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At least 235 records · Page 13Linked to original sources
PubMed1979

Chart review skills: a dimension of clinical competence.

A study of undergraduate medical students' abilities to identify salient information in reviewing patient charts was conducted by members of the Department of Surgery at Southern Illinois University School of Medicine. Specific goals of the two-year study were to develop and test a method for assessing chart skills and to test the following hypotheses: (a) knowledge base is a component of chart review skill; (b) chart skills are related to basic observational skills; (c) performance on one chart is positively correlated with performance on other charts; (d) chart performance is affected by distraction and time pressure; and (e) chart performance improves with clinical experience. Evaluation instruments and methodology are described. Hypotheses a, b, and e and the time effect hypothesized in d were supported; hypothesis c was not supported. Results of the study provide a foundation for further research exploring the effect of instruction on chart performance and investigating the relationships between chart performance and other measures of clinical competence.

Clinical Competence↗
PubMed2002

Grappling with the evaluation of clinical competencies: a view from the Residency Review Committee for Urology.

We sought to highlight the perspective of the Residency Review Committee for Urology regarding the current changes in residency program accreditation. Although the pedagogic underpinnings of the shift of the American Committee for Graduate Medical Education to outcomes-based accreditation appear solid, several concerns were raised by the Residency Review Committee for Urology: the paucity of effective evaluation tools, the likely increased expense of these measures, and the lack of evidence that these changes will ultimately improve the training of residents. As a result, the Committee plans to continue cautiously (but optimistically) in the process of incorporating the teaching and evaluation of the clinical competencies in the program requirements.

Accreditation↗
PubMed1999

[Evaluation of clinical competence. The immediate future of nursing].

In this article, the authors analyze the concept of professional competence and they describe some of the methods destined to be used in the evaluation of said competence in nursing professionals. The authors describe different levels of professional performance to which an evaluation may be carried out according to the conceptual model developed by Miller. Special emphasis is placed on the third level of evaluation which is based on simulations of professional practice whose protagonists are the so called simulated or role-playing/standardized sick. One type of very novel evaluation test is the Objective Structured Clinical Examination (OSCE) which makes use of, besides the simulated or role-playing/standardized sick, other mediums such as manikins, standardized tests, open-ended short answer questions, etc. This is one of the most complete clinical competence evaluation methods currently available, although one should not forget that this evaluation is carried out in a simulated, laboratory, setting.

Clinical Competence↗
PubMed1993

A comparison of self-perceived clinical competencies in primary care residency graduates.

One hundred seventy-eight graduates from four primary care residency training programs with common hospital sites (medicine/pediatrics, 72; family medicine, 29; pediatrics, 35; and internal medicine, 42) responded to a mailed survey questionnaire regarding distribution of professional time and self-perceived clinical competencies. Most of the internists, family physicians, and internist/pediatricians (MED/PED) were in primary care, and 57% of the pediatricians were subspecialists. Respondents rated each of 24 clinical vignettes as to their level of comfort in managing the patient problems presented. MED/PED and pediatricians responded similarly to all the infant, child, and adolescent cases. Family physicians were less comfortable in managing the complicated neonatal situations but more comfortable with adolescent health care than the MED/PED or pediatricians. MED/PED reported greater comfort than family physicians in complex internal medicine issues, but less than internists in intensive care and geriatric consultation. Significant differences in reported competency existed among these primary care practitioners despite substantially overlapping training backgrounds.

Adolescent↗
PubMedDate not supplied

[How to improve clinical competence].

Every day there are many patients that suffer or undergo more or less serious damage to their health because of the poor quality of healthcare they receive. Most of these injuries could be avoided by improving the professional quality of healthcare. This presentation outlines an ideal pathway by providing methodological indications and practical tools to clinicians and healthcare workers who wish to increase their skills in planning, supporting and evaluating initiatives of professional quality improvement in their organizations. In particular, the article indicates how clinical competence can be expressed, measured, evaluated and improved. To this end we introduce some basic concepts relative to efficacy (is what I do for my patients useful?), appropriateness (am I doing it to the right persons?) and effectiveness (does the treatment, when transferred to a local operating context, improve the health of the patients receiving it?). The article gives some suggestions to measure quality through process indicators (what has been done to the patients during the process of caring) and outcome indicators (the benefits obtained by the patients from the treatments received), highlighting both advantages and limitations. We then introduce four increasingly complex models for evaluating health interventions: descriptive evaluation, process evaluation, outcome evaluation and experimental designs. Finally, we describe Shewhart's cycle of continuous improvement, which is a useful tool for implementing, directing and spreading continuous quality improvement into an healthcare organisation.

Clinical Competence↗
PubMed1979

Clinical competence in internal medicine.

To describe more explicitly the components of competence required of the internist, The American Board of Internal Medicine has analyzed the medical encounter and defined the major variables involved: the abilities required of the internist, the tasks that must be performed to solve a medical problem, the medical illness, and the patient. The abilities of the internist have been categorized into attitudes and habits, interpersonal skills, motor and technical skills, and intellectual abilities. The latter have been further subdivided into the abilities to acquire and use knowledge, to organize, to synthesize information, and to apply clinical judgment. For each of these abilities statements of clinical competence that relate to the tasks required have been developed. The Board is publishing this paper, an excerpt of a longer document, with the hope that it will be useful to residents, faculty, and practicing internists.

Attitude of Health Personnel↗
PubMed2005

Female patients' preferences related to interpersonal communications, clinical competence, and gender when selecting a physician.

PURPOSE: In obstetrics and gynecology (ob-gyn), a physician's gender can affect patients' access to care as well as medical education curricula and career counseling. The authors focused on the importance that female patients place on various physician characteristics, and how this importance varied by patients' characteristics and compared for family practitioners, obstetrician-gynecologists, and surgeons. METHOD: In 1999-2000, an anonymous questionnaire was distributed for one week to all women scheduled for an ob-gyn visit at six community campuses of Michigan State University College of Human Medicine. The first section of the questionnaire listed 16 physician characteristics and asked patients to rate the importance of each using a six-point scale (1 = not at all important, to 6 = very important). The items were presented three times, in reference to the patients' choice of a family physician, ob-gyn, and surgeon. The questionnaire also asked for patients' demographic information. Descriptive statistics were used to summarize patient demographics and ratings. Multivariate relationships were tested using analyses of variance (repeated-measures analysis of variance [ANOVA]) and multiple regression. RESULTS: In the 1,059 completed questionnaires, items related to physician gender were among the lowest rated, regardless of specialty. A factor analysis resulted in a three factor solution: Interpersonal Communications, Clinical Competence, and Gender. Interpersonal Communications ratings varied least by physician specialty and patient characteristics; Gender ratings varied most. Physician behaviors rather than physician attributes play an important role in women's choices. CONCLUSIONS: For most women, physician gender was one of the least important characteristics, regardless of specialty. Excellent skills might give all physicians an edge in patients' choice decisions, a finding contrary to widely held beliefs about more limited future opportunities for men in some specialties.

Adult↗
PubMed1996

Validity of simple approach to scoring and standard setting for standardized-patient cases in an examination of clinical competence.

The results are disappointing, providing little support for the validity of the case-passing decisions based on this simple approach to scoring and standard setting. The case-passing decisions predicted what the case author intended for about only 73% or 74% of the students on average and, with agreement expected by chance removed, predicted what the case author intended for about only 25% of the students. Even with the use of the optimal pass/fail cutoffs and the dropping of students with ambiguous borderline global ratings, the case-passing decisions failed to agree with the case authors' global ratings for 15% to 30% of the students. The findings might be dismissed as simply due to low reliabilities of passing decisions and global ratings based on a single case. Although this concern would apply to intercase reliabilities, which would be subject to case specificity, the appropriate reliabilities here would seem to be intracase (i.e., intrarater), which should be fairly high (if they could be computed). Nevertheless, it seems reasonable to expect much better agreement between results of case scoring and of standard setting developed by the case author and the case author's global ratings of performance on that case, given that the case author might recall the checklist, assign a weight to each item, and so forth. Also, case-passing decisions would possibly agree more with global ratings of live or videotaped performances than with ratings of written summaries of performance; however, that question remains a challenge for further research. In conclusion, the study provides only weak evidence, at best, for the validity of the scoring and standard setting commonly used with SP assessment. The results do not undermine claims about the realism of the SP approach, however, nor do they call into question the standardization afforded by this method of assessing clinical competence. The results do raise serious concerns about this simple approach to scoring and standard setting for SP-based assessments and suggest that we should focus more on the observation and evaluation of actual student performance on SP cases in the development of valid scoring and standard setting.

Achievement↗
PubMed1999

Behaviors that cause clinical instructors to question the clinical competence of physical therapist students.

BACKGROUND AND PURPOSE: Clinical instructors (CIs) observe behavior to determine whether students have the skills assumed necessary for safe and effective delivery of physical therapy services. Studies have examined assumptions about necessary skills, but few studies have identified the types of student behaviors that are "red flags" for CIs. This study examined the student behaviors that negatively affect students' clinical performance, which can alert CIs to inadequate performance. SUBJECTS: Twenty-eight female and 5 male CIs discussed the performance of 23 female and 17 male students who were anonymous. METHODS: Using questionnaires and semistructured interviews that were taped and transcribed, CIs described demographics and incidents of unsafe and ineffective physical therapy. After reading the transcripts, investigators identified and classified the behaviors into categories and checked their classification for reliability (kappa=.60-.75). RESULTS: Behaviors in 3 categories emerged as red flags for CIs: 1 cognitive category--inadequate knowledge and psychomotor skill (43% of 134 behaviors)--and 2 noncognitive categories--unprofessional behavior (29.1%) and poor communication (27.6%). The CIs noticed and valued noncognitive behaviors but addressed cognitive behaviors more often with students. Students who did not receive feedback about their performance were unlikely to change their behavior. The CIs used cognitive behaviors often as reasons to recommend negative outcomes. CONCLUSION AND DISCUSSION: Clinical instructors need to identify unacceptable cognitive and noncognitive behaviors as early as possible in clinical experiences. Evidence suggests that they should discuss their concerns with students and expect students to change.

Adult↗