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Biomedical subjects

M H Swartz

Publications and source records attributed to M H Swartz.

At least 19 recordsLinked to original sources
PubMed2001

The effect of examinee and patient ethnicity in clinical-skills assessment with standardized patients.

CONTEXT: Ethnicity has been a continuing concern for the valid assessment of clinical performance with standardized patients (SPs). The concern is that examinee ethnicity and SP ethnicity might interact, such that examinees might score higher in encounters with SPs of the same ethnicity. OBJECTIVE: To test for an interaction of examinee ethnicity and SP ethnicity on clinical performance in an SP examination. MAIN OUTCOME MEASURES: History-taking and physical-examination scores and interpersonal-and communication-skills scores, both based on checklists completed by SPs. Poststation scores for answers to case-related questions concerning pathophysiology, diagnosis, test selection, and test interpretation. SETTING AND PARTICIPANTS: Two graduating classes of over 1,000 fourth-year medical students each in the New York City Consortium were tested on the SP assessment administered at The Morchand Center of Mount Sinai School of Medicine. DESIGN AND ANALYSIS: The primary analyses were two-way (2 x 2) analyses, to test the main and interaction effects of examinee ethnicity and SP ethnicity. Effect-size measures (standardized mean differences, d) were computed to provide a sharper picture of the effects. RESULTS: Of the 24 interaction analyses, only three were statistically significant (not significantly more than expected by chance) and the results were mixed: one analysis showed better examinee performance in encounters with SPs of the same ethnic background and the other two showed the opposite. For all 24 interactions, significant or not, the results showed weak effects and no consistent pattern. White examinees scored on average 0.12 standard deviations above black examinees in encounters with white SPs, and 0.11 standard deviations higher in encounters with black SPs. CONCLUSIONS: These initial results are encouraging and should dispel some of the concern about ethnicity in SP assessment, at least about the operation of an examinee-by-SP-ethnicity interaction that would pose a serious threat to the validity of the examination scores.

Clinical Competence↗
PubMed1999

Relationship between clinical competence and interpersonal and communication skills in standardized-patient assessment.

PURPOSE: To evaluate the relationship between clinical competence and interpersonal and communication skills, in an attempt to clarify current thinking about these two dimensions as measured with standardized-patient (SP) examinations. METHOD: Simple Pearson correlations were computed between total examination scores for clinical competence and interpersonal and communication skills. Three sets of different types of data involving 15 separate examinations were used to explore the generality of the findings. To control for a within-case halo effect and measurement error, corrected cross-half correlations and corrected cross-case correlations were also computed. RESULTS: The simple correlations and the corrected cross-half and cross-case correlations showed moderate and above relationships between these two dimensions in the clinical context. The simple correlations centered around .50, and the corrected cross-half and cross-case correlations were slightly higher, centering around .65 and .70, respectively. CONCLUSION: The authors' thinking is that the moderate relationship between clinical competence and interpersonal and communication skills is not due to a flaw in the measurement of clinical competence, as has been suggested, but rather is a natural consequence of the clinical encounter, which exacts an interdependence of these two dimensions. At least, this possibility must be seriously considered so medical educators can think and act appropriately in the assessment of clinical performance.

Adult↗
PubMed1999

Global ratings of videotaped performance versus global ratings of actions recorded on checklists: a criterion for performance assessment with standardized patients.

PURPOSE: To test whether global ratings of checklists are a viable alternative to global ratings of actual clinical performance for use as a criterion for standardized-patient (SP) assessment. METHOD: Five faculty physicians independently observed and rated videotaped performances of 44 medical students on the seven SP cases that comprise the fourth-year assessment administered at The Morchand Center of Mount Sinai School of Medicine to students in the eight member schools in the New York City Consortium. A year later, the same panel of raters reviewed and rated checklists for the same 44 students on five of the same SP cases. RESULTS: The mean global ratings of clinical competence were higher with videotapes than checklists, whereas the mean global ratings of interpersonal and communication skills were lower with videotapes. The correlations for global ratings of clinical competence showed only moderate agreement between the videotape and checklist ratings; and for interpersonal and communication skills, the correlations were somewhat weaker. CONCLUSION: The results raise serious questions about the viability of global ratings of checklists as an alternative to ratings of observed clinical performance as a criterion for SP assessment.

Adult↗
PubMed1998

Essentials of a complete physical examination.

The goal of the physical examination is to obtain valid information concerning the health of the patient. The examiner must be able to identify, analyze, and synthesize the accumulated information into a comprehensive assessment. This article outlines the details of the examinations of the individual organ systems that should be evaluated during a podiatric screening physical examination. Some parts of the physical examination have been omitted intentionally. Attention is paid to the recognition of pedal manifestations of systemic disease.

Female↗
PubMed1997

Validating the standardized-patient assessment administered to medical students in the New York City Consortium.

PURPOSE: To test the criterion validity of existing standardized-patient (SP)-examination scores using global ratings by a panel of faculty-physician observers as the gold-standard criterion; to determine whether such ratings can provide a reliable gold-standard criterion to be used for validity-related research; and to encourage the use of these gold-standard ratings for validation research and examination development, including scoring and standard setting, and for enhancing understanding of the clinical competence construct. METHOD: Five faculty physicians independently observed and rated videotaped performances of 44 students from one medical school on the seven SP cases that make up the fourth-year assessment administered at The Morchand Center of Mount Sinai School of Medicine to students in the eight member schools in the new York City Consortium. RESULTS: The validity coefficients showed correlations between scores on the examination and the overall ratings ranging from .60 to .70. The reliability coefficients for ratings of overall examination performance reached the commonly recommended .80 level and were very close at the case level, with interrater reliabilities generally in the .70 to .80 range. CONCLUSION: The results are encouraging, with validity coefficients high enough to warrant optimism about the possibility of increasing them to the recommended .80 level, based on further studies to identify those measurable performance characteristics that most reflect the gold-standard ratings. The high interrater reliabilities indicate that faculty-physician ratings of performance on SP cases and examinations can or may be able to provide a reliable gold standard for validating and refining SP assessment.

Clinical Clerkship↗
PubMed1996

Psychometric properties of a standardized-patient checklist and rating-scale form used to assess interpersonal and communication skills.

The results show that the SP checklist scores and the SP ratings of interpersonal and communication skills have comparable psychometric properties. The reliabilities of the five-item rating form (.76) and the single global rating of patient satisfaction (.70) were slightly higher than the reliability of the 17-item checklist (.65); this finding is of particular significance, given the greater length of the checklist. Also, the checklist scores and ratings appear to be measuring the same underlying dimension, with correlations of the checklist with the five ratings and with the single global rating being .82 and .81, respectively. Van der Vleuten and associates, in two excellent articles, noted a recent shift away from the use of subjective measures of clinical competence, such as rating scales, toward the use of presumably more objective measures, such as SP checklists. Their concern was that these objective measures may focus on somewhat trivial and easily measured aspects of the clinical encounter, and that more subtle but critical factors in clinical performance may be overlooked or ignored. They referred to such measurement as "objectified" rather than objective. The shift is based on the presumption that objective or objectified measurement is superior to subjective measurement, such as ratings, with respect to psychometric properties such as reliability. On the basis of a survey of several studies, though, the authors concluded that "objectified methods do not inherently provide more reliable scores" and "may even provide unwanted outcomes, such as negative effects on study behavior and triviality of the content being measured." The results of the present study support this conclusion, showing somewhat higher reliabilities for subjective ratings than for the objective (or perhaps objectified) checklist. Also, the high uncorrected correlations suggest that the more reliable ratings are measuring the same underlying dimension as are the checklist scores. The present study also illustrates the application of a recently proposed method for constructing a valid SP checklist, which would consist of items that best reflect global ratings of performance. In this study, the ratings were provided by the SPs themselves, but ratings could be obtained from faculty-physician experts who observe student performance on the SP case. Thus, performance on individual checklist items would be correlated with expert ratings, to identify the items that best predict the ratings. The checklist, then, would be constructed of just those items that best predict the ratings, and the checklist could be used for future testing without the need for further faculty ratings (yet the checklist scores would reflect the faculty ratings). With this approach, it would seem possible to construct checklists for history-taking and physical-examination skills, as well as for interpersonal and communication skills. Thus, the faculty ratings would provide a basis for case development and refinement, including scoring and standard setting, and scores on the checklist would serve as a proxy for the gold-standard faculty ratings. The study suggests that SP ratings may be more efficient and more reliable than SP checklists for assessing interpersonal and communication skills. The study also demonstrates that global ratings by SPs (or by expert physician observers) can provide a basis for SP-test construction.

Clinical Competence↗
PubMed1977

Mitral valve prolapse: a review of associated arrhythmias.

The syndrome of mitral valve prolapse with associated auscultatory-electrocardiographic findings is now well documented. Two representative cases of repetitive tachyarrhythmias in patients with mitral valve prolapse are discussed as well as an analysis of the 589 cases in the English literature of arrhythmias in patients with mitral valve prolapse. The average age of the patients was 38 years; 70 per cent of them were women. Symptoms were variable, but palpitations occurred in 44 per cent, lightheadedness in 12 per cent and syncope in 4 per cent. Premature atrial and/or ventricular contractions were found in 55 per cent, premature ventricular contractions in 45 per cent, supraventricular tachycardia in 6.1 per cent and ventricular tachycardia in 6.3 per cent. Sudden death was noted in 1.4 per cent. A discussion of the pathogenesis of arrhythmias and therapy concludes this review.

Adolescent↗
PubMed1977

The normal electrocardiogram as a predictor of left ventricular function in patients with coronary artery disease.

Fifty-five consecutive patients with a normal resting electrocardiogram and coronary artery disease were examined to determine left ventricular function. Fifty-two (95%) had no evidence of left ventricular asynergy; 3 patients had only mild hypokinesis. Of this group of patients, 25 (47%) had one vessel disease, 17 (30%) had two vessel disease, and 13 (23%) had three vessel disease. Significant left ventricular asynergy was not found in patients with coronary artery disease and normal electrocardiograms. In addition, a normal electrocardiogram was not related to the number of coronary arteries involved.

Adult↗
PubMed1976

Dermatoglyphic patterns in patients with mitral valve prolapse: a clue to pathogenesis.

Fingerprints were obtained from 100 patients with mitral valve prolapse and compared with those of 100 control subjects matched for sex and race. Arches were found in 16.8 percent of all digital patterns in patients with mitral valve prolapse but in only 2.5 percent of all digits in the control group. Whereas no patient in the control group had four or more arches, 19 percent of patients with mitral valve prolapse had this finding. In addition, arches were found on 16 and 9 percent, respectively, of digits IV and V in patients with mitral valve prolapse but were not found on these digits in the control group. The finding of four or more arches or arches on digits IV or V may be important supportive evidence of mitral valve prolapse when evaluating patients with atypical chest pain and palpitations. Antenatal factors may be involved in the pathogenesis of mitral valve prolapse since it is possible that a genetic or environmental factor that interferes with the development of the mitral valve may also influence epidermal ridge patterns.

Analysis of Variance↗