediately acting muscle relaxants (pancuronium and atracurium)) taking into account the patient's age, the presence or absence of chronic obstructive lung disease (preoperative risk factors), the type of surgery and the duration of anaesthesia (perioperative risk factors). Seven thousand and twenty-nine patients undergoing abdominal, urological, gynaecological or orthopaedic surgery were included in the study. A total of 290 patients (4.1%) suffered from one or more postoperative pulmonary complications. Six thousand and sixty-two patients received general anaesthesia and 4.5% of these had postoperative pulmonary complications. Of the patients admitted to major surgery receiving pancuronium, 12.7% (135/1062) developed postoperative pulmonary complications, compared to only 5.1% (23/449) receiving atracurium (P < 0.05). When stratified for type of surgery and duration of anaesthesia, conventional statistics showed no difference between pancuronium and atracurium as regard postoperative pulmonary complications. However, a logistic regression analysis indicated that long-lasting procedures involving pancuronium entailed a higher risk of postoperative pulmonary complications than did other procedures. In patients having regional anaesthesia, only 1.9% (18/967) developed postoperative pulmonary complications (P < 0.05 compared to general anaesthesia). However, when stratified for type of surgery there was a significantly higher incidence of postoperative pulmonary complications only in patients undergoing major orthopaedic surgery under general anaesthesia, 11.5% compared to 3.6% in patients given a regional anaesthesia.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

Pulmonary vasodilatation and augmentation of right ventricular function following terbutaline infusion in severe chronic pulmonary disease.

Twenty patients with a median age of 61 years and a median forced expired volume in 1 s (FEV1) after bronchodilating therapy of 0.55 l were studied in order to measure the effect of intravenous terbutaline on bronchial tone, cardiac function, pulmonary haemodynamics, gas exchange, and oxygen transport capacity during rest and in 10 patients during exercise. Terbutaline infusion during rest resulted in an increase in heart rate from 84 to 103 beats min-1 (P less than 0.01), a decrease in mean systemic arterial pressure from 95 to 80 mmHg (P less than 0.02), an unchanged mean pulmonary arterial pressure (18 mmHg), an increase in cardiac index from 2.89 to 3.86 l min-1 m-2 (P less than 0.01), an increase in right ventricular ejection fraction from 45 to 53% (P less than 0.01), an increase in left ventricular ejection fraction from 63 to 67% (NS), an unchanged arterial oxygen tension, and an increase in calculated oxygen delivery from 533 to 638 ml O2 min-1 m-2 (P less than 0.01). During exercise terbutaline infusion resulted in an increase in heart rate from 108 to 120 beats min-1 (P less than 0.05), a decrease in mean systemic arterial pressure from 117 to 106 mmHg (P less than 0.01), a decrease in mean pulmonary arterial pressure from 29 to 22 mmHg (P less than 0.01), an increase in cardiac index from 4.53 to 4.64 min-1 m-2 (NS), an unchanged arterial oxygen tension, and an increase in the calculated oxygen delivery from 834 to 856 ml O2 min-1 m-2 (NS). It was concluded that terbutaline augments right ventricular function: increases right ventricular ejection fraction and decreases right ventricular end-diastolic volume, and further decreases pulmonary vascular resistance without decreasing arterial oxygen tension, and increases oxygen delivery in patients with chronic pulmonary disease during rest and exercise.

Aged↗

PubMed1990

Positive correlation between 'the arterial oxygen extraction tension' and mixed venous pO2 but lack of correlation between 'the oxygen compensation factor' and cardiac output in 38 patients.

pH and blood gases were measured in simultaneous samples of arterial blood from the radial artery and mixed venous blood from the pulmonary artery using an ABL300 and OSM3 (Radiometer A/S, Denmark). Cardiac output was measured by thermodilution. The patients were suffering from chronic obstructive pulmonary disease or adult respiratory distress syndrome. The data indicate that patients respond to a decreased arterial oxygen availability by allowing the mixed venous pO2 to fall rather than by increasing the cardiac output to maintain a normal mixed venous pO2. In other words, the arterial oxygen extraction tension and the oxygen compensation factor were both highly correlated to the mixed venous pO2 but unrelated to the cardiac index. For this reason the arterial oxygen extraction tension appears to be a more relevant parameter of the overall arterial oxygen availability than the oxygen compensation factor. Comparison of the arterial and mixed venous data confirms the accuracy of the Oxygen Status Algorithm for calculating the various oxygen parameters, including the p50, the estimated 2,3-diphosphoglycerate concentration, and the estimated physiological shunt, on the basis of a single arterial blood sample.

2,3-Diphosphoglycerate↗

PubMed1989

Right and left ventricular performance during endotoxin-induced pulmonary hypertension in sheep.

We investigated right and left ventricular performance by radionuclide angiocardiography in anaesthetized and instrumented sheep following a (1.5 micrograms/kg) sublethal Escherichia coli endotoxin infusion. Six animals served as controls and five were pre-treated with intravenous Ibuprofen (12 mg/kg). In control sheep an acute five-fold increase of pulmonary vascular resistance (PVR) resulted in a significant decrease of right ventricular ejection fraction (RVEF) and stroke volume. Left ventricular ejection fraction (LVEF) was unchanged as was pulmonary capillary wedge pressure (PCWP). The calculated right and left ventricular end-diastolic volumes (RVEDV; LVEDV) changed significantly in opposite directions during the acute increase of PVR. Right ventricular end-diastolic pressure increased significantly paralleled by an increase of RVEDV. The decrease of LVEDV with an unchanged PCWP suggested a decrease of left ventricular compliance. Pre-treatment with Ibuprofen resulted in complete cardiovascular stability after endotoxin.

Animals↗

PubMed1988

Ventilation-perfusion inequality during endotoxin-induced pulmonary vasoconstriction in conscious sheep: mechanisms of hypoxia.

In sheep low-dose endotoxin infusion causes transient thromboxane-mediated pulmonary vaso- and bronchoconstriction. These changes are paralleled by a decrease of arterial PO2. To elucidate the mechanisms of hypoxia we analysed ventilation-perfusion (VA/Q) distributions by the multiple inert gas elimination technique before and after endotoxin infusion in six conscious sheep. We found that hypoxia after endotoxin could be explained by both a VA/Q inequality and a simultaneous decrease in the mixed venous oxygen tension. The latter was due to a decrease of cardiac output. True shunt did not contribute to hypoxia as it was unchanged.

Animals↗

PubMed1986

Prognosis in treated hypertension.

The aim of this study has been to demonstrate to what extent antihypertensive treatment reduces the survival gap between hypertensives and the general population. In 673 outpatients treated for arterial hypertension, the 10-year survival has been assessed by actuarial methods and compared with expected survival of a matched background population computed from the life tables of the Danish population. In primary hypertension WHO stage I, survival did not differ from that of the background population, a congruence which of course may be a mere chance but excludes any major difference. However, when severe organ involvement was present, as in WHO stage III and renal hypertension, treatment did not eliminate the survival gap. The survival rate did not differ between sexes or between patients with high and low body mass, but decreased with increasing age. Myocardial infarction was the most frequent single cause of death, whereas stroke accounted for less than 10% of all fatalities.

Adolescent↗

PubMed1985