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Biomedical subjects

J Foulkes

Publications and source records attributed to J Foulkes.

At least 19 recordsLinked to original sources
PubMed2001

Spontaneous, elicited and cued causal attributions in the year following a first myocardial infarction.

OBJECTIVES: To assess myocardial infarction (MI) patients' causal beliefs, how they change over time and the effects of different assessment methods. METHOD: The study used a longitudinal design with a follow-up to 1 year. The participants were 100 MI patients who were recruited within 72 hours of admission. Each participant was interviewed and their causal attributions (spontaneous, elicited and cued) were assessed using four different methods. RESULTS: 'Stress', 'smoking', 'it is in the family', 'eating fatty foods' and 'work' items were the most commonly mentioned causes for the MI at all times of measurement and across all measures. On each occasion 'stress' and 'smoking' were selected as the most important causes and patients made fewer attributions over time. Finally, the attributional assessment method used did not affect type of attributions but fewer attributions were reported using the spontaneous method. CONCLUSION: Patients do provide causal attributions following an MI. While many are similar to causal factors identified by medicine, patients appear to place more emphasis on 'stress'. As predicted by attribution theory, attributions changed over time. The method of obtaining the attributions does not appear to affect the attributions made but greatly affects their number. While all the methods used have their place, the cued method with a list of possible attributions offers a rich return for effort expended.

Journal Article↗
PubMed2001

The General Medical Council's Performance Procedures: the development and implementation of tests of competence with examples from general practice.

OBJECTIVE: This paper describes the development of the tests of competence used as part of the General Medical Council's assessment of potentially seriously deficient doctors. It is illustrated by reference to tests of knowledge and clinical and practical skills created for general practice. SUBJECTS AND TESTS: A notional sample of 30 volunteers in 'good standing' in the specialty (reference group), 27 practitioners referred to the procedures and four practitioners not referred but who were the focus of concern over their performance. Tests were constructed using available guidelines and a specially convened working group in the specialty. METHODS: Standards were set using Angoff, modified contrasting group and global judgement methods, as appropriate. RESULTS: Tests performed highly reliably, showed evidence of construct validity, intercorrelated at appropriate levels and, at the standards employed, demonstrated good separation of reference and referred groups. Likelihood ratios for above and below standard performance based on competence were large for each test. Seven of 27 doctors referred were shown not to be deficient in both phases of the performance assessment.

Adult↗
PubMed2000

Assessing validity in written tests of general practice - exploration by factor analysis of candidate response patterns to paper 1 of the MRCGP examination.

OBJECTIVE: To investigate the content validity of Paper 1 of the MRCGP examination. METHOD: Exploratory factor analysis was carried out on candidate responses to Paper 1 of the May and October MRCGP examination in 1998. Contribution of each test question across factors was assessed using a pattern matrix of the oblique rotation. Common dimensions and variations between factor sets were identified. Key testing areas were then matched against the 'domains of competence' intended to be assessed by Paper 1 (as defined within the examination blueprint matrix). RESULTS: Whilst critical appraisal, disease prevention/evidence-based medicine and clinical management emerged as areas tested consistently, content variation was observed between factor sets extracted from both sittings. In addition, some overlap, in terms of domains tested, was seen among other assessment instruments used within the examination. CONCLUSION: Paper 1 conforms to the majority of its stated intentions. However, further development of techniques for investigating validity will be required in order to minimize content variation between both sittings of the examination as well as to help more closely define areas of competence to be tested by Paper 1 of the MRCGP examination.

Education, Medical, Undergraduate↗
PubMed1998

ABS to MRCS at the RCS: philosophy, format and future.

After considering the ABS and CSiG parts of the FRCS examination and the standard for the new MRCS examination, it became important that the MRCS evolved away from the template of multiple true-false questions. Formats other than true-false questions can be used to test mental processes that are not simple factual recall. Formal mathematical tests can be evolved to equate different parts of the examination so that raw marks can be more clearly related to grades. Dispensing with the arbitrary requirement for five items in an MCQ question will enable better questions to be asked. Finally, an examination must be valid in context. With the above advances the examination will be effective, but its goal can be assessed only if the vision of the MRCS learning course is attained. The course aims to prepare surgeons for higher surgical training with a good general knowledge of surgery and an in-depth knowledge of the basic principles of surgery. The surgical trainee who has attained the MRCS should be able to manage a sick patient who suffers from the complications associated with surgery by using the principles of surgical anatomy, physiology and pathology. The trainee should know what to do initially during the 'golden hour' of opportunity, whom to call for help, and when.

Education, Medical, Graduate↗
PubMed1998

Simulated surgery in the summative assessment of general practice training: results of a trial in the Trent and Yorkshire regions.

BACKGROUND: General practice registrars are now required to undertake a summative assessment of their consulting skills. Simulated surgeries have been developed as an alternative to the existing method of assessing video-recorded consultations. AIM: To evaluate the simulated surgery assessment method, developed in the General Practice Postgraduate Education Department in Leicester, for use in assessing general practice consultation skills. METHOD: General practice registrars in Leicester performed two eight-patient simulated surgeries separated by four weeks. Assessment outcomes were compared to demonstrate the consistency of the method. Pilot surgeries in Yorkshire were videotaped, and then rated by video-raters trained for summative assessment. RESULTS: The method consistently identified those registrars who were competent and those who were not yet competent in consulting skills. It proved acceptable to candidate doctors and has fewer resource requirements for both examiners and candidates than other consulting skills assessment methods. CONCLUSION: The method developed in Leicester and successfully transferred to Yorkshire is feasible on a large scale, and offers an acceptable alternative to other consulting skills assessment methods. In this study it consistently identified competent from incompetent candidate doctors.

Clinical Competence↗
PubMed1990

The regulation of transcription of the gerA spore germination operon of Bacillus subtilis.

The gerA operon of Bacillus subtilis 168 comprises three genes concerned with the triggering of spore germination by L-alanine and its analogues. The expression of this operon has been characterized using chromosomal lacZ fusions to the gerA promoter. The gerA promoter is switched on 2.5-3 hours after the initiation of sporulation, in parallel with glucose dehydrogenase. A high proportion of the gerA-driven beta-galactosidase detected in sporulating cells is found in the mature spore; the gerA promoter is therefore active in the forespore compartment of the sporulating cell. The gerA promoter is not expressed in spoO, spoII or spoIIIA, B, E and G mutant backgrounds, but is expressed in spoIIIC and D and in spoIV and V mutants. The in vivo transcriptional startpoint of the operon has been mapped by primer extension experiments; sequences upstream from this startpoint show significant homology with recognition sequences for RNA polymerase containing sigma G (E sigma G). The gerA operon was transcribed in vitro by E sigma G with a startpoint identical to that used in vivo, and expression of the gerA operon was rapidly induced in vegetative cells by induction of sigma G synthesis. These data indicate that the gerA operon is an additional member of the sigma G regulon, which includes a number of genes expressed in parallel only in the forespore compartment of sporulating B. subtilis cells.

Bacillus subtilis↗
PubMed1985

Effects of sterilization on menstruation.

We surveyed 551 women more than a year after they or their husbands had had a sterilization operation. According to menstrual data from before and after the operation, a much greater proportion of women who had been sterilized had longer periods after the operation than before, but so did women whose husbands had had a vasectomy. Women who had taken an oral contraceptive before operation, had more days of bleeding and heavier bleeding than women who had been using other methods of contraception; those who had an intrauterine device removed had fewer days of bleeding after the sterilization operation. Discontinuing the previous contraception probably had a greater effect on menstruation than had the operation, for the effect was the same for those who had sterilization and the women whose husbands had an operation.

Contraception↗
PubMed1976

Long-term effects of laparoscopic sterilization on menstruation.

The menstrual changes after laparoscopic sterilization were assessed in 200 women and compared with changes after conventional tubal ligation. About one third of the patients after laparoscopy had longer and heavier periods, but those women who were using oral contraception before operation fared worst. The reason for the menstrual changes may not be due to operation alone. There was no significant difference between laparoscopy and laparotomy in terms of increase in heavy bleeding or number of days of bleeding.

Contraceptives, Oral↗