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Biomedical subjects

Rachel Yudkowsky

Publications and source records attributed to Rachel Yudkowsky.

13 recordsLinked to original sources
PubMed2006

Prior experiences associated with residents' scores on a communication and interpersonal skill OSCE.

OBJECTIVE: This exploratory study investigated whether prior task experience and comfort correlate with scores on an assessment of patient-centered communication. METHODS: A six-station standardized patient exam assessed patient-centered communication of 79 PGY2-3 residents in Internal Medicine and Family Medicine. A survey provided information on prior experiences. t-tests, correlations, and multi-factorial ANOVA explored relationship between scores and experiences. RESULTS: Experience with a task predicted comfort but did not predict communication scores. Comfort was moderately correlated with communication scores for some tasks; residents who were less comfortable were indeed less skilled, but greater comfort did not predict higher scores. Female gender and medical school experiences with standardized patients along with training in patient-centered interviewing were associated with higher scores. Residents without standardized patient experiences in medical school were almost five times more likely to be rejected by patients. CONCLUSIONS: Task experience alone does not guarantee better communication, and may instill a false sense of confidence. Experiences with standardized patients during medical school, especially in combination with interviewing courses, may provide an element of "deliberate practice" and have a long-term impact on communication skills. PRACTICE IMPLICATIONS: The combination of didactic courses and practice with standardized patients may promote a patient-centered approach.

Analysis of Variance↗
PubMed2006

Developing an institution-based assessment of resident communication and interpersonal skills.

PURPOSE: The authors describe the development and validation of an institution-wide, cross-specialty assessment of residents' communication and interpersonal skills, including related components of patient care and professionalism. METHOD: Residency program faculty, the department of medical education, and the Clinical Performance Center at the University of Illinois at Chicago College of Medicine collaborated to develop six standardized patient-based clinical simulations. The standardized patients rated the residents' performance. The assessment was piloted in 2003 for internal medicine and family medicine and was subsequently adapted for other specialties, including surgery, pediatrics, obstetrics-gynecology, and neurology. We present validity evidence based on the content, internal structure, relationship to other variables, feasibility, acceptability, and impact of the 2003 assessment. RESULTS: Seventy-nine internal medicine and family medicine residents participated in the initial administration of the assessment. A factor analysis of the 18 communication scale items resulted in two factors interpretable as "communication" and "interpersonal skills." Median internal consistency of the scale (coefficient alpha) was 0.91. Generalizability of the assessment ranged from 0.57 to 0.82 across specialties. Case-specific items provided information about group-level deficiencies. Cost of the assessment was about $250 per resident. Once the initial cases had been developed and piloted, they could be adapted for other specialties with minimal additional effort, at a cost saving of about $1,000 per program. CONCLUSION: Centrally developed, institution-wide competency assessment uses resources efficiently to relieve individual programs of the need to "reinvent the wheel" and provides program directors and residents with useful information for individual and programmatic review.

Clinical Competence↗
PubMed2006

Procedures for establishing defensible absolute passing scores on performance examinations in health professions education.

BACKGROUND: Establishing credible, defensible, and acceptable passing scores for performance-type examinations in real-world settings is a challenge for health professions educators. Our purpose in this article is to provide step-by-step instructions with worked examples for 5 absolute standard-setting methods that can be used to establish acceptable passing scores for performance examinations such as Objective Structured Clinical Examinations or standardized patient encounters. SUMMARY: All standards reflect the subjective opinions of experts. In this "how-to" article, we demonstrate procedures for systematically capturing these expert opinions using 5 research-based methods (Angoff, Ebel, Hofstee, Borderline Group, and Contrasting Groups). We discuss issues relating to selection of judges, use of performance data, and decision-making processes. CONCLUSIONS: Different standard-setting methods produce different passing scores; there is no "gold standard." The key to defensible standards lies in the choice of credible judges and in the use of a systematic approach to collecting their judgments. Ultimately, all standards are policy decisions.

Clinical Competence↗
PubMed2004

Assessing the head-to-toe physical examination skills of medical students.

Second-year medical students performed a head-to-toe screening physical examination on trained patient instructors (PIs) as a high-stakes examination before beginning clinical clerkships. PIs completed a 138-item checklist and instructed the students in the proper performance of any incorrectly executed or omitted items. To assess the accuracy of the PI ratings, 'monitor' PIs watching the encounter by video completed checklists for 11 retests of failed students in 2001 and for 28 randomly selected encounters in 2002. Checklist-level discrepancies measured by mean absolute checklist difference were 8% in 2001 and 9% in 2002. Case-level mean difference between raters in 2002 was -2.9%. The inter-rater reliability for a single rater, estimated by the intra-class correlation coefficient for total encounter scores, was 0.95. The assessment and feedback were well received by the students. The Head-to-Toe examination provides a reliable assessment of a student's ability to carry out a complete screening physical examination. Patient instructors can be trained to acceptable accuracy and reliability despite the length and complexity of the exercise, and can provide effective feedback and teaching targeted to individual student deficiencies.

Clinical Competence↗
PubMed2004

Toward meaningful evaluation of clinical competence: the role of direct observation in clerkship ratings.

PROBLEM STATEMENT AND PURPOSE: The lack of direct observation by faculty may affect meaningful judgments of clinical competence. The purpose of this study was to explore the influence of direct observation on reliability and validity evidence for family medicine clerkship ratings of clinical performance. METHOD: Preceptors rating family medicine clerks (n = 172) on a 16-item evaluation instrument noted the data-source for each rating: note review, case discussion, and/or direct observation. Mean data-source scores were computed and categorized as low, medium or high, with the high-score group including the most direct observation. Analyses examined the influence of data-source on interrater agreement and associations between clerkship clinical scores (CCS) and scores from the National Board of Medical Examiners (NBME(R)) subject examination as well as a fourth-year standardized patient-based clinical competence examination (M4CCE). RESULTS: Interrater reliability increased as a function of data-source; for the low, medium, and high groups, intraclass correlation coefficients were.29,.50, and.74, respectively. For the high-score group, there were significant positive correlations between CCS and NBME score (r =.311, p =.054); and between CCS and M4CCE (r =.423, p =.009). CONCLUSION: Reliability and validity evidence for clinical competence is enhanced when more direct observation is included as a basis for clerkship ratings.

Certification↗
PubMed2003

Using standardised students in faculty development workshops to improve clinical teaching skills.

PURPOSE: We describe the use of standardised students (SSs) in interdisciplinary faculty development programmes to improve clinical teaching skills. Standardised students are actual health professions students who are trained to portray a prototypical teaching challenge consistently across many encounters with different faculty participants. METHODS: The faculty development programmes described focused on the skills of providing feedback and brief clinical teaching. At the beginning of each session, each participant was videotaped in encounters with 2 different SSs. Using microteaching (an instructional method in which learners view short segments of their own videotaped performance and discuss the tapes with a facilitator, consultant or other workshop participants), each group of participants and instructors reviewed the tapes and reflected on the encounters, providing immediate feedback to participants and modelling different approaches to the same teaching problem. The same process was repeated with more complicated scenarios after 2 weeks and again after 6 months offering reinforcement, further practice and more sophisticated development of the strategies learned. Participants completed post-session evaluations and a follow-up telephone survey. RESULTS: A total of 36 faculty members from the colleges of medicine, dentistry, pharmacy and nursing participated in workshops in 2000-01. The workshops were rated as highly relevant to participants' teaching, and most participants reported that they had learned a great deal. Participants most appreciated reviewing the videotaped interactions, the feedback they received, the interactions with their colleagues, the interdisciplinary nature of the groups and the practical focus of the workshops. CONCLUSIONS: Standardised students provide a high fidelity, low risk, simulated environment in which faculty can reflect on and experiment with new teaching behaviours. Such encounters can enhance the effectiveness and impact of faculty development programmes to improve clinical teaching skills.

Clinical Competence↗
PubMed2002

Two perspectives on the indicators of quality in psychiatry residencies: program directors' and residents'.

PURPOSE: To determine whether psychiatry program directors and residents agree on the characteristics most important in determining the quality of a residency program. METHOD: The authors carried out factor analyses of the results of two national surveys that asked participants to rate the importance of 41 items in determining the quality of residency programs: a 1997 survey completed by 180 psychiatry residents and a 1998 survey completed by 234 psychiatry program directors and rotation heads. RESULTS: Residents' factors determining program quality were the interpersonal culture in the program, the curriculum, academic resources and opportunities, clinical resources and opportunities, and outcomes. Program directors' factors were program administration, curriculum and clinical resources, the quality of the institution, the supportiveness of the program, and individual preferences. CONCLUSIONS: Program directors and residents focus on different indicators of the quality of residency programs, differences that can be conceptualized as those between the "producer" and the "consumer" of the program. Four domains appear to underlie the results of the resident and faculty factor analyses: the context, content, culture, and consequences of the program. Multidimensional evaluations by multiple stakeholders may be the most appropriate way to evaluate the quality of residency programs. These results also strongly suggest that the interpersonal culture of a program should be assessed as part of its evaluation process.

Attitude of Health Personnel↗
PubMed2002

Microteaching and standardized students support faculty development for clinical teaching.

OBJECTIVE: If faculty development programs are to have impact, we believe they should be made up of several self-reinforcing workshops that provide opportunities for behavior review, practice, reflection, and reinforcement within a context of interdisciplinary perspectives. A program was developed that supports these four activities and includes clinical faculty from medicine, dentistry, nursing, and pharmacy. DESCRIPTION: At the University of Illinois at Chicago we have focused our efforts to improve clinical teaching through a program of two parallel courses. One course focuses on the "one-minute teacher" approach to clinical teaching. We call this course "Teaching-on-the-Fly," reflecting what many of our faculty attendees have suggested they do. The second course is "Feedback Strategies." The two courses are identical in format, which is a series of three three-to-four-hour small-group workshops of not more than eight participants. The first two workshops in each series are titled "Teaching-on-the-Fly I and II" and "Feedback Strategies I and II," respectively. Workshop I is separated from Workshop II by two weeks. During this hiatus faculty are urged to practice the skills learned and to reflect on what worked and what did not work in Workshop I. Six months following both series' Workshop II, "Advanced Teaching-on-the-Fly" and "Advanced Feedback Strategies" workshops are held. Each workshop begins with videotaping of two separate teaching encounters in which each participant interacts with standardized students. Standardized student and clinical faculty interactions are meant to mimic typical teaching and feedback situations. Teaching encounters are limited to five minutes, maximizing the similarity to the stress and frenetic quality of many of today's clinical settings. In Workshop II and in the advanced workshops the standardized students offer one positive comment to the faculty immediately following their encounter. Students are taught how to give this feedback. Immediately after videotaping, faculty adjourn to a small-group discussion. Workshops consist of reflective discussions during the review of each participant's videotape, brief lectures, and responsive comments and instruction by the workshop leaders. Participants are asked to reflect on each workshop and to bring examples of problems and opportunities gained to succeeding workshops in the series. DISCUSSION: Several theories support these clinical teaching workshops. (1) Outcomes research in continuing medical education suggests the need for ongoing reinforcement, which we do structurally through the three-session model. (2) We use a classical microteaching approach to develop insight and self-awareness. Each videotaped encounter is reviewed, stopped at key points, and discussed by the entire group. These discussions commonly open up after the workshop leaders ask questions such as, "What were you thinking there?" or "What were you trying to do?" or "What would you ask next?" (3) We emphasize the importance of knowing-in-action and the related reflection that guides action in practice. (4) The quality of the workshops is enhanced using standardized students, whom we carefully train and use repeatedly. At least two students have worked with us from their first years through their final clinical years. We are currently examining the program's impact through videotape review.

Education, Medical, Continuing↗
PubMed2002

Using standardized patients for formative feedback in an introduction to psychotherapy course.

Standardized patients (SPs) were used in a 9-week Introduction to Psychodynamic Psychotherapy course for 11 first-year psychiatry residents. After 7 weeks of coursework, each resident conducted a simulated initial psychotherapy session. The SPs used were experienced in simulating psychiatric disorders and were free to use as much or as little personal history as they wished. Session ratings by the SPs afforded written feedback to the residents. The sessions were videotaped and selected segments viewed and discussed by the class. Residents kept their tapes and were encouraged to review them on their own and with their supervisors. Residents, SPs, and class instructor all rated the experience very positively. Standardized patients may be a useful adjunct to psychotherapy education. They can provide valuable learning opportunities without giving rise to concerns that complicate the videotaping of actual patients.

Journal Article↗
PubMedDate not supplied

Beyond fulfilling the core competencies: an objective structured clinical examination to assess communication and interpersonal skills in a surgical residency.

OBJECTIVE: The Accreditation Council for Graduate Medical Education (ACGME) has challenged program directors to assess their residents' core competencies, including communication and interpersonal skills (CIS). We report our institution's experience using a series of standardized patient encounters in an objective structured clinical examination (OSCE) to evaluate CIS in surgical residents. METHODS: Standardized patients rated the residents' ability to maintain a patient-centered approach across 6 challenging communication tasks. Residents received verbal feedback from the patients after each encounter and completed a survey indicating their experience and comfort with each task. Individual and group reports documented resident competency and provided aggregate information for curriculum review. Formal grades were not assigned. RESULTS: Twenty-two residents in 2 surgical residency programs piloted the assessment. The Generalizability of the assessment was 0.81. Scores of second- and third-year residents were not significantly different. Residents found the program to be helpful and able to assess their skills. CONCLUSIONS: The standardized patient-based OSCE is an effective method to assess communication and interpersonal skills and provides useful information for curriculum review.

Communication↗