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F Daniel Duffy

Publications and source records attributed to F Daniel Duffy.

8 recordsLinked to original sources
PubMed2004

The role of physician specialty board certification status in the quality movement.

The Institute of Medicine's reports and discussions on quality of medical care have focused on a systems-based approach to quality improvement. Our objective is to summarize evidence and theory about the role of a physician's current board certification status in quality improvement. The first body of evidence includes the validity of board certification demonstrated by the testing process, the relationship of examination scores with other measures of physician competence, and the relationship between certification status and clinical outcomes. The second body of evidence involves the adaptation of error prevention theory to medical care. Patient safety is enhanced when problem-solving uses readily accessed habits of behavior, the same behavior necessary to achieve board certification. The third body of evidence, obtained through a Gallup poll, demonstrates that certification and maintenance of certification are highly valued by the public. The majority of respondents thought it important for physicians to be reevaluated on their qualifications every few years and that physicians should do more to demonstrate ongoing competence than is currently required by the profession. We conclude that a physician's current certification status should be among the evidence-based measures used in the quality movement.

Physician's Role↗
PubMed2004

A new model for accreditation of residency programs in internal medicine.

A renewed emphasis on clinical competence and its assessment has grown out of public concerns about the safety, efficacy, and accountability of health care in the United States. Medical schools and residency training programs are paying increased attention to teaching and evaluating basic clinical skills, stimulated in part by these concerns and the responding initiatives of accrediting, certifying, and licensing bodies. This paper, from the Residency Review Committee for Internal Medicine of the Accreditation Council for Graduate Medical Education, proposes a new outcomes-based accreditation strategy for residency training programs in internal medicine. It shifts residency program accreditation from external audit of educational process to continuous assessment and improvement of trainee clinical competence.

Accreditation↗
PubMed2004

Assessing competence in communication and interpersonal skills: the Kalamazoo II report.

Accreditation of residency programs and certification of physicians requires assessment of competence in communication and interpersonal skills. Residency and continuing medical education program directors seek ways to teach and evaluate these competencies. This report summarizes the methods and tools used by educators, evaluators, and researchers in the field of physician-patient communication as determined by the participants in the "Kalamazoo II" conference held in April 2002. Communication and interpersonal skills form an integrated competence with two distinct parts. Communication skills are the performance of specific tasks and behaviors such as obtaining a medical history, explaining a diagnosis and prognosis, giving therapeutic instructions, and counseling. Interpersonal skills are inherently relational and process oriented; they are the effect communication has on another person such as relieving anxiety or establishing a trusting relationship. This report reviews three methods for assessment of communication and interpersonal skills: (1) checklists of observed behaviors during interactions with real or simulated patients; (2) surveys of patients' experience in clinical interactions; and (3) examinations using oral, essay, or multiple-choice response questions. These methods are incorporated into educational programs to assess learning needs, create learning opportunities, or guide feedback for learning. The same assessment tools, when administered in a standardized way, rated by an evaluator other than the teacher, and using a predetermined passing score, become a summative evaluation. The report summarizes the experience of using these methods in a variety of educational and evaluation programs and presents an extensive bibliography of literature on the topic. Professional conversation between patients and doctors shapes diagnosis, initiates therapy, and establishes a caring relationship. The degree to which these activities are successful depends, in large part, on the communication and interpersonal skills of the physician. This report focuses on how the physician's competence in professional conversation with patients might be measured. Valid, reliable, and practical measures can guide professional formation, determine readiness for independent practice, and deepen understanding of the communication itself.

Clinical Competence↗
PubMed2003

The mini-CEX: a method for assessing clinical skills.

OBJECTIVE: To evaluate the mini-clinical evaluation exercise (mini-CEX), which assesses the clinical skills of residents. DESIGN: Observational study and psychometric assessment of the mini-CEX. SETTING: 21 internal medicine training programs. PARTICIPANTS: Data from 1228 mini-CEX encounters involving 421 residents and 316 evaluators. INTERVENTION: The encounters were assessed for the type of visit, sex and complexity of the patient, when the encounter occurred, length of the encounter, ratings provided, and the satisfaction of the examiners. Using this information, we determined the overall average ratings for residents in all categories, the reliability of the mini-CEX scores, and the effects of the characteristics of the patients and encounters. MEASUREMENTS: Interviewing skills, physical examination, professionalism, clinical judgment, counseling, organization and efficiency, and overall competence were evaluated. RESULTS: Residents were assessed in various clinical settings with a diverse set of patient problems. Residents received the lowest ratings in the physical examination and the highest ratings in professionalism. Comparisons over the first year of training showed statistically significant improvement in all aspects of competence, and the method generated reliable ratings. CONCLUSIONS: The measurement characteristics of the mini-CEX are similar to those of other performance assessments, such as standardized patients. Unlike these assessments, the difficulty of the examination will vary with the patients that a resident encounters. This effect is mitigated to a degree by the examiners, who slightly overcompensate for patient difficulty, and by the fact that each resident interacts with several patients. Furthermore, the mini-CEX has higher fidelity than these formats, permits evaluation based on a much broader set of clinical settings and patient problems, and is administered on site.

Clinical Competence↗
PubMed2003

The teaching of chest auscultation during primary care training: has anything changed in the 1990s?

OBJECTIVE: To survey the teaching time and importance given to cardiopulmonary auscultation during internal medicine (IM) and family practice (FP) residencies, and to compare current practices to those of the early 1990s. DESIGN: A nationwide mail survey of IM and FP program directors (PDs). SETTING: All Accreditation Council for Graduate Medical Education-accredited IM and FP residencies. PARTICIPANTS: A total of 538 of 939 PDs (57.5%). MEASUREMENTS AND MAIN RESULTS: In contrast to the early 1990s, when there had been no significant difference in teaching practices between IM and FP programs, more IM than FP residencies taught cardiopulmonary auscultation in 1999 (cardiac auscultation: IM residencies, 48%; FP residencies, 29.2% [p < 0.001]; pulmonary auscultation: IM residencies, 23.7%; FP residencies, 12.2% [p < 0.001]). Across the decade there also had been a significant increase in the percentage of IM programs offering structured education in chest auscultation (cardiac auscultation increase, 27.1 to 48% [p < 0.001]; pulmonary auscultation increase, 14.1 to 23.7% [p < 0.02]), but no significant changes for FP residencies. IM PDs gave more clinical importance to auscultation and expressed a greater desire for expanded teaching than did their counterparts in FP programs. CONCLUSIONS: This study indicates a significant gain over the last decade in the percentage of IM residencies offering structured teaching of cardiopulmonary auscultation. This same gain did not occur for FP programs. Whether these differences in attitudes and teaching practices will translate into improved auscultatory proficiency of IM trainees will need to be determined.

Auscultation↗