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Biomedical subjects

R B Hays

Publications and source records attributed to R B Hays.

At least 19 recordsLinked to original sources
PubMed2002

Selecting performance assessment methods for experienced physicians.

BACKGROUND: While much is now known about how to assess the competence of medical practitioners in a controlled environment, less is known about how to measure the performance in practice of experienced doctors working in their own environments. The performance of doctors depends increasingly on how well they function in teams and how well the health care system around them functions. METHODS: This paper reflects the combined experiences of a group of experienced education researchers and the results of literature searches on performance assessment methods. CONCLUSION: Measurement of competence is different to measurement of performance. Components of performance could be re-conceptualised within a different domain structure. Assessment methods may be of a different utility to that in competence assessment and, indeed, of different utility according to the purpose of the assessment. An exploration of the utility of potential performance assessment methods suggests significant gaps that indicate priority areas for research and development.

Clinical Competence↗
PubMed2002

Is insight important? measuring capacity to change performance.

BACKGROUND: Some doctors who perform poorly appear not to be aware of how their performance compares with accepted practice. The way that professionals maintain their existing expertise and acquire new knowledge and skills - that is, maintain their 'currency' of practice - requires a capacity to change. This capacity to change probably requires the individual doctor to possess insight into his or her performance as well as motivation to change. There may be a range of levels of insight in different individuals. At some point this reaches a level which is inadequate for effective self-regulation. Insight and performance may be critically related and there are instances where increasing insight in the presence of decreasing performance can also cause difficulties. OBJECTIVE: This paper presents an exploration into the nature of insight, its relationship to professional performance and its measurement as part of performance, reflecting the combined experiences of a group of experienced education researchers and the results of literature searches on insight and performance. CONCLUSION: There may be individuals in whom insight is so lacking that they are beyond remediation. If there is a dichotomy between adequate and inadequate levels of insight, testing this could be a cost-effective way of determining where efforts for remediation should be focussed.

Clinical Competence↗
PubMed2001

Setting performance standards for medical practice: a theoretical framework.

BACKGROUND: The assessment of performance in the real world of medical practice is now widely accepted as the goal of assessment at the postgraduate level. This is largely a validity issue, as it is recognised that tests of knowledge and in clinical simulations cannot on their own really measure how medical practitioners function in the broader health care system. However, the development of standards for performance-based assessment is not as well understood as in competency assessment, where simulations can more readily reflect narrower issues of knowledge and skills. This paper proposes a theoretical framework for the development of standards that reflect the more complex world in which experienced medical practitioners work. METHODS: The paper reflects the combined experiences of a group of education researchers and the results of literature searches that included identifying current health system data sources that might contribute information to the measurement of standards. CONCLUSION: Standards that reflect the complexity of medical practice may best be developed through an "expert systems" analysis of clinical conditions for which desired health care outcomes reflect the contribution of several health professionals within a complex, three-dimensional, contextual model. Examples of the model are provided, but further work is needed to test validity and measurability.

Clinical Competence↗
PubMed2000

Is Australian rural practice changing? Findings from the National Rural General Practice Study.

The National Rural General Practice Study (NRGPS) was the first comprehensive national study covering rural and remote general practitioners throughout Australia. It was undertaken in 1996-1997 and drew on data from existing sources such as the Australian Bureau of Statistics and the Australian Institute of Health and Welfare, together with a postal survey of general practitioners in rural and remote areas. There was a 75% response rate to the survey, which covered professional issues, personal and social issues, personal background, patient issues, recruitment and retention programs and changing health services. Overall, the study findings confirmed those of previous individual State-based studies in the early 1990s and showed that there had been some changes since those previous studies. In particular, access to continuing medical education has improved, the rural medical workforce appears to be ageing, the proportion of women rural doctors is increasing and the projected length of stay in rural practice is decreasing. Whereas in the early 1990s the projection for rural doctor numbers was continuing decline, the NRGPS projected overall numbers in rural practice as staying approximately the same over the next 5 years. In the light of these trends, the challenge is to implement targeted initiatives that improve the recruitment and retention of rural and remote general practitioners.

Adult↗
PubMed2000

From science to application: the development of an intervention package.

Many community-based organizations and health departments want to implement HIV prevention interventions with scientifically demonstrated effectiveness. The Replicating Effective Programs (REP) project supported researchers in developing intervention packages designed to help prevention partners replicate effective programs in their settings. Intervention packages convey the intervention's foundation, components, and methods and are one part of a larger system needed to transfer research-based HIV prevention technology to service providers. Implementation packages were developed using a multistage process. The original researchers drafted the materials, advisory groups reviewed the packages, and adopting agencies used the materials in trial runs. The advisory groups and adopting agencies recommended extensive use of examples, thorough explanations about the rationale for each intervention component, explicit representation of people of color in the materials, clear statements about the intended audience(s), and an easy-to-use and visually appealing format. Packages were revised based on these recommendations and the outcomes of the trial runs.

Community Health Services↗
PubMed2000

Transfer of research-based HIV prevention interventions to community service providers: fidelity and adaptation.

HIV prevention research interventions usually follow protocols with specific procedures. If a community-delivered intervention uses the same procedures with the same populations as those in the original research, the behavior change effects should be similar. However, community-based providers may not replicate an intervention exactly as it was conducted in the effectiveness study. Adaptation may be needed to better meet the needs of the clients, community, or organization. We propose that interventions can be defined in terms of core elements likely to be responsible for effectiveness. These core elements cannot be changed without fundamentally changing the intervention, whereas other characteristics may be modified without altering effectiveness. HIV prevention researchers and service providers can collaborate to develop interventions that not only are effective but can also be successfully implemented by service organizations. If researchers actively involve service providers and community members in intervention planning, technology transfer goals can be better achieved.

Community Health Services↗
PubMed1999

Mobilizing young gay and bisexual men for HIV prevention: a two-community study.

BACKGROUND: To develop, implement and evaluate a community-level HIV prevention program (the Mpowerment Project) for young gay men in two US communities. DESIGN: Using a multiple baseline design, a cohort of young gay men was recruited independently of the intervention in each community and surveyed twice (1 year apart) regarding sexual risk behavior and psychosexual variables. The intervention was then implemented sequentially in each community. The cohorts were resurveyed immediately post- and 1-year post-intervention. Since there were few differences between the two communities, data were pooled to increase statistical power. INTERVENTION: The program had four components: peer outreach, whereby young gay men encouraged other men to engage in safer sex; peer-led small groups; a publicity campaign; and a young men's center. RESULTS: Baseline rates of unprotected anal intercourse were stable. Following intervention, the proportion of men who engaged in unprotected anal intercourse decreased from 38.3 to 30.9% (-19.3% relative reduction), with a reduction from 19.2 to 13.6% (-29.2% relative reduction) with non-primary partners, and a reduction from 57.7 to 41.8% (-27.6% relative reduction) with boyfriends. Reductions were sustained 1 year later with non-primary partners, but mixed results were found regarding sex with boyfriends. CONCLUSIONS: Mobilizing young gay men to support each other about safer sex is an effective approach to HIV prevention, but programs must be sustained. To reach young gay men, HIV prevention activities must be embedded into the satisfaction of needs for social and community belonging.

Adolescent↗
PubMed1999

Factors related to the willingness of young gay men to participate in preventive HIV vaccine trials.

Given their high seroincidence, young gay men will be targeted for recruitment into HIV vaccine trials but many challenges stand in the way of enlisting their cooperation. This study examined factors associated with young gay men's willingness to participate in vaccine trials and identified reasons for agreeing or not agreeing to participate. The data come from the Young Men's Survey, a cohort of western U.S. young gay men aged 18 to 29 years, surveyed using mail-back questionnaires. Participants who reported being HIV-negative or who had not been tested for HIV (n = 390) were asked to rate their desire to be given an HIV vaccine and their degree of willingness to participate in a vaccine trial. They also responded to open-ended questions regarding their reasons for participating or not participating. Of these respondents, 91% wanted to be given an HIV vaccine, yet many had serious reservations about participating in a vaccine trial. Men who had engaged in HIV risk behavior reported greater willingness to participate. The most common reasons for wanting to participate were desires to contribute to ending the AIDS epidemic and desire to help others; however, fears for one's own health and safety made many reluctant to participate.

AIDS Vaccines↗
PubMed1999

Analysis by training status of performance in the certification examination for Australian family doctors.

OBJECTIVES: Following recent changes to eligibility requirements for recognition as a general practitioner in Australia, an increasing proportion of candidates select the non-training, or practice-eligible, route to the RACGP Fellowship Examination, without the benefit of formal general practice training. DESIGN: Pass rates for the training and practice-eligible cohorts from the 1996 and 1997 examinations were determined and compared. SETTING: Royal Australian College of General Practitioners (RACGP). SUBJECTS: General practitioner candidates for the RACGP. RESULTS: The analysis of the 1996 and 1997 examinations showed that the overall pass rate and individual examination segment scores of the practice-eligible route candidates were lower than those for candidates from the training route. CONCLUSIONS: The observed difference in performance is more probably due to different preparation for the examination than any systematic bias against particular groups of candidates. All candidates for the examination would benefit from exposure to the general practice curriculum and supervised experience in Australian general practice.

Australia↗
PubMed1999

Improving educational needs assessment for general practitioners.

OBJECTIVE: To improve the quality of educational needs analysis for groups of general practitioners through the development of a range of simple, inexpensive practice based performance measures of general practice. METHOD: Members of one volunteer semi rural division of general practice were allocated randomly to groups that collected or provided data on: local referral patterns; consulting, prescribing and ordering, as collected by the Health Insurance Commission; and age, gender, reasons for encounter and management of a sample of patients. Other information was provided by a recent division community needs analysis, a consumer survey, national health targets and local health professionals. These data were combined to develop a list of educational topics that deserved attention. RESULTS: A total of 56% of GPs agreed to participate, providing Health Insurance Commission data for seven GPs, referral patterns for 11 GPs and BEACH surveys for five GPs. Much of the data collected for other purposes proved to be of little value in determining specific educational needs and the more time consuming methods attracted poor participation rates. The most useful data were those collected locally by the division. CONCLUSION: Educational needs analyses for groups of GPs should consider the perspectives of the profession, funders and patients, in addition to those of individual GPs. Practice based measures of GP performance need to be made more relevant to current practice, while remaining inexpensive and not intruding too much into GPs' time. A range of potential measures is provided.

Australia↗