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Biomedical subjects

James A Clardy

Publications and source records attributed to James A Clardy.

7 recordsLinked to original sources
PubMed2004

Demonstration of portfolios to assess competency of residents.

Residency educators are identifying approaches to measure resident competence. Portfolios are well suited since they require work already completed as part of patient care where competency must be demonstrated. This paper describes assessment of the reliability and validity of portfolios in a psychiatry residency program. This was a cross-sectional study across 4years of residency education. Using guidelines, 18 residents assembled portfolios containing five entries chosen from 13 skills. Trained raters scored the portfolios. Residents and faculty were interviewed about their perceptions. Generalizability results indicated five entries and two raters were sufficient for relative decisions. Six entries or a third rater would be sufficient for absolute decisions. Portfolio scores tended to improve with years of training and correlated with psychiatric knowledge but not clinical performance. Residents and faculty identified benefits to assembling a portfolio. Portfolios incorporate tasks embedded in the residency to provide evidence of resident competency. The results support that the score is reliable and valid.

Clinical Competence↗
PubMed2004

Biopsychosocial formulation: recognizing educational shortcomings.

OBJECTIVE: Since Engel introduced the biopsychosocial model, it has been extensively examined. The authors expect psychiatrists to formulate cases using the biopsychosocial model. However, resident psychiatrists' ability to generate formulations using this model has received little attention. METHODS: The authors evaluated resident biopsychosocial formulations using biopsychosocial scores from trained, blinded raters across four institutions. Second, the authors determined if an intervention could improve biopsychosocial formulation. DESIGN: This study included non-experimental and pre-post components using resident portfolio scores to measure biopsychosocial. PARTICIPANTS/SETTING: Residents from four postgraduate years (PGY) in four different programs participated. In one institution, faculty made a concerted effort to improve biopsychosocial formulation. There were 33 entries in 2000-2001 and 46 entries in 2001-2002. RESULTS: Using the combined data from all institutions, no PGY level averaged a rating of 3.0 (competent) in either year. In the institution implementing an intervention, a significant improvement was noted. CONCLUSION: This pilot study indicates that we can improve resident competency in this area.

Clinical Competence↗
PubMed2004

Can one portfolio measure the six ACGME general competencies?

OBJECTIVE: To determine that portfolios, useable by any program, can provide needed evidence of resident performance within the ACGME general competencies. METHODS: Eighteen residents constructed portfolios with selected entries from thirteen psychiatric skills. Two raters assessed whether entries reflected resident performance within the general competencies. They indicated no (0), some (1), or definite evidence (2) for each competency. Median scores were reported by competency and psychiatric skill. RESULTS: Eighty entries were rated: 100% of the psychiatric skills reflected some evidence for medical knowledge; 92% provided some evidence for patient care, communication and interpersonal skills, and professionalism; 77% provided some evidence for systems-based practice, and 31% provided some evidence for practice-based learning. Ten of the 13 skills reflected evidence for at least five of the competencies. CONCLUSIONS: Any combination of five entries reflects all competencies with the exception of practice-based learning. This deficit can be corrected with revision of portfolio guidelines.

Adolescent↗
PubMed2003

P.R.N. (As-needed) orders and exposure of psychiatric inpatients to unnecessary psychotropic medications.

OBJECTIVE: The objective of this study was to evaluate whether the practice of writing standing p.r.n. (as-needed) orders exposes psychiatric inpatients to unnecessary psychotropic medications. METHODS: Medical records for 223 new hospital admissions between July 15 and October 15, 1999, when p.r.n. orders were allowed, and 224 new admissions between November 15, 1999, and February 15, 2000, when p.r.n. orders were not allowed and only "now" orders were permitted, were reviewed from the three acute adult psychiatric units of the Arkansas State Hospital in Little Rock. Data were collected on demographic and clinical characteristics, scheduled and unscheduled psychotropic medications as noted in the medication administration records, use of seclusion and restraint, and incident reports of physical aggression. The mean numbers of unscheduled psychotropic medication doses administered during the two periods were compared. RESULTS: The number of unscheduled psychotropic medications administered decreased from 1,812 in the first period to 976 in the second period (adjusted mean doses per admission, 7.8 to 4.3). The decrease in use of unscheduled medications when standing p.r.n. orders were no longer allowed was not associated with corresponding increases in adverse events: there were fewer incidents of restraint (four compared with eight), fewer incidents of seclusion (41 compared with 48), and fewer incidents of physical aggression (35 compared with 40). In addition, there were no significant changes in the dosages of scheduled psychotropic medications on day 7 of admission, indicating that physicians were not increasing dosages in response to the elimination of p.r.n. orders. CONCLUSIONS: The practice of writing p.r.n. orders may expose psychiatric inpatients to unnecessary psychotropic medications.

Adult↗
PubMed2002

Using an explicit guideline-based criterion and implicit review to assess antipsychotic dosing performance for schizophrenia.

OBJECTIVE: Using structured implicit review as the gold standard, this study assessed the sensitivity and specificity of an explicit antipsychotic dose criterion derived from schizophrenia guidelines. DESIGN: Two psychiatrists reviewed medical records and made consensus-structured implicit review ratings of the appropriateness of discharge antipsychotic dosages for hospitalized patients who participated in a schizophrenia outcomes study. Structured implicit review ratings were compared with the explicit criterion: whether antipsychotic dose was within the guideline-recommended range of 300-1000 chlorpromazine milligram equivalents (CPZE). In addition, reasons for deviation from guideline dose recommendations were examined. SETTING AND STUDY PARTICIPANTS: A total of 66 patients hospitalized for acute schizophrenia at a Veterans Affairs medical center or state hospital in the southeastern US. MAIN OUTCOME MEASURES: The sensitivity and specificity of the explicit dose criterion at hospital discharge were determined in comparison with the gold standard of structured implicit review. RESULTS: At hospital discharge, 61% of patients (n = 40) were receiving doses within the guideline-recommended range. According to structured implicit review ratings, antipsychotic dose management was appropriate for 80% (n = 53) of patients. When the 300-1000 CPZE dose criterion (dosage within or outside the recommended range) was compared with structured implicit review, it demonstrated 84.6% sensitivity and 71.7% specificity for detecting inappropriate antipsychotic dose. CONCLUSIONS: The explicit antipsychotic dose criterion may provide a useful and efficient screen to identify patients at significant risk for quality of care problems; however, the relatively low specificity suggests that the measure may not be appropriate for quality measurement programs that compare performance among health plans.

Adult↗
PubMed2002

Portfolios as a novel approach for residency evaluation.

The authors describe the development process for a portfolio that programs may use for evaluating psychiatry residents. A committee carefully developed the portfolio requirements for 13 necessary skills in psychiatry. Psychiatrists were trained to rate portfolios. Review of the development and training process suggested that portfolios provided information both on individual residents and on the residency program itself. The process requires orientation of both residents and faculty, attention to time demands, and availability of examples and resources.

Journal Article↗