Biomedical subjects

M B Donnelly

Publications and source records attributed to M B Donnelly.

At least 19 recordsLinked to original sources

PubMed1997

Measuring the ability of residents to manage oncologic problems.

BACKGROUND: An OSCE was used to measure the ability of a cohort of residents to manage oncologic problems. METHODS: Nine oncologic clinical problems were presented to 56 surgical residents. Each problem contained a 5-minute data-gathering period (DGP) and a 5-minute data-interpretation period (DIP). A performance score was determined for each resident for each problem. Reliability was estimated by coefficient alpha; validity, by the construct of experience. Wilks's lambda criterion was used to determine whether training level could be identified by OSCE performance. RESULTS: The DGP reliability was 0.80; the DIP, 0.49. Senior residents performed significantly better than junior residents (P = 0.0001), who performed significantly better than interns (P = 0.0009). Of the residents, 62% were competent on the DGP, but only 21% on the DIP. Important deficits in knowledge and clinical skills were apparent at all levels of training. CONCLUSION: The education and evaluation of residents in oncology need improvement.

Clinical Competence↗

PubMed1997

Ward evaluations: should they be abandoned?

Even in the era of the objective structured clinical examination (OSCE), the predominant method of resident evaluation is the faculty ward evaluation (WE), despite many concerns about its reliability. The aim of this study was to determine the value of the WE as a measurement of clinical competence in terms of both reliability and validity. In a one-year period, surgery faculty members evaluated 72 residents. An average of 7 faculty members evaluated each resident. The evaluation form contained 10 specific performance ratings and an overall evaluation. Inter-rater reliability of the overall performance ratings was calculated by using the intraclass correlation. Validity of the WE was evaluated in four ways. Inter-rater reliability of the overall performance rating was 0.82; the reliability of a single overall rating was 0.39. (1) A discriminant function analysis indicated that residents at advanced levels of training received more positive evaluations than residents at less advanced levels (P < 0.0001). (2) The overall rating was significantly correlated (r = 0.55, P < 0.0001) with the overall score of a concurrent OSCE. (3) A factor analysis showed high correlations among the items, indicating a lack of discrimination between the skills. (4) Overall ratings were insensitive to performance deficiencies. Only 1.3% of the ratings were unsatisfactory or marginal. The WE was sufficiently reliable to estimate the faculty's view of each resident. The fact that the ratings tended to differentiate residents by level of training and that ratings significantly correlated with the OSCE provides strong evidence of their validity. However, factor analysis indicated that the faculty members were making one global, undifferentiated judgment and that these ratings did not identify deficient performance skills. We conclude that ward evaluations have a place in the assessment of residents.

Clinical Competence↗

PubMed1997

Residents' evaluation of a problem-based learning curriculum in a general surgery residency program.

METHODS: To determine residents' satisfaction with problem-based learning and its tutors, to determine how residents prepare for sessions, and to identify the characteristics of both effective sessions and tutors, we analyzed 132 evaluations from 24 residents who completed 1 or more of the 9 cases presented during the first 9 months of our program. The 38-item evaluation questionnaire asked residents to rate tutor characteristics, various aspects of the sessions, and methods used to prepare for the sessions. RESULTS: Residents were well satisfied with the problem-based learning sessions and with the logistics of our program; they found the overall quality of the tutor more important than that of the case; they valued an active, thought-provoking tutor more than a traditional facilitator; and they most often used standard textbooks to prepare for the sessions. CONCLUSIONS: Problem-based learning is a practical, enjoyable graduate curricular vehicle when implemented with well-written cases and active tutors.

Adult↗

PubMed1997

The multidisciplinary structured clinical instruction module as a vehicle for cancer education.

BACKGROUND: The Structured Clinical Instruction Module (SCIM) modifies the Objective Structured Clinical Examination (OSCE) for teaching purposes. This study determined the effectiveness of a breast cancer SCIM in enhancing residents' clinical skills. METHODS: Twenty-five residents, 15 faculty members, and 12 breast cancer patients (simulated and actual) participated in the multistation, multidisciplinary SCIM. Afterward, faculty members, residents, and patients evaluated the SCIM. Residents completed an 18-item self-assessment of their skills before and after the SCIM. RESULTS: All residents, faculty members, and patients rated the SCIM as either outstanding or above average as an educational experience. The residents' self-assessments of their skills were significantly higher after the SCIM than before. CONCLUSIONS: This study shows that residents are aware of their deficiencies in breast cancer management. The SCIM provides an excellent format for residents to improve their clinical skills.

Attitude of Health Personnel↗

PubMed1997

Improving residents' clinical skills with the structured clinical instruction module for breast cancer: results of a multiinstitutional study. Breast Cancer Education Working Group.

BACKGROUND: The purpose of this study was to determine, in a multiinstitutional setting, the effectiveness of the structured clinical instruction module (SCIM) as an instructional format for surgical residents. METHODS: The breast cancer SCIM is an abbreviated (3-hour) clinical skills course that places residents in realistic clinical settings. The curriculum encompasses all aspects of breast cancer patient assessment. The SCIM was administered to 137 residents at five institutions. Sixty-six faculty members and 52 patients participated. All participants were surveyed with multiitem questionnaires. The residents were also asked to perform a self-assessment of their skills before and after the SCIM. RESULTS: The SCIM was delivered at all institutions without difficulty. All participants rated the SCIM highly (from "above average" to "outstanding"). Mean ratings (on a 5-point scale) for the overall effectiveness of the SCIM as an educational format follow: [table: see text] The pretest mean (on a 5-point scale) on the self-assessment was 2.46 ("less than competent"); the posttest mean was 3.54 ("more than competent") (p < 0.0001). CONCLUSIONS: Residents are acutely aware of their deficiencies in understanding breast cancer. The SCIM is a standardized, reproducible, portable, and effective educational vehicle.

Breast Neoplasms↗

PubMed1997

Cancer pain education among family physicians.

This study used performance-based testing (objective structured clinical evaluation, OSCE) to evaluate the skills of family physicians in assessing and managing the severe pain of a cancer patient, and evaluated a new method of education about the management of cancer pain. Twenty-four primary care physicians completed a detailed pain assessment of the same standardized cancer pain patient (Part A). A proctor observed the interviews and rated the physicians on a variety of pre-determined items believed to be important for pain assessment. The physicians were then allowed 5 min to answer management questions about the patient's cancer pain (Part B). After reviewing each physician's performance on Parts A and B, the proctor provided immediate feedback and instruction (Part C) on basic principles of cancer pain assessment and management. On average, the primary care physicians asked 52% (+/-4.5%) of the indicated questions of a detailed pain assessment. Performance was poorest in asking about previous pain history, temporal pattern of pain, and pain intensity. Performance on the pain assessment was best for eliciting pain location and pain-relieving factors. Primary care physicians obtained mean scores of 36% (+/-3%) on Part B of the OSCE. Although opioid therapy was frequently prescribed, only 42% of prescriptions were for regular administration. Performance on Parts A and B correlated poorly with years in practice, and older physicians tended to perform a less detailed pain assessment than their younger colleagues. Most physicians enjoyed participating in this instructional formal and believed that the proctor feedback increased the educational value of the module. The results of our study suggest that many family physicians may be inadequate in their clinical assessment and management of cancer pain. Our study supports the need for continuing education in cancer pain management, regardless of years in practice. Further study should evaluate the effects of different educational programs on clinical practice in patient care.

Education, Medical, Graduate↗

PubMed1997

Residents' management of the symptoms associated with terminal cancer.

The principal aim of palliative care is to bring symptomatic relief to patients with progressive disease. Residents graduating from a university general surgery training program should be competent to manage common symptoms associated with advanced cancer. This study used performance-based testing to evaluate the skills of resident physicians in managing common symptoms of a patient with advanced cancer. Thirty-three resident physicians (PGY 1 to 6) were presented with four clinical symptoms of a patient with advanced cancer: (1) nausea and vomiting associated with regular morphine use; (2) lack of appetite in the last weeks of life of a terminally ill patient; (3) constipation associated with codeine analgesia; and (4) dyspnea associated with diffuse lung metastases. The management plan for the symptom problems was evaluated by using a predefined checklist. A significant number of residents showed deficits in the management of common symptoms of advanced cancer. Scheduled dosing of antiemetics was infrequently prescribed for opioid-related nausea and vomiting. Most physicians inappropriately managed lack of appetite by using forced feeding. Opioids were infrequently used in the management of terminal dyspnea. The absence of difference in scores between junior and senior residents suggests that adequate management of the symptoms of terminal cancer is not being effectively taught in postgraduate training programs.

Anorexia↗

PubMed1997

The structured clinical instruction module as a tool for improving students' understanding of breast cancer.

The Structured Clinical Instruction Module (SCIM) is a novel format for teaching clinical skills. A multidisciplinary SCIM was presented to 30 medical students to improve their understanding of breast cancer. The SCIM consisted of 12 10-minute stations, each covering a different aspect of the diagnosis and management of breast cancer (e.g., history, physical examination, treatment options, mammography, cytology, and pathology). The students rotated through the various stations in groups of three. Nine patients and 14 faculty members participated. At the end of the SCIM, students, faculty, and patients rated their level of agreement (on a five-point scale ranging from "Strongly Disagree" to "Strongly Agree") with statements on a multi-item evaluation questionnaire. All ratings were positive. The students agreed most that the small-group format was an effective instructional method (mean, 4.6). Both students and faculty agreed that the SCIM increased students' clinical skills (mean, 4.4 in both evaluations). Faculty expressed a willingness to participate in future such workshops (mean, 4.6). Patients agreed most strongly that they enjoyed the SCIM (mean, 5.0) and that faculty feedback to students was excellent (mean, 5.0). The SCIM was well received by all participants in this pilot project.

Breast Neoplasms↗

PubMed1996

The use of objective structured clinical examination (OSCE) for evaluation and instruction in graduate medical education.

This study had two purposes: determining the reliability and validity of the Objective Structured Clinical Examination (OSCE) in assessing performance by trainees at all levels, including medical students and chief residents; and estimating the impact of providing OSCE participants with immediate feedback about their performance. A comprehensive 210-min OSCE was administered to 53 surgical residents and 6 junior medical students. Faculty experts proctored all patient stations and provided immediate feedback to participants after the patient interaction segments (Part A). The participants then answered questions about the patients seen (Part B). The reliability of the OSCE was high (.91), identical to that of a previous resident OSCE with no feedback. The standard error of measurement for both parts was approximately 4%. At the 95% confidence interval, each participant's actual level of clinical performance (Part A) and clinical knowledge (Part B) could be estimated with an error of +/-8%. Participants showed significant differences in clinical performance (Part A, P < 0.01) and knowledge (Part B, P < 0.01) by level of training. Most participants (74%) rated the OSCE as an above average or outstanding educational method. The OSCE is a valid and reliable test of residents' clinical skills. Feedback to participants during the OSCE was positively received and did not perturb test reliability.

Clinical Competence↗

PubMed1996

Cancer pain assessment and management by housestaff.

Pain control for cancer patients is a significant problem in health care, and lack of expertise by clinicians in assessing and managing cancer pain is an important cause of inadequate pain management. This study was designed to use performance-based testing to evaluate the skills of resident physicians in assessing and managing the severe chronic pain of a cancer patient. Thirty-three resident physicians (PGY 1-6) were presented with the same standardized severe cancer pain patient and asked to complete a detailed pain assessment. The residents then completed questions related to management of the cancer pain patient. In the cancer pain assessment, residents did well in assessing pain onset (70%), temporal pattern of pain (64%), and pain location (73%). However, only 33% and 45% physicians adequately assessed the pain description and pain intensity, respectively, and assessment of pain-relieving factors, previous pain history, and psychosocial history was done poorly or not at all by 70%, 88%, and 94% of residents. Only 58% of the residents were judged to be competent in this clinical cancer pain assessment. In the cancer pain management section, opioid analgesic therapy was prescribed by 98% of residents, and 91% used the oral route. However, only 18% of prescriptions were for regular use and 88% of residents did not provide analgesics for breakthrough pain. A significant number of graduated physicians were judged to be not competent in the assessment and management of the severe pain of a standardized cancer patient. Opioids and NSAIDs were the analgesics of choice; however, most were prescribed on a PRN basis only. Co-analgesics were rarely prescribed. Few physicians managed persistent, severe cancer pain according to the WHO guideline of increasing the opioid dose. The lack of significant difference in scores between junior and senior residents suggest that adequate cancer pain management is not being effectively taught in postgraduate training programs.

Clinical Competence↗

PubMed1996

The surgical clerkship: characteristics of the effective teacher.

A good relationship between medical students and clinicians is crucial to a positive learning experience. To increase contact between surgical teaching staff and students, a teacher programme was instituted in the problem-based surgical clerkship at the University of Kentucky. This study examined the teacher traits and skills that medical students perceive as distinguishing effective from ineffective teachers. The 312 evaluations collected from students in successive surgical clerkship rotations (87% response rate) were used to determine the characteristics of the effective teacher. Results suggest that students rate increased contact with surgical teaching staff highly and that they value increased mentoring by the staff. The traits of teachers rated highly by students in the surgical clerkship include: being a positive role model, encouraging communication, and being well organized. Comparing data from the 2 years of the clerkship also revealed that providing feedback to staff on their performance as teachers enabled them to improve their instructional skills.

Adult↗

PubMed1996

Developing generalists for Kentucky.

Since 1985, nearly half of the graduates of the University of Kentucky College of Medicine have chosen generalist careers, even though its students received almost no outpatient ambulatory training in primary care before 1990. This study determined the factors influencing the choice of generalist specialties in the absence of ambulatory training experience. A questionnaire was mailed to the 516 graduates of the classes of 1964 through 1989 who had entered a generalist specialty. A three-way ANOVA with one repeated measure was used to determine whether there were statistically significant differences in the responses of practitioners in the three generalist specialties (family practice, general internal medicine, or general pediatrics). Sufficiently complete responses were received from 187 graduates (116 family practitioners, 40 general pediatricians, and 31 general internists). Many of the physicians who had spent formative years in rural areas were practicing in rural communities. Many respondents had already decided upon a generalist career before entering medical school. Clerkships in internal medicine and pediatrics were an important influence, as was mentor role modeling. For pediatricians, an elective ambulatory care experience was also important. Educational experiences exert meaningful influences on students interested in a generalist career. Formal ambulatory care training experiences, while not critical for the selection of a generalist career, may heighten or confirm interest. Efforts that encourage students from rural communities to enter medical school appear to produce rural physicians.

Analysis of Variance↗

PubMed1996

Factors influencing medical students' choice of academic medicine as a career.

The purpose of this study was to identify the characteristics of physicians who chose academic medicine as a career. A questionnaire was sent to all graduates of the University of Kentucky College of Medicine who held full-time positions in academic medical centers (n = 143). Ninety graduates (63%) returned usable questionnaires. Most of the physicians grew up in urban areas. Seventy-seven percent of the graduates entered academic medicine directly from their residency or fellowship programs. The most important factors cited by respondents as influencing a career choice of academic medicine were an interest in teaching and a belief that their personality and skills suited them to an academic environment. An interest in doing research was not a very important factor. Respondents also indicated why they chose their particular specialty. The two most important factors were the content of the specialty and intellectual stimulation. Most of these physicians (64%) were very satisfied with their careers in academic medicine.

Academic Medical Centers↗

PubMed1995

The structured clinical instruction module: a novel strategy for improving the instruction of clinical skills.

We have previously shown that both medical students and residents demonstrate numerous important deficits when evaluating patients with abdominal complaints. To address these deficits, we implemented a pilot instructional program derived from the Objective Structured Clinical Examination. Fifty third-year medical students were presented with a 1-hr Structured Clinical Instruction Module (SCIM) of five stations, each station addressing a different aspect of the surgical evaluation of the abdomen. Simulated patients were present at two of the stations. Faculty from appropriate disciplines were present at the stations to provide standardized instruction according to predetermined curricular objectives. The medical students evaluated the SCIM for its specific characteristics, and they evaluated each of the five stations for its efficacy in increasing their clinical skills. All the specific aspects of the SCIM were given a rating significantly higher than neutral (P < 0.0001). Students agreed most strongly that the faculty were well prepared for the SCIM and that the faculty were enthusiastic. All of the SCIM stations were given a rating significantly higher than average (P < 0.0001). When compared to a conventional workshop, the SCIM scored significantly higher on all three common evaluation items. The SCIM was very well received by medical students as a format for clinical instruction. This unique modification of the Objective Structured Clinical Examination has potential for teaching important clinical skills that are not consistently mastered within current surgical curricula.

Adult↗

PubMed1995

The relationship between faculty ward evaluations, OSCE, and ABSITE as measures of surgical intern performance.

BACKGROUND: This study determined the degree to which ward evaluations, the American Board of Surgery In-Training Examination (ABSITE), and an Objective Structured Clinical Examination (OSCE) provide equivalent information about intern performance. METHODS: Twenty-two general surgery interns completed both the ABSITE and a 17-problem, 35-station OSCE. Faculty members completed several 12-item ward evaluations for each intern. Pearson product-moment correlations were employed to determine the degree of association among the various evaluation measures. RESULTS: The total OSCE score correlated with both the total ABSITE score and the overall ward evaluations, but the latter two measures did not correlate with each other. The ward evaluations identified the performance of 1 of the 22 interns (5%) as deficient, the ABSITE identified 9 (41%) as deficient in knowledge, and the OSCE 8 (36%). CONCLUSIONS: In the future, performance-based testing methods such as the OSCE should become more important as an evaluative parameter in assessing the clinical performance of postgraduate surgical trainees.

Attitude of Health Personnel↗

PubMed1995

The Objective Structured Clinical Examination. The new gold standard for evaluating postgraduate clinical performance.

OBJECTIVE: The authors determine the reliability, validity, and usefulness of the Objective Structured Clinical Examination (OSCE) in the evaluation of surgical residents. SUMMARY BACKGROUND DATA: Interest is increasing in using the OSCE as a measurement of clinical competence and as a certification tool. However, concerns exist about the reliability, feasibility, and cost of the OSCE. Experience with the OSCE in postgraduate training programs is limited. METHODS: A comprehensive 38-station OSCE was administered to 56 surgical residents. Residents were grouped into three levels of training; interns, junior residents, and senior residents. The reliability of the examination was assessed by coefficient alpha; its validity, by the construct of experience. Differences between training levels and in performance on the various OSCE problems were determined by a three-way analysis of variance with two repeated measures and the Student-Newman-Keuls post hoc test. Pearson correlations were used to determine the relationship between OSCE and American Board of Surgery In-Training Examination (ABSITE) scores. RESULTS: The reliability of the OSCE was very high (0.91). Performance varied significantly according to level of training (postgraduate year; p < 0.0001). Senior residents performed best, and interns performed worst. The OSCE problems differed significantly in difficulty (p , 0.0001). Overall scores were poor. Important and specific performance deficits were identified at all levels of training. The ABSITE clinical scores, unlike the basic science scores, correlated modestly with the OSCE scores when level of training was held constant. CONCLUSION: The OSCE is a highly reliable and valid clinical examination that provides unique information about the performance of individual residents and the quality of postgraduate training programs.

Clinical Competence↗

PubMed1995

Demographic, educational, and psychosocial factors influencing the choices of primary care and academic medical careers.

PURPOSE: To identify demographic, psychosocial, and educational variables that differentiate physicians who have chosen careers in primary care from those who have chosen academic medicine. METHOD: Questionnaires were distributed in the spring of 1992 to 704 physicians (546 in primary care practices and 143 in academic medicine) who had graduated from the University of Kentucky College of Medicine, 1964-1991. Mann-Whitney U tests and analyses of variance were used for statistical comparisons. RESULTS: A total of 336 physicians responded: 246 in primary care and 90 in academic medicine. The primary care physicians tended to come from smaller cities than did the academic physicians (p < .0001). The primary care physicians also had made their career choices earlier than did the academic physicians (p < .0001). For the academic physicians, long-term participation in research, intellectual stimulation, content of specialty, and influence of a mentor or role model were significantly more important factors than they were for the primary care physicians, for whom length of training, direct patient contact, and threats of malpractice suits were significantly more important. CONCLUSION: The results corroborate the findings of previous studies that suggest that career-choice factors are influenced by admission procedures and curricular structures. The number of graduates choosing careers in either primary care or academic medicine may be increased by increasing their experiences in those fields. Medical schools may be able to use demographic, psychosocial, and curricular factors to fulfill their particular primary mandates, whether they be producing physicians in primary care or in academic medicine.

Academic Medical Centers↗

PubMed1994

Assessing surgical residents' and medical students' interpersonal skills.

Effective physician-patient interaction is an important part of surgical practice. This study had three goals: (1) to measure the interpersonal skills (IS) of surgical students and residents in structured clinical settings and to determine the reliability of such measurements; (2) to determine the relationship of IS to clinical performance; and (3) to determine the impact of level of training on IS. Twenty third-year medical students and 30 junior-level interns (23 PGY-1s, 7 PGY-2s) interacted with nine actual or simulated patients as part of an objective structured clinical examination. Using a global rating scale, faculty graded both the IS and the organizational skills of the candidates. A two-way analysis of variance indicated significant differences among the three groups of trainees (P = 0.0002) and among the IS scores for each of the nine patient problems (P < 0.0001). Both the PGY-2s and the medical students exhibited significantly better interpersonal skills than did the PGY-1s. The IS scores correlated significantly with the data gathering scores, the data interpretation scores, and the organizational scores. We conclude that faculty measurement of IS is moderately reliable even when a simple global rating scale is used. Overall IS scores were rather poor, particularly in the PGY-1 group. IS were highly correlated with overall objective clinical performance.

Clinical Competence↗