PubMed · 10497499
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R Melifonwu. Supporting act.. https://doi.org/10.7748/ns.13.40.18.s34
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This paper reports findings from a study funded by the National Board for Nursing, Midwifery and Health Visiting for Scotland to test selected nursing and midwifery clinical competence assessment tools for reliability and validity. The study, which took place over two years from July 1997, involved comparing items in the selected tools with statutory competencies for nurses and midwives, collecting assessment data from a sample of 257 nursing and 43 midwifery students in four educational institutions and administering additional assessment measures (the Nursing Competencies Questionnaire (NCQ) (Bartlett et al., An evaluation of pre-registration nursing education: a literature review and comparative study of graduate outcomes, Oxford Centre for Health Care Research & Development, Oxford Brookes University, Oxford, 1998) and the Key Areas Assessment Instrument-KAAI) to the total student sample (and to their lecturers and practice assessors) at two time points which were six months apart. Our focus was the programme-specific clinical competence assessment tools but by testing these tools we also provide evidence on the validity of other methods of competence assessment. Validity of the methods was assessed, primarily, by calculating multivariate and univariate correlation coefficients between them. The NCQ and KAAI were analysed for internal consistency. The NCQ and the versions of KAAI for lecturers and practice assessors were found to have good internal consistency. The version of the KAAI tool developed for students showed reasonable internal consistency for nursing students, but less consistency for midwifery students. Correlational analysis of data collected on students showed that there is little or no relationship between most of the clinical competence assessment methods in current use, or between these methods and those introduced by the research team. This finding supports previous research, particularly in medical education and confirms that the different methods address different abilities.A clear finding from this study is that no single method is appropriate for assessing clinical competence. A multi-method UK-wide strategy for clinical competence assessment for nursing and midwifery is needed if we are to be sure that assessment reveals whether or not students have achieved the complex repertoire of knowledge, skills and attitudes required for competent practice.
BACKGROUND: The professional standards of international medical graduates have been the subject of controversy, but empirical research on this topic has been limited. OBJECTIVES: This report considers whether international medical graduates are at greater risk than US medical graduates for exclusion by the federal government from federally funded programs, such as Medicare and Medicaid. RESEARCH DESIGN: The list of excluded physicians was merged with data regarding 87,729 family and general practice physicians from the American Medical Association Physician Masterfile, 555 of whom were currently excluded. Logistic regression was used to estimate the effect of international medical graduate status on the probability of exclusion, controlling for board-certification status and other physician characteristics. International medical graduates from high-income Organization for Economic Cooperation and Development (OECD) countries are distinguished from other international medical graduates. RESULTS: The adjusted exclusion rates of international medical graduates from OECD countries were similar to that of US medical graduates. Among board-certified physicians, the relative risk of exclusion of non-OECD international medical graduates was 2.19 (P <0.001) compared with US medical graduates. Board certification had an even stronger association: US medical graduates who had never been board certified had a relative risk of 4.12 (P <0.001) compared with board-certified US medical graduates. The never board-certified relative risk was 1.72 (P <0.001) among non-OECD international medical graduates compared with board-certified graduates. Among physicians who had never been board certified, rates of US and international medical graduates did not differ substantially. CONCLUSIONS: Further investigation is needed regarding the causal determinants of exclusion disparities. It is unclear to what extent these disparities may reflect differences in ethical conduct, quality of care, or prejudicial enforcement practices, and the extent to which board certification can causally reduce actions leading to exclusion.
This article examines the level and conditions of development of the concept of "health promoting hospital (HPH)", in France and in Europe. Part of the literature on HPH was reviewed, looking at the kind of partnerships implemented within the HPH projects, and at the organisational strategies adopted by hospitals to be health promoting. The literature review is followed by an overview of the priorities defined by health policies in Europe. This research shows that there is still a lack of guidelines on how to put the health promotion concept into practice in health care settings. Moreover, it stresses that further research is needed in order to better define which personal skills ought to be developed through health education in health care settings, and how the development of such skills may be articulated to other priorities in health care settings.