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Biomedical subjects

J R Lough

Publications and source records attributed to J R Lough.

17 recordsLinked to original sources
PubMed2001

Audit and summative assessment: a completed audit cycle.

OBJECTIVE: To develop and test a system for delivering a completed audit cycle for summative assessment of general practitioner registrars in the United Kingdom. DESIGN: A trainer-based questionnaire on criteria for a completed audit cycle, followed by two marking exercises of audit projects submitted by general practice registrars. SETTING: Training practices in the West of Scotland between 1997 and 1998. SUBJECTS: Trainers and registrars in the above practices. RESULTS: 116 (89%) agreed that two collections of data were an essential or desirable part of an audit project. All 57 registrars who started in August 1997 successfully completed an audit cycle, seven (12%) after resubmission. Using two rather than three independent assessors to screen the projects, the marking instrument was shown to have a sensitivity of 95% (95% confidence interval (CI) +/-3.9%) and a specificity of 77% (95% CI +/-7.5%). All assessors found the new system easier to mark and 47 registrars (87%) found completing an audit cycle as or easier than expected. CONCLUSION: Evidence from the pilot project has shown that a general practice registrar's ability to review and critically analyse a piece of his/her work, with appropriate management of any necessary change, can be tested feasibly by means of a completed audit cycle within the registrar year. The process retains adequate levels of sensitivity and specificity and requires fewer assessors for marking the projects.

Clinical Competence↗
PubMed1999

Supporting practice-based audit: a price to be paid for collecting data.

BACKGROUND: There has been considerable investment by health authorities in the funding of support staff whose job is to collect data for audit purposes. It is important to understand what costs are involved in such a data collection exercise. The cost advantages of using existing practice staff or externally funded staff are not known. AIM: To assess the cost of transposing data on workload to computer software for audit purposes and retrieving data on five chronic diseases from case records. METHOD: Four audit support staff monitored the time taken to collect specific data as part of a broad audit programme in 12 training practices within one health board area in the West of Scotland in 1997. The time taken was used to estimate comparative costs for using a receptionist or practice nurse for carrying out a similar exercise. RESULTS: Average costs for collecting data per 1000 patients for waiting time, appointments, recall, and telephone audits were 5.24 Pounds for reception staff, 5.64 Pounds for audit support staff, and 9.68 Pounds for a practice nurse. The average cost for collecting data per patient with diabetes, asthma, epilepsy, hypertension, or rheumatoid arthritis was 1.48 Pounds for reception staff, 1.60 Pounds for audit support staff, and 2.74 Pounds for a practice nurse. CONCLUSIONS: The cost of collecting data varies considerably depending on which staff are chosen for the purpose. Practices should consider carefully how best to collect data for audit in terms of cost.

Allied Health Personnel↗
PubMed1997

Audit and summative assessment: system development and testing.

Registrars in general practice have to submit an audit project as one of four parts of summative assessment. A criterion-referenced marking schedule has been developed in the West of Scotland, consisting of five independent criteria all of which have to be judged above minimum competence to pass. A system was developed to test the instrument using a marking exercise which calculated the sensitivity and specificity of the assessment process, for different combinations of assessors. One hundred and two registrar audit projects were then assessed by three independent assessors. Ninety-two (90%) passed and 10 projects (10%) were referred back to the registrar as being below minimum competence. After resubmission six projects (6%) passed, two projects (2%) were still below minimum competence, and two (2%) were not resubmitted. A referral process for assessing the audit projects of general practice registrars has been developed to maximize the opportunity of finding a project below minimum competence.

Education, Medical, Graduate↗
PubMed1997

Training for audit: lessons still to be learned.

BACKGROUND: Audit is a criterion for training in general practice, and registrars are reliant on their trainers' teaching of basic audit methods. Their ability to teach this had been assumed, but registrars' projects submitted as part of summative assessment offered an opportunity to test this. AIM: To test trainers' knowledge of basic audit methods. Their knowledge was based on an ability to recognize key audit criteria using a marking schedule that they had helped to create. METHOD: All 158 trainers in the west of Scotland were asked to mark five general practice registrar audit projects using a marking schedule consisting of five independent criteria. Each project had one criterion that was below a level of minimum competence, as agreed by a group of 'expert' assessors. RESULTS: A total of 114 trainers (72%) completed the marking exercise of five audit projects. Three (3%) correctly identified the five criteria that were below minimum competence. They did this by highlighting many other criteria not below minimum competence. For all trainers, there was a direct relationship between the number of criteria they correctly identified as being below minimum competence and the total number of other criteria that they incorrectly identified. CONCLUSION: Trainers are failing to recognize basic audit methodology using a marking schedule they themselves helped to design. This has implications for their ability to teach audit to their registrars and may explain some of the difficulty in implementing audit.

Education, Medical, Continuing↗
PubMed1997

Teaching audit--lessons from summmative assessment.

In 1995 and 1996, 9% of registrars in the West of Scotland failed to demonstrate minimum competence in their audit project for summative assessment. Adverse trainer advice was implicated. This study set out to assess trainers' and registrars' confidence with audit teaching, the methods of teaching audit, and the perceived needs of both groups.

Education, Medical, Graduate↗
PubMed1997

Summative assessment.

Explore the source record for details and available documents.

Education, Medical, Graduate↗
PubMed1995

Audit: trainers' and trainees' attitudes and experiences.

Little is known about the audit activity taking place among general practitioners as part of their vocational training. All 155 trainers and their trainees in the West of Scotland were asked about their attitudes to and their experiences of audit. Two hundred and thirty-five replies were received from 310 questionnaires sent, giving an 85% response from trainers and 67% from trainees. Both trainers and trainees had positive attitudes to audit with regard to its use: for assessing work (87% of trainers, 97% trainees); as an appropriate use of resources (92% of trainers, 78% of trainees); as an appropriate use of time (91% trainers, 76% trainees); in improving patient care (96% of trainers, 76% of trainees). Most trainers (90%) and 52% of trainees had started collecting data with a view to starting an audit, 56% of trainers and 23% of trainees had personally set a standard and 54% of trainers but only 12% of trainees had completed a cycle of audit. Despite very positive attitudes to audit there is a problem completing a cycle of audit, particularly among trainees. They will thus be denied the benefit of negotiating and evaluating change as part of their training, skills which will be necessary to ensure a lifelong awareness of the quality of care they are providing.

Attitude of Health Personnel↗
PubMed1995

Audit and summative assessment: two years' pilot experience.

An audit project has been submitted by all trainees in the West of Scotland since 1992 as part of a pilot process for summative assessment. The impact of 2 consecutive years of audit was assessed on 117 trainees in May 1994. A response rate of 89% was achieved. For 82 trainees (79%) this was their first practical experience of audit and as a result of it 85% felt more confident in introducing change to their next practice. Protected time was still a problem for the majority (53%) and one-third wanted more help from their trainer. Thirty trainees (29%) had attended four or fewer formal practice meetings in their 10 months of training, with 10% never having attended one. The previous trainee's audit project was rarely or never discussed with 70 trainees (87%) and only 12 trainees were evaluating changes recommended. An audit project as part of summative assessment may be encouraging trainees to think about change after they leave their training practices. Few, however, are evaluating change and protected time and support are still required. The marking of the summative assessment audit project may need to address this.

Education, Graduate↗
PubMed1995

General practitioner trainees' experience of undertaking audit projects: preliminary report from the west of Scotland region.

BACKGROUND: Departments of general practice increasingly provide formal teaching in audit. However, little is known about audit projects carried out by trainees in general practice. AIM: A study was undertaken to ascertain general practitioner trainees' experience of undertaking an audit project in the trainee year, with reference to their understanding of audit theory, perceived usefulness of the project in enhancing clinical knowledge, time taken to do the audit and practice team involvement in the project. METHOD: All 104 trainees in the west of Scotland region completing their trainee year on 31 July 1993 were sent a postal questionnaire that month. The replies to the questionnaire were analysed and compared with the audit project that each trainee had submitted in June 1993 as part of a pilot project for summative assessment. RESULTS: Responses were received from 103 trainees (99%). Seventy trainees (68%) felt strongly that their audit project was relevant to patient care but only 31 (30%) felt strongly that the project was a useful way of enhancing clinical knowledge of the disease process. Data collection was the most time consuming aspect of the audit project, 23% of trainees reporting taking a day or more to complete this stage. Trainees who chose their own audit project were more likely to complete two sets of data collection than those who had not chosen their own project. Seventy nine trainees (77%) indicated that trainers had been involved in their project and 51 trainees indicated that one of the other practice partners had been involved in their project. CONCLUSION: Performing an audit as a trainee is feasible in the time limit of the one year in general practice. The educational benefit appears to be limited to the knowledge of audit process, rather than to clinical knowledge. Audit projects of relevant size and complexity, involving appropriate members of the practice team, are to be encouraged, as is the development of an instrument for assessing trainee audit.

Education, Medical, Continuing↗
PubMed1995

Audit and summative assessment: a criterion-referenced marking schedule.

BACKGROUND: 1996 will see the introduction of summative assessment of general practitioner registrars (trainees). One part of this assessment is the written submission of practical work. In the west of Scotland, audit projects have been chosen as the format for practical work. A valid and reliable marking schedule for such projects is needed. AIM: A study was undertaken to develop a criterion-referenced marking schedule for assessing registrars' audit projects for summative assessment. METHOD: Medical and non-medical professionals, in a series of workshops, compiled a list of essential elements of good audit. These features were tested and refined using registrars' audit projects. All trainers in the west of Scotland were then sent a list of 14 criteria and asked to indicate whether each criterion was an essential or desirable component of a registrar's audit project for summative assessment. A final workshop was held to develop an audit marking schedule. RESULTS: Of 155 trainers in the west of Scotland, 135 replied to the list of criteria for registrar audit projects (87%). Ten criteria were deemed essential or desirable by 80% or more of the respondents. Participants in the final workshop selected five criteria which would form the audit project marking schedule for registrars undergoing summative assessment. These were: defined reason for choice of audit project, relevance of criteria chosen, appropriate preparation and planning, appropriate interpretation of relevant data and detailed proposals for change. For an audit project to pass assessment all five criteria must be present. CONCLUSION: A criterion-referenced approach to assessing registrars' audit projects, developed from their trainers' opinions of essential or desirable criteria for good audit, is described. Further evaluation of the criterion-referenced marking schedule is required.

Educational Measurement↗
PubMed1988

A comparison of felodipine and propranolol as additions to hydrochlorothiazide in the treatment of hypertension.

Eighty one patients with uncomplicated hypertension who required additional antihypertensive medication (diastolic Phase V [dBP] greater than or equal to 95 mm Hg) after 4 weeks treatment with hydrochlorothiazide (HCTZ) 25 mg o.m. were randomized to receive felodipine 5 mg b.i.d. (n = 40) or propranolol (n = 41) 80 mg b.i.d. in addition to HCTZ 25 mg o.m. If the dBP measured about 12 h post-dose was not less than or equal to 90 mm Hg after 4 weeks, the dose of felodipine or propranolol was doubled. The double blind trial period was 8 weeks for all patients. Over the 8 week period, felodipine reduced the seated dBP from 100 to 83 mm Hg and propranolol from 101 to 86 mm Hg. The attained seated dBPs were significantly different in the two groups. About one third of patients in each group received the high dose of second-line therapy. After 8 weeks 91% of patients receiving HCTZ+felodipine and 84% receiving HCTZ+propranolol had a dBP less than or equal to 90 mm Hg. Both regimens were well-tolerated with an equal incidence but different pattern of adverse events (felodipine: flushing, headache and peripheral oedema; propranolol: dyspepsia, fatigue and vasospasm). In this 8-week study, felodipine and propranolol were safe and effective second-line antihypertensive drugs when added to hydrochlorothiazide. At the doses selected, felodipine was at least as effective as propranolol.

Adult↗
PubMed1986

A psychiatric study of idiopathic oedema.

Twenty-five women with idiopathic oedema and twenty-five women attending gynaecology clinics were assessed by means of a standardised psychiatric interview, an interview on dietary habits, and a specially designed interview on current health. The patients with idiopathic oedema were significantly more depressed and anxious, with a trend towards widespread neurotic symptoms. There was no evidence that diuretic or laxative abuse is an important aetiological factor. In many patients with idiopathic oedema excessive fluid retention may be related to the neuroendocrine abnormalities associated with psychiatric illness.

Adult↗