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PubMed2003

Graduates' perceptions of their clinical competencies in allergy and immunology: results of a survey.

PURPOSE: The Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) have identified six areas of general competency. This study surveyed graduates of allergy and immunology training programs about their perceived clinical competency and the adequacy of their subspecialty training. METHOD: In August 2000 and May 2001, a questionnaire was mailed to 373 physicians who had completed a fellowship in allergy and immunology in the United States between 1995 and 2001. Physicians were asked to rate the perceived importance and adequacy of their training in, and their level of competency for, 57 general competencies and subspecialty-specific competencies and procedures. RESULTS: A total of 253 physicians responded (68%). All items in the six ACGME/ABMS general competencies had high ratings (>/= 90%) for perceived importance. One item in the practice-based learning area had low ratings for adequacy of training (57%) and intermediate for competency (75%). Two items in the system-based practice area had low ratings for training (65% and 67%) and intermediate for competency (86% and 88%). Generally, core specialty-specific items (allergic rhinitis, asthma, and urticaria) had high ratings (>/= 90%) for importance, training, and competency. Without exception, items with ratings of less than 70% for adequacy of training also had ratings of less than 90% for competency. CONCLUSION: The general competencies were considered important, but training in system-based practice and practice-based learning may be deficient. Although self-perceived competency in core areas of allergy and immunology was high, weaknesses in training and self-perceived competency in selected areas were identified.

Adult↗
PubMed1981

The validity and reliability of a new examination of the clinical competence of medical students.

In a previous study we described a problem-based criterion-referenced test of the clinical competence of medical students which was felt to offer advantages over the traditional final-year examination. This paper reports the validity and reliability studies on which it is possible to judge the value of this new test when compared to the traditional approach. The results demonstrate a high level of content validity and provide evidence of the construct validity of the test. Efforts to obtain measures of concurrent and predictive validity were thwarted by a failure to attain reliable assessments of ward performance from resident and consultant staff. Satisfactory levels of internal consistency were established for the whole test. Marker reliability was satisfactory in all sections of the test except for those requiring examiners to rate practical clinical skills. This was so despite the use of simulated patients, behavioural check-lists and rater training. Possible solutions to this problem are discussed. It is concluded that this new approach overcomes many of the measurement problems inherent in the traditional final examination. It has been shown to be feasible to construct and administer in the medical school setting without the need for the allocation of additional resources.

Australia↗
PubMed1982

The impact of early specialization on the clinical competence of residents.

To study the relation between first-year postgraduate training and performance on a test of general clinical competence, we analyzed results on the Part III National Board Examination according to the type of residency chosen by 1514 graduates of Jefferson Medical College between 1970 and 1979. The results show that physicians in family medicine, internal medicine, or flexible programs score higher on Part III than do those in surgery, pediatrics, obstetrics/gynecology, psychiatry, or pathology, even after correction for their performance on Part II of the boards. Although these differences could be due to other factors, we suggest that in the first year of some residency programs, knowledge and skills in broad areas of medicine are not being sufficiently emphasized, and that changes are needed to strengthen the residents' general capabilities.

Clinical Competence↗
PubMed2000

Clinical competence in pain assessment.

Our knowledge about the content of the clinical knowledge used by nurses in a surgical recovery unit for assessment of postoperative pain is fairly limited. The aim of the present study was to analyse and describe the variations of nurses' conceptions of the impact of clinical experience on competence in post-operative pain assessment. The informants consist of critical care nurses. A phenomenographical approach has been applied to tape-recorded interview data. The results reveal that clinical competence in pain assessment was described in three categories: (a) to be able to see; (b) to be able to differentiate; (c) to be able to give. The observations articulate what nurses perceive that they have learnt from experience in performing many clinical pain assessments and point to some difficulties in using a single-data source for the development of valid and truthful professional knowledge. In the development of professional experience, it is of the utmost importance to be able to change perspective from what is most frequent and general to what is special and unique, to base one's standpoint on the individual patient's experience and integrate this with previous professional experience.

Adult↗
PubMed2000

But can they do it? Clinical competency assessment.

There are four distinct steps in the development of an effective competency assessment process. Step 1 is the definition of competency criteria in consultation with prospective employers. Step 2 is the selection of assessment tools. The method or tool that will provide a comprehensive, reliable, valid and cost-effective measure of clinical competence does not currently exist; therefore the judicious selection of the right combination of evaluation methods based on predetermined competency criteria is crucial. Step 3 is implementation of the selected assessment tools, followed by Step 4, evaluation of the process and any changes in the work environment. Then the cycle is instituted again with redefinition of competency criteria if indicated.

Clinical Competence↗
PubMedDate not supplied

Tracking clinical competencies on the web.

CONTEXT: The American Registry of Radiologic Technologists (ARRT) has defined several core examinations that student radiographers must perform to demonstrate competency. Furthermore, the ARRT has left the method of tracking competency exams to educators. OBJECTIVE: This article describes a Web-based system that can be used to track clinical competencies. METHOD: The pedagogy employed in designing a meaningful and successful Web site to track competencies can be overwhelming. Considerations include selecting software, the design and implementation process, and providing security to protect confidential information. CONCLUSION: The Web-based system described in this article is innovative, sensible and relatively easy to adopt. This tracking method provides faculty members with instantaneous access and a quick review of the student's competency examinations. Students' competency information for the entire program is contained in 1 electronic file. With minor modification, the system can be used in a variety of educational and administrative settings.

Certification↗
PubMed1983

Criteria, purposes, and methods for evaluating the clinical competence of students in the allied health professions.

A review is presented of the methods related to the development of criteria and methods for evaluating the clinical competence of students in the allied health professions. The evaluation instrument should reflect the competencies expected of the student at the entry level of the profession and should be objective, valid, reliable, and practical. Since strengths and limitations are inherent in all types of evaluative techniques, a combination of techniques is desirable. The evaluation process should serve as a means of assessing student performance, improving instruction, evaluating program goals and objectives, and encouraging student development.

Clinical Competence↗
PubMedDate not supplied

Using simulation to evaluate clinical competence after impairment.

It is important for individual dentists and the profession to have access to a process for evaluating the clinical competence of practitioners who are professionally impaired as a result of an accident or a medical disability. No common standards for such evaluations currently exist, however, as demand for this type of assessment is still rare. This article reviews the evaluative approach taken by a team of experienced dental educators in examining three dentists who suffered from medical disabilities. An attempt was made to standardize the evaluation process by using clinical simulation to create an environment that would be comfortable for the dentists and acceptable to the lawyers and the insurance companies. Following evaluation, recommendations on individual competence were made, contributing to a faster resolution of legal and insurance issues.

Adult↗
PubMedDate not supplied

Text-to-algorithm conversion to facilitate comparison of competing clinical guidelines.

This study aimed to test the usefulness and reliability of text-to-algorithm conversion in comparing competing clinical guidelines and defining their differences. Two pairs of competing guidelines for measles immunization, published in 1989 and 1994, were analyzed and compared. Five categories of differences were detected: differences in recommendations, excluded elements, logical inconsistencies, nonspecific phrases, and approaches to contraindications. On a scale of 0-10 (where identical=10), the overall comparison scores were 6.01 for the guidelines published in 1989 and 5.54 for the guidelines published in 1994. Text-to-algorithm conversions performed by three different persons on the 1989 guidelines were compared and found similar. Text-to-algorithm conversion is an important step in facilitating comparison of competing guidelines. It has the potential to assist in making rational and systematic choices between competing guidelines before actual field testing takes place. Physicians can use it to analyze and to learn a prose clinical guideline, to critique existing guidelines, and to simulate hypothetical patients for teaching and evaluating clinical management.

Adolescent↗
PubMed1988

Evaluation of clinical competence in medical oncology training programs.

The American Board of Internal Medicine (ABIM) has asked that directors of medical oncology training programs establish systems to evaluate, document, and substantiate the clinical competence of subspecialty trainees who seek certification. The Board defines the certificable medical oncologist at the completion of training as being competent to provide comprehensive and specialized medical care based on a high standard of demonstrated component skills. These skills clearly exceed those demonstrated by the certified internist. The goal of this expanded evaluation program is to ensure that the public and the profession can identify, through certification, physicians capable of providing a high standard of medical care.

Certification↗
PubMed1988

Evaluation of clinical competence in cardiovascular disease.

The American Board of Internal Medicine has called on directors of cardiology training programs to establish systems to evaluate, document and substantiate those components of overall clinical competence considered essential for certification in the subspecialty. Many of these can be assessed only by repeated direct observations. In particular, proficiency is now required in advanced cardiac life support including cardioversion, electrocardiography (including ambulatory electrocardiographic monitoring) and exercise testing, echocardiography, insertion of arterial lines and right heart catheterization (including insertion of temporary pacemakers). The goal of this expanded evaluation program is to ensure that the public and the profession can identify, through certification, physicians with demonstrated excellence in cardiovascular disease.

Cardiology↗
PubMed1999

A summative evaluation of clinical competence: students' and nurses' perceptions of inpatients' individual physical and emotional needs.

The ability to assess individual patients' physical and emotional needs was used as one foundation for evaluation of clinical competence for Swedish student nurses. Each of the randomly sampled 48 student nurses and their corresponding supervisors (48 nurses) assessed the perceived needs of a patient they both knew well by separately answering a questionnaire concerning basic physical and emotional needs. Simultaneously the selected patients (n = 48) were interviewed about their perceived needs. Student nurses' and nurses' assessments were compared with the individual patient's opinion. Both the students' and the nurses' assessments showed close similarities with the patients' own estimations, although certain under- and overestimations for both physical and emotional needs were found, with a predominance of overestimation of emotional needs. Student nurses and nurses also showed uncertainty in some of their assessments, mainly concerning emotional needs. Their assessments were closer than student nurses/patients or nurses/patients, and also closer for physical than for emotional needs. The conformity in student nurses' and their supervisors' assessments might be understood as the supervisors' influence as role models. Attention should be paid both in nursing education and in clinical practice to the need for individualization of patient care.

Adult↗
PubMedDate not supplied

Standardizing the assessment of clinical competence: an overview of intensive care course design.

Rationale for the development of the Certificate in Health Studies: Intensive Care and High Dependency for Adults course developed at Queens University Belfast, Northern Ireland. Structure and content of clinical module reviewed. Clinical assessment strategy discussed. Focus on the utilization of a standardized portfolio, individualized learning contract and objective structured clinical examination (OSCE) to evaluate clinical competence. Evaluation of OSCE as an assessment tool and of the course provision.

Achievement↗
PubMed1988

Evaluation of clinical competence in pulmonary disease.

The American Board of Internal Medicine has called upon directors of pulmonary disease training programs to establish systems to evaluate, document, and substantiate those components of overall clinical competence considered essential for certification in the subspecialty. Many of these can be assessed only by repeated direct observations. In particular, proficiency is now required in endotracheal intubation, fiberoptic bronchoscopy, mechanical ventilatory support, thoracentesis and percutaneous pleural biopsy, percutaneous arterial puncture, vascular monitoring, calibration and operation of hemodynamic recording systems, and supervision of the technical aspects of pulmonary function testing. The goal of this expanded evaluation program is to ensure that the public and the profession can identify through certification, physicians with demonstrated excellence in the practice of pulmonology.

Certification↗
PubMed2003

Pelvic examination teaching: linking medical student professionalism and clinical competence.

The Professional Patient teaching program is an essential part of assuring competency in the performance of the pelvic examination and professional behaviors. Through a series of integrated teaching sessions from the first year reproductive anatomy laboratory, the second year basic clinical pelvic examination teaching program, to the third year teaching program, students perform at an enhanced level of clinical competency and professional behavior. A Professional Patient commented: "We create a safe environment where medical students not only learn the clinical portion of the exam, but also focus on the patient as the primary source of information on patient comfort. Students receive immediate feedback from us and have ample opportunity to ask questions about aspects of the clinical pelvic examination or doctor/patient communication skills. We guide them, teach them, and help them prepare for examinations with other patients who will not be as open or in tune with their bodies as we are."

Anxiety↗