Inter-observer error among surgeons and nurses in presymptomatic detection of breast disease.
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Biomedical subjects
Publications and source records attributed to W O Spitzer.
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Multiple choice questions used in continuing medical education may require characteristics different from those used in tests and examinations. The questions of three continuing education exercise were assessed by 48 board certified family physicians. Each physician answered one third of the questions and then judged them on usefulness in patient management, as discriminators of quality of medical care, and on educational value. The relevance of each question was determined by a composite index based on these factors. The content of each question was independently analyzed by three physicians. Relevant questions tended to be those concerned with surgery, symptoms, and management, and those requiring more than simple factual recall. Questions on office management or concerning specific diagnoses were considered less relevant. Neither the manner of asking the question nor the severity of the illness appeared to influence relevance. This information should benefit those developing continuing education programs for family physicians, especially those designed for self-administered individual learning.
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The Core Content Review of Family Medicine was assessed for its relevance to family practice. Three sets of questionnaires were completed and assessed by 48 experienced, certificated family physicians, of whom half were faculty members from university departments of family medicine and half were in private practice. The answers to 57% of the questions were correct. In the opinion of the panelists the answers to 62% of the questions permitted discrimination between physicians providing care of good quality and those providing care that was less than adequate. The panelists rated 78% of the questions as being educationally useful. Two thirds of the questions were deemed relevant according to a composite criterion. Examples are given of the questions considered most relevant and of those considered least relevant.
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For several years, the government of Ontario has undertaken to foster and develop experimental systems for the delivery of primary health care in the province. At the same time, the government wished to devise a strategy whereby the new health care programs could be rigorously evaluated. A Task Force on Evaluation of Primary Health Care Services produced a plan which yields quantitative information about the function of primary health care units. Three essential indexes of performances, comprising categories of Utilization and Financial Performance (UF-Index), Availability, Accessibility and Scope of Services (A-Index) and Quality of Care (Q-Index), were designed. Two additional quantitative indexes, Consumer Satisfaction and Health Professional Satisfaction, were proposed. The derivation and determination of the three essential indexes are provided in the paper in detail, along with acceptable criteria for performance and methods for comparing the performances of different types of practices in different kinds of population.
To meet the growing demand for more innovative teaching in primary care medicine and simultaneously to improve the overall quality of family practice, McGill University and The Montreal General Hospital, with the cooperation of the McGill School of Nursing, have inaugurated a faculty development center offering a program for advanced studies in primary care medicine and nursing. This program is offered to physicians and nurses who are already members of, or plan to join, a university faculty to teach primary care medicine. The program is diverse and interdisciplinary. Advanced courses are offered in teaching methods, investigative principles, biomedical communication, and management. In addition, each student Fellow participates in academic activities in fields of education, clinical practice, research, and community health care. All Fellows and faculty of the center rotate periodically to several satellite community-based teaching practice units in urban and rural areas of Quebec and to a region of northern New Brunswick. This activity enriches the medical manpower of the various regions, and the urgan physicians acquire an increased awareness of the particular problems and challenges of practicing medicine where full hospital and laboratory services are not always available.
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Long-term surveillance of the employment experience and developing roles of 99 nurses and 79 associated physicians who participated in the first 5 years of the McMaster University educational program for family practice nurses was undertaken with a descriptive survey. Data were gathered by mailed questionnaires; a 97.8% response rate was attained. Sociodemographic profiles of both groups and characteristics of the practice setting where copractitioner teams functioned were determined. Selected noteworthy results show that 92.7% of the nurses were currently employed, and that 82.5% of the graduates continued in their original practice. Nurses' time invested in patient care activities increased by 105%; time devoted to clerical and housekeeping duties decreased by 42%. Changes in roles for both categories of copractitioners were important. The interdisciplinary arrangements resulted in appreciable financial disadvantages to physicians and only modest income incentives to nurses. A series of successes of the model of practice under assessment has been identified; offsetting ongoing difficulties and problems have also been enumerated. The data from this project and preceding studies can facilitate the solution of unresolved problems on the basis of evidence rather than opinion.
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The new Utilization and Financial Index (UF-Index) was developed to measure the economic effects of deployment of new health professionals or of other changes in the provision of health services. By means of several steps, information on concurrent use of various categories of health service is converted into a single quantitative index. The index has been used to evaluate the financial effects of introduction of nurse practitioners into primary care practices by means of two complementary studies.