Changes in the US Medical Licensure Examination and impact on US medical schools.
Explore the source record for details and available documents.
Clinical Competence↗
Biomedical subjects
John H Littlefield
Publications and source records attributed to John H Littlefield.
Improving resident performance assessment data: numeric precision and narrative specificity.
PURPOSE: To evaluate the use of a systems approach for diagnosing performance assessment problems in surgery residencies, and intervene to improve the numeric precision of global rating scores and the behavioral specificity of narrative comments. METHOD: Faculty and residents at two surgery programs participated in parallel before- and-after trials. During the baseline year, quality assurance data were gathered and problems were identified. During two subsequent intervention years, an educational specialist at each program intervened with an organizational change strategy to improve information feedback loops. Three quality-assurance measures were analyzed: (1) percentage return rate of forms, (2) generalizability coefficients and 95% confidence intervals of scores, and (3) percentage of forms with behaviorally specific narrative comments. RESULTS: Median return rates of forms increased significantly from baseline to intervention Year 1 at Site A (71% to 100%) and Site B (75% to 100%), and then remained stable during Year 2. Generalizability coefficients increased between baseline and intervention Year 1 at Site A (0.65 to 0.85) and Site B (0.58 to 0.79), and then remained stable. The 95% confidence interval around resident mean scores improved at Site A from baseline to intervention Year 1 (0.78 to 0.58) and then remained stable; at Site B, it remained constant throughout (0.55 to 0.56). The median percentage of forms with behaviorally specific narrative comments at Site A increased significantly from baseline to intervention Years 1 and 2 (50%, 57%, 82%); at Site B, the percentage increased significantly in intervention Year 1, and then remained constant (50%, 60%, 67%). CONCLUSIONS: Diagnosing performance assessment system problems and improving information feedback loops improved the quality of resident performance assessment data at both programs.
Adult↗
Educating treatment professionals about addiction science research: demographics of knowledge and belief changes.
Communication of accurate, objective, and timely scientific information to treatment professionals is important--especially in the "drug abuse" and addiction field where misinformation and a lack of exposure to new information are common. The purpose of this study was to assess knowledge and belief changes that accompanied educational workshops (3 or 6 hr-long) on addiction science targeted to treatment professionals (N=1403) given in the United States and Puerto Rico between July 2000 and August 2001. Each workshop covered three main concepts: (1) terms and definitions; (2) basic neurochemistry of addiction; and (3) how new neurobiological knowledge will affect the treatment of addictions in the future. Analysis of variance was used to compare mean pretest to posttest change scores among levels of four independent variables: gender, age, occupation/position, and race/ethnicity. Workshop participants achieved a significant improvement in knowledge about addiction with younger groups achieving greater gains. Participants' beliefs shifted in the desired direction. Significant differences in belief shifts occurred among occupational and gender groups, but not among race/ethnicity or age groups. There was also a consistent change in the policy belief subscale that related to how strongly the audience members believed research on addiction was important. We conclude that addiction science education provided to treatment professionals can increase their knowledge and change their beliefs about the causes of addictions. In addition, the workshop participants form a base of constituents who are likely to support greater addiction research funding.
Adolescent↗
Do peer chart audits improve residents' performance in providing preventive care?
PURPOSE: One recommended method to evaluate residents' competence in practice-based learning and improvement is chart audit. This study determined whether residents improved in providing preventive care after a peer chart audit program was initiated. METHOD: Residents audited 1,005 charts and scored their peers on 12 clinical preventive services. The mean total chart audit scores were compared across five time blocks of the 45-month study. RESULTS: Residents' performance in providing preventive care initially improved significantly but declined in the last ten months. However, their performance remained significantly higher than at the beginning. CONCLUSIONS: By auditing their peers' charts, residents improved their own performance in providing preventive care. The diffusion of innovations theory may explain the prolonged implementation phase and problems in maintaining a chart audit program.
Analysis of Variance↗
Effectiveness of addiction science presentations to treatment professionals, using a modified Solomon study design.
OBJECTIVES: Knowledge of addiction research findings is critical for healthcare professionals who treat addicted patients. However, there is little information available about the instructional effectiveness of lecture-slide presentations in changing knowledge vs. beliefs of such professionals. DESIGN: A modified Solomon four-group experimental design was used to assess the instructional effectiveness (knowledge gain vs. belief changes) of three-hour addiction science workshops presented to health-care professionals by neurobiologically-trained academic researchers. Effectiveness of the workshops was assessed by a 28-item questionnaire on participant versus control group knowledge/beliefs on addiction. Six-month follow-up questionnaires measured "retention" of knowledge and belief changes. RESULTS: The workshop participants showed significant knowledge gain and belief changes, whereas the two control groups showed no change in knowledge or beliefs. After six months, knowledge gains decreased, but were still higher than pre-test scores. In contrast, belief changes on three subscales persisted over six months in 40 to 52 percent of the subjects. CONCLUSIONS: These results illustrate a successful continuing education model by which academic researchers who are skilled teachers present a three-hour lecture-slide workshop with extensive question-and-answer sessions on addictions. We conclude that motivated health-care professionals can experience important knowledge gains and belief changes by participating in such workshops. In contrast to the transient retention of knowledge, belief changes persisted surprisingly well for at least six months in about half the subjects. These results suggest that long-term changes in the professional orientation of these health-care workers are possible.
Adult↗
A multimedia patient simulation for teaching and assessing endodontic diagnosis.
Teaching and assessing diagnostic skills are difficult due to relatively small numbers of total clinical experiences and a shortage of clinical faculty. Patient simulations could help teach and assess diagnosis by displaying a well-defined diagnostic task, then providing informative feedback and opportunities for repetition and correction of errors. This report describes the development and initial evaluation of SimEndo I, a multimedia patient simulation program that could be used for teaching or assessing endodontic diagnosis. Students interact with a graphical interface that has four pull-down menus and related submenus. In response to student requests, the program presents patient information. Scoring is based on diagnosis of each case by endodontists. Pilot testing with seventy-four junior dental students identified numerous needed improvements to the user interface program. A multi-school field test of the interface program using three patient cases addressed three research questions: 1) How did the field test students evaluate SimEndo I? Overall mean evaluation was 8.1 on a 0 to 10 scale; 2) How many cases are needed to generate a reproducible diagnostic proficiency score for an individual student using the Rimoldi scoring procedure? Mean diagnostic proficiency scores by case ranged from .27 to .40 on a 0 to 1 scale; five cases would produce a score with a 0.80 reliability coefficient; and 3) Did students accurately diagnose each case? Mean correct diagnosis scores by case ranged from .54 to .78 on a 0 to 1 scale. We conclude that multimedia patient simulations offer a promising alternative for teaching and assessing student diagnostic skills.
Clinical Competence↗