Biomedical subjects

Jon Veloski

Publications and source records attributed to Jon Veloski.

6 recordsLinked to original sources

PubMed2006

Systematic review of the literature on assessment, feedback and physicians' clinical performance: BEME Guide No. 7.

BACKGROUND AND CONTEXT: There is a basis for the assumption that feedback can be used to enhance physicians' performance. Nevertheless, the findings of empirical studies of the impact of feedback on clinical performance have been equivocal. OBJECTIVES: To summarize evidence related to the impact of assessment and feedback on physicians' clinical performance. SEARCH STRATEGY: The authors searched the literature from 1966 to 2003 using MEDLINE, HealthSTAR, the Science Citation Index and eight other electronic databases. A total of 3702 citations were identified. INCLUSION AND EXCLUSION CRITERIA: Empirical studies were selected involving the baseline measurement of physicians' performance and follow-up measurement after they received summaries of their performance. DATA EXTRACTION: Data were extracted on research design, sample, dependent and independent variables using a written protocol. DATA SYNTHESIS: A group of 220 studies involving primary data collection was identified. However, only 41 met all selection criteria and evaluated the independent effect of feedback on physician performance. Of these, 32 (74%) demonstrated a positive impact. Feedback was more likely to be effective when provided by an authoritative source over an extended period of time. Another subset of 132 studies examined the effect of feedback combined with other interventions such as educational programmes, practice guidelines and reminders. Of these, 106 studies (77%) demonstrated a positive impact. Two additional subsets of 29 feedback studies involving resident physicians in training and 18 studies examining proxy measures of physician performance across clinical sites or groups of patients were reviewed. The majority of these two subsets also reported that feedback had positive effects on performance. HEADLINE RESULTS: Feedback can change physicians' clinical performance when provided systematically over multiple years by an authoritative, credible source. CONCLUSIONS: The effects of formal assessment and feedback on physician performance are influenced by the source and duration of feedback. Other factors, such as physicians' active involvement in the process, the amount of information reported, the timing and amount of feedback, and other concurrent interventions, such as education, guidelines, reminder systems and incentives, also appear to be important. However, the independent contributions of these interventions have not been well documented in controlled studies. It is recommended that the designers of future theoretical as well as practical studies of feedback separate the effects of feedback from other concurrent interventions.

Clinical Competence↗

PubMed2006

Use of critical incidents to develop a rating form for resident evaluation of faculty teaching.

CONTEXT: Monitoring the teaching effectiveness of attending physicians is important to enhancing the quality of graduate medical education. METHODS: We used a critical incident technique with 35 residents representing a cross-section of programmes in a teaching hospital to develop a 23-item rating form. We obtained ratings of 11 attending physicians in internal medicine and general surgery from 54 residents. We performed linear and logistic regression analysis to relate the items on the form to the residents' overall ratings of the attending physicians and the programme directors' ratings of the attending physicians. RESULTS: The residents rated the attending physicians highly in most areas, but lower in provision of feedback, clarity of written communication and cost-effectiveness in making clinical decisions. When we used the residents' overall ratings as the criterion, the most important aspects of attending physicians' teaching were clarity of written communication, cost-effectiveness, commitment of time and energy and whether the resident would refer a family member or friend to the physician. When we used the programme directors' ratings as the criterion, the additional important aspects of performance were concern for the residents' professional well-being, knowledge of the literature and the delivery of clear verbal and written communication. CONCLUSIONS: The critical incident technique can be used to develop an instrument that demonstrates content and construct validity. We found that residents consider commitment of time to teaching and clinical effectiveness to be the most important dimensions of faculty teaching. Other important dimensions include written and verbal communication, cost-effectiveness and concern for residents' professional development.

Attitude of Health Personnel↗

PubMed2006

Assessing physicians' orientation toward lifelong learning.

BACKGROUND: Despite the importance of lifelong learning as an element of professionalism, no psychometrically sound instrument is available for its assessment among physicians. OBJECTIVE: To assess the validity and reliability of an instrument developed to measure physicians' orientation toward lifelong learning. DESIGN: Mail survey. PARTICIPANTS: Seven hundred and twenty-one physicians, of whom 444 (62%) responded. MEASUREMENT: The Jefferson Scale of Physician Lifelong Learning (JSPLL), which includes 19 items answered on a 4-point Likert scale, was used with additional questions about respondents' professional activities related to continuous learning. RESULTS: Factor analysis of the JSPLL yielded 4 subscales entitled: "professional learning beliefs and motivation,""scholarly activities,""attention to learning opportunities," and "technical skills in seeking information," which are consistent with widely recognized features of lifelong learning. The validity of the scale and its subscales was supported by significant correlations with a set of criterion measures that presumably require continuous learning. The internal consistency reliability (coefficient alpha) of the JSPLL was 0.89, and the test-retest reliability was 0.91. CONCLUSIONS: Empirical evidence supports the validity and reliability of the JSPLL.

Education, Medical, Continuing↗

PubMed2004

USMLE Step 2 performance and test administration date in the fourth year of medical school.

PURPOSE: To determine whether the time interval between completing the third-year curriculum and test administration affects a student's USMLE Step 2 score. METHOD: Scores for 846 students in the classes of 2000-2004 were grouped in ten time periods depending on test date. A linear regression model to predict performance on Step 2 using gender, Step 1, and grades in medicine, pediatrics and obstetrics-gynecology was developed based on the class of 1999. Analysis of covariance was used to test the effect of time on scores, adjusting for predicted performance. RESULTS: Step 2 scores decreased significantly (p <.001) across time. Students' mean scores were four points higher than predicted in the early months and five to eight points lower near the end of the senior year. CONCLUSIONS: Students who scheduled Step 2 early in the senior year achieved higher scores, on average, than those who waited until later in the year.

Clinical Competence↗

PubMed2002

Conceptualization and measurement of clinical competence of residents: a brief rating form and its psychometric properties.

Conceptualization and measurement of clinical competence of residents are of interest to medical educators. Yet there is a scarcity of operational tools with satisfactory psychometric support for measuring clinical competence. In this study, we investigated the underlying structure, criterion-related validity and alpha reliability of a brief rating form (20 items) developed to assess clinical competence of residents. The study sample consisted of 882 physicians (654 men, 228 women) in postgraduate training at Thomas Jefferson University Hospital between 1998 and 2000. Construct validity of the form was supported by factor analysis. Two relevant factors emerged: 'Knowledge, Data-Gathering and Processing Skills', and 'Interpersonal Skills and Attitudes'. Criterion-related validity was supported by significant linear associations between factor scores and performance on the medical licensing examinations. Alpha reliability coefficients for the two factors were 0.98 and 0.97, respectively. This brief rating form can be employed as one measure to evaluate clinical competence of residents with reasonable confidence in its measurement properties.

Clinical Competence↗

PubMedDate not supplied

Clinical vignette-based surveys: a tool for assessing physician practice variation.

Clinical vignette-based surveys have been used for more than 30 years to measure variation in physicians' approaches to the diagnosis and treatment of patients with similar health problems. Vignettes offer advantages over medical record reviews, analysis of claims data, and standardized patients. A vignette-based survey can be completed more quickly than a record review or standardized patient program. Research has shown that vignette-based surveys produce better measures of quality of care than medical record reviews when used to measure differential diagnosis, selection of tests, and treatment decisions. Although standardized patients are preferred when measuring communication and physical examination skills, vignettes are more cost-effective than standardized patients when assessing clinical physicians' decision making. Vignettes offer better opportunities to isolate physicians' decision making and to control case-mix variation than do analyses of claims data sets. Clinical vignette-based surveys are simple and economical tools that can be used to characterize physicians' practice variation.

Data Collection↗