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Delphi study to identify core competencies in geriatric dentistry.

The Delphi technique and an expert panel of general practitioners were used to identify geriatric dentistry core competencies--the necessary knowledge, skills, and values of new graduates to meet the oral health needs of older patients. Of the 74 dentists solicited, 50 dentists agreed to participate, and 40 dentists returned two questionnaires. Respondents were mostly male, white, in solo practice, with a mean age of 51.6 (SD 7.4) years. The first survey asked the participants to identify at least three topics in geriatric dentistry that they believed to be essential to a dental curriculum to graduate competent practitioners who can effectively treat older patients. The 45 unique responses were used in the second questionnaire that asked the practitioners to rate the importance of each topic for inclusion in a curriculum. For the 29 items describing skills, respondents indicated how often they performed the skill in their practices. Finally, the respondents considered all 45 items, and selected the five most crucial topics. Overall, participants achieved good consensus as to core knowledge, skills, and values needed to provide general dental care to older patients.

Clinical Competence↗

PubMed1999

Planning for major incidents involving children by implementing a Delphi study.

This paper provides a practical approach to the difficult problem of planning for a major incident involving children. It offers guidance on how general principles resulting from an expert Delphi study can be implemented regionally and locally. All phases of the response are covered including preparation, management of the incident, delivery of medical support during the incident, and recovery and support. A check list for regional planners is provided. Supplementary equipment is discussed and action cards for key roles in the paediatric hospital response are shown. Particular emphasis is placed on management of the secondary-tertiary interface including the special roles of paediatric assessment teams and paediatric transfer teams. A paediatric primary triage algorithm is provided. The important role of local interpretation of guidance is emphasised.

Child↗

PubMed2005

Preliminary identification of core domains for outcome studies in psoriatic arthritis using Delphi methods.

OBJECTIVE: To develop a consensus based set of core domains for outcome studies in psoriatic arthritis. METHODS: A list of 26 potential domains was prepared through literature review and email discussions amongst the GRAPPA steering committee members and scored by rheumatologists identified through membership of the CASPAR study and the steering committee. Each participant was emailed an up to date review of outcome measures in psoriatic arthritis and asked to distribute 100 points amongst each potential domain. In two subsequent rounds the group median, interquartile range, and earlier responses were emailed to each respondent to provide an opportunity to revise their scoring. RESULTS: Thirty two participants responded to the first round, of whom 30 responded to the third round. For DC-ART, the highest scoring domains were actively inflamed joint count, radiological damage score, patient global assessment, pain, physical function, acute phase response, and quality of life (scores 7 to 12). For SMARD, the highest scoring domains were pain, patient global assessment, physical function, quality of life, and active joint count (scores 10 to 18). For clinical record keeping, three domains scored highly at 10 (pain, patient global assessment, and active joint count). For rehabilitation, the highest scoring domains were physical function, quality of life, pain, patient global assessment, work limitations, and work incapacity (scores 10 to 15). CONCLUSION: Amongst rheumatologists with an interest in psoriatic arthritis, a reduced list of potential standard outcome domains have been defined by Delphi consensus methods.

Arthritis, Psoriatic↗

PubMed2006

Optimising a curriculum for clinical haematology and biochemistry in sports medicine: a Delphi approach.

OBJECTIVES: To investigate issues of curriculum in the context of a postgraduate sports medicine training programme, specifically in the field of clinical biochemistry and haematology. METHODS: Following the Delphi methodology, a series of sequential questionnaires was administered to curriculum developers, clinical teachers, examiners, and registrars. RESULTS: Agreement on a core syllabus for this subject with an indication of the core aims and objectives of teaching and learning in this field and the associated required skills and competencies. An indication of current and ideal teaching and learning methods and reasons for these preferences. A consensus of key features of a teaching module for this field and of appropriate methods of examination. CONCLUSIONS: The data derived from this study, as well as the experience of engaging in it, will better inform curriculum developers, teachers, and students of one another's perceptions as to what is important in and appropriate to teaching and learning in this field of sports medicine. Engagement in the exercise and broader consideration of the outcomes by those who develop the curriculum, teach, and formulate the examination process will facilitate attainment of the ideal of well aligned teaching, learning, and examination in this specific field.

Biochemistry↗

PubMed1999

Identifying appropriate tasks for the preregistration year: modified Delphi technique.

OBJECTIVES: To identify the tasks that should constitute the work of preregistration house officers to provide the basis for the development of a self evaluation instrument. DESIGN: Literature review and modified Delphi technique. SETTING: Northern Deanery within the Northern and Yorkshire office NHS executive. SUBJECTS: 67 educational supervisors of preregistration house officers. MAIN OUTCOME MEASURES: Percentage of agreement by educational supervisors to tasks identified from the literature. RESULTS: Over 61% of communication items, 70% of on call patient care items, 75% of routine patient care items, 45% of practical procedure items, and over 63% of self management items achieved over 95% agreement that they should be part of the house job of preregistration house officers. Poor agreement was found for the laboratory and clinical investigations that house officers could perform with or without supervision. CONCLUSIONS: The tasks of house officers were identified but issues in using this method and in devising a universally acceptable list of tasks for preregistration house officers were apparent.

Clinical Laboratory Techniques↗

PubMed2000

Prescribing indicators for UK general practice: Delphi consultation study.

OBJECTIVES: To identify prescribing indicators based on prescribing analysis and cost (PACT) data that have face validity for measuring quality or cost minimisation. DESIGN: Modified two round Delphi questionnaire requiring quantitative and qualitative answers. SETTING: Health authorities in England. PARTICIPANTS: All health authority medical and pharmaceutical advisers in the first round and lead prescribing advisers for each health authority in the second round. MAIN OUTCOME MEASURES: Face validity (median rating of 7-9 on a nine point scale without disagreement) and reliability (rating 8 or 9) of indicators for assessing quality and cost minimisation. RESULTS: Completed second round questionnaires were received from 79 respondents out of 99. The median rating was 7 for cost minimisation and 6 for quality, and in all except four cases individual respondents rated indicators significantly higher for cost than for quality. Of the 41 indicators tested, only seven were rated valid and reliable for cost minimisation and five for quality. CONCLUSION: The 12 indicators rated as valid by leading prescribing advisers had a narrow focus and would allow only a limited examination of prescribing at a general practice, primary care group, or health authority level.

Delphi Technique↗

PubMed2005

What should undergraduate medical students know about psoriasis? Involving patients in curriculum development: modified Delphi technique.

OBJECTIVE: To identify the content of a psoriasis curriculum for medical students. DESIGN: Literature review and modified Delphi technique. SETTING: Primary and secondary care in Oxfordshire and Buckinghamshire. SUBJECTS: 19 dermatologists (7 teaching hospital consultants; 6 consultants in district general hospitals; 6 registrars); 2 general practitioner senior house officers working in dermatology, 5 dermatology nurses, 7 rheumatologists, 25 general practitioner tutors, and 25 patients with chronic psoriasis. MAIN OUTCOME MEASURES: Percentage of agreement by participants to items derived from literature and our existing psoriasis syllabus. RESULTS: 71 (84.5%) of 84 questionnaires were returned. A 75% level of consensus was reached on key items that focused on the common presentations of psoriasis, impact, management, and communication skills. Students should be aware of the psychosocial impact of psoriasis, examine the skin while showing sensitivity, and be able to explain psoriasis to patients in a way that enables patients to explain the condition to others. CONCLUSIONS: The panels identified the important items for a psoriasis curriculum. The views of patients were particularly helpful, and we encourage educators to involve patients with chronic diseases in developing curriculums in the future. The method and results could be generalised to curriculum development in chronic disease.

Attitude to Health↗

PubMed2006

Developing a quality criteria framework for patient decision aids: online international Delphi consensus process.

OBJECTIVE: To develop a set of quality criteria for patient decision support technologies (decision aids). DESIGN AND SETTING: Two stage web based Delphi process using online rating process to enable international collaboration. PARTICIPANTS: Individuals from four stakeholder groups (researchers, practitioners, patients, policy makers) representing 14 countries reviewed evidence summaries and rated the importance of 80 criteria in 12 quality domains on a 1 to 9 scale. Second round participants received feedback from the first round and repeated their assessment of the 80 criteria plus three new ones. MAIN OUTCOME MEASURE: Aggregate ratings for each criterion calculated using medians weighted to compensate for different numbers in stakeholder groups; criteria rated between 7 and 9 were retained. RESULTS: 212 nominated people were invited to participate. Of those invited, 122 participated in the first round (77 researchers, 21 patients, 10 practitioners, 14 policy makers); 104/122 (85%) participated in the second round. 74 of 83 criteria were retained in the following domains: systematic development process (9/9 criteria); providing information about options (13/13); presenting probabilities (11/13); clarifying and expressing values (3/3); using patient stories (2/5); guiding/coaching (3/5); disclosing conflicts of interest (5/5); providing internet access (6/6); balanced presentation of options (3/3); using plain language (4/6); basing information on up to date evidence (7/7); and establishing effectiveness (8/8). CONCLUSIONS: Criteria were given the highest ratings where evidence existed, and these were retained. Gaps in research were highlighted. Developers, users, and purchasers of patient decision aids now have a checklist for appraising quality. An instrument for measuring quality of decision aids is being developed.

Decision Support Techniques↗

PubMed2002

Delphi type methodology to develop consensus on the future design of EMS systems in the United Kingdom.

OBJECTIVE: To develop consensus opinion on future design characteristics of Emergency Medical Services (EMS) systems in the UK with particular regard to advanced life support skills (ALS). DESIGN: A Delphi questionnaire design with two rounds to gain a consensus of opinion. Investigation of four aspects of EMS design is reported-type of response to a priority based dispatch category, transportation options, enhancement of paramedic skills, and structure of a first responder system. SUBJECTS: Chief executives, directors of operations, and medical directors of Ambulance Trusts in the United Kingdom. OUTCOME MEASURES: Likert scales (0-9) to score opinion on a series of statements with achievement of inter-round consistency. A median score of 0-4 was classified as disagreement and 6-9 as agreement. RESULTS: A 65% response to the first questionnaire and with iteration, 52% response to the second questionnaire was attained. A tiered response (paramedics, technicians, and basic life support first responders) with technicians responding to selected category A and B calls and all category C calls (median score (MS) 7.5, interquartile range (IQR) 4), was recommended. Inter-unit handover of selected calls to maintain paramedic availablity ( MS 7.5, IQR 3.75) and enhancement of paramedic skills (MS 7.0, IQR 4.0) was also proposed. Finally, the development of a first responder system fully integrated into the EMS (MS 8.0, IQR 2.75) involving other agencies including the police force, fire service, and trained members of the local community was agreed. CONCLUSIONS: Senior expert staff from Ambulance Trusts in the UK achieved consensus on certain design characteristics of EMS systems. These are significantly different from the present EMS model.

Administrative Personnel↗

PubMed2004

A Delphi study to identify performance indicators for emergency medicine.

OBJECTIVES: The aim of this study was to identify performance indicators thought to reflect the quality of patient care in the emergency department. METHODS: A three round accelerated Expert Delphi study was conducted by email or fax. A panel of 33 experts drawn from the fields of emergency medicine, emergency nursing, professional service users, and patients were consulted. Participants were initially asked to propose performance indicators that reflected the quality of care given in the emergency department setting in the United Kingdom. In the second round these proposals were collated and scored using a 9 point Likert scale; those that had not reached consensus were returned for reconsideration in the light of group opinion. Those statements reaching a pre-defined consensus were identified. RESULTS: 224 performance indicators were proposed. Altogether 36 indicators reached consensus reflecting good departmental performance after round three; 24 of these were process measures. CONCLUSIONS: 36 potential indicators of good quality of care in the emergency department in the UK have been identified.

Delphi Technique↗

PubMed2004

Planning for chemical incidents by implementing a Delphi based consensus study.

This paper provides a practical approach to the difficulties surrounding planning for chemical incidents, based upon the results of a Delphi based consensus study. It is intended to offer advice, which can be implemented at regional and local prehospital and hospital level. The phases of the response that are covered include preparation, management of the incident, delivery of medical support during the incident, and recovery and support after the incident.

Accidents, Occupational↗

PubMed2004

Desirable attributes of the ambulance technician, paramedic, and clinical supervisor: findings from a Delphi study.

OBJECTIVES: To identify those attributes experts regard as desirable qualities in the ambulance technician, paramedic, and clinical supervisor. METHODS: The Delphi technique was used to gain a consensus view from a panel of experts. The first round of the study asked the experts to list the attributes they believed were desirable for the ambulance technician, the ambulance paramedic, and the clinical supervisor. The first round of the study generated 3403 individual statements that were collapsed into 25 broad categories, which were returned to the experts, who were required to rate each of the attributes along a visual analogue scale in respect of each of the identified occupational groups. RESULTS: On completion of the second round the data were analysed to demonstrate rank ordering of desirable attributes by occupational group. The level of agreement within each group was determined by analysis using the Kendall coefficient of concordance. This showed high levels of agreement within the technician group but less agreement within the paramedic and clinical supervisor group. All were highly significant p<0.0001. CONCLUSIONS: There was significant agreement among the experts as to the desirable attributes of ambulance staff, many of which do not feature in existing ambulance training curriculums. The findings of this study may therefore be of value in informing future curriculum development and in providing guidance for the selection of staff for each of the occupational groups.

Ambulances↗

PubMed2006

Exposure or expert? Setting standards for postgraduate education through a Delphi technique.

OBJECTIVES: The aim of this study was to determine if a syllabus of upper limb anatomy for emergency clinicians composed by an expert panel reflected clinical practice as experienced by those at whom the syllabus would be directed. METHODS: A three round Delphi study was performed using an expert group. We compared this with a measure of the exposure to anatomical concepts in the day to day practice of trainees in emergency medicine. RESULTS: In total, 404 separate anatomical facts relating to the upper limb were reviewed by both groups. There was poor agreement (kappa = 0.348) between the expert group and the trainees. CONCLUSION: We have shown disparity between what an expert group believes trainees should know and what trainees are actually exposed to in clinical practice. We believe this demonstrates that curriculum development must strike a balance between important (expert) and common (exposure) information. We have shown how an expert:exposure matrix may be used to inform curriculum development.

Curriculum↗

PubMed2005

Required competencies of occupational physicians: a Delphi survey of UK customers.

BACKGROUND: Occupational physicians can contribute to good management in healthy enterprises. The requirement to take into account the needs of the customers when planning occupational health services is well established. AIMS: To establish the priorities of UK employers, employees, and their representatives regarding the competencies they require from occupational physicians; to explore the reasons for variations of the priorities in different groups; and to make recommendations for occupational medicine training curricula in consideration of these findings. METHODS: This study involved a Delphi survey of employers and employees from public and private organisations of varying business sizes, and health and safety specialists as well as trade union representatives throughout the UK. It was conducted in two rounds by a combination of computer assisted telephone interview (CATI) and postal survey techniques, using a questionnaire based on the list of competencies described by UK and European medical training bodies. RESULTS: There was broad consensus about the required competencies of occupational physicians among the respondent subgroups. All the competencies in which occupational physicians are trained were considered important by the customers. In the order of decreasing importance, the competencies were: Law and Ethics, Occupational Hazards, Disability and Fitness for Work, Communication, Environmental Exposures, Research Methods, Health Promotion, and Management. CONCLUSION: The priorities of customers differed from previously published occupational physicians' priorities. Existing training programmes for occupational physicians should be regularly reviewed and where necessary, modified to ensure that the emphasis of training meets customer requirements.

Analysis of Variance↗

PubMed1994

Research priorities in occupational medicine: a survey of United Kingdom medical opinion by the Delphi technique.

An attempt to achieve an agreed set of priorities for research in occupational medicine was undertaken by the Delphi technique. Fifty three senior practitioners of occupational medicine in academe (25) and industry or government (28) were canvassed about their views and choices for priority activity. Forty six (86%) responded to the initial enquiry and 48 (91%) provided rank order choices from a second, more detailed questionnaire. The first priority for more research on the natural history of work related ill health identified musculoskeletal disorders of the back and upper limbs followed by asthma, accidents, skin disorders, vibration induced disease, suicide and depression, and finally hearing loss. The second priority area was audit and particularly the need for its use in occupational health screening procedures. Environmental impact of industrial activity was third with the community health effects being more important than individual health effects. Stress related disease was fourth with emphasis on risk factors. The fifth area was neuropsychological effects of work exposures particularly the need for more research on diagnostic tests. Other assorted areas of concern were the cost effectiveness of occupational health, risk assessment, reproductive hazards, the effects of pharmacological agents, and the development of biomarkers as early evidence of an exposure effect. The remarkable degree of unanimity on the issues and choices and the general agreement between physicians from academe and industry on what constitute the priorities warrants further discussion and positive action.

Delphi Technique↗

PubMed2000

Requirements for occupational medicine training in Europe: a Delphi study.

OBJECTIVES: To identify the common core competencies required for occupational physicians in Europe. METHOD: A modified Delphi survey was conducted among members of the European Association of Schools of Occupational Medicine (EASOM), the Occupational Medicine Section of the Union of European Medical Specialities (UEMS), and of the European Network of Societies of Occupational Physicians (ENSOP). An initial questionnaire based on the training syllabus of the United Kingdom Faculty of Occupational Medicine was circulated and respondents were asked to rate the importance of each item. The results were discussed at a conference on the subject of competencies. A further questionnaire was developed and circulated which asked respondents to rank items within each section. RESULTS: There was a 74% response in the first round and an 80% response in the second. Respondents' ratings from most important to least important were; occupational hazards to health, research methods, health promotion, occupational health law and ethics, communications, assessment of disability, environmental medicine, and management. In the second round, among those topics ranked most highly were; hazards to health and the illnesses which they cause, control of risks, and diagnoses of work related ill health. Topics such as principles of occupational safety and selection of personal protection equipment were of least importance. Although the assessment of fitness was regarded as important, monitoring and advising on sickness absence were not highly rated. Management competency was regarded as of low importance. CONCLUSION: This survey identified that respondents had traditional disease focused views of the competencies required of occupational physicians and that competencies were lagging behind the evolving definition of occupational health.

Competency-Based Education↗

PubMed2000

New Zealand and United Kingdom experiences with the RAND modified Delphi approach to producing angina and heart failure criteria for quality assessment in general practice.

OBJECTIVES: (1) To describe the development of minimum review criteria for the general practice management in New Zealand (NZ) of two chronic diseases: stable angina and systolic heart failure, and (2) to compare the NZ angina criteria with a set produced in Manchester to assess the extent to which use of the same approach to criteria development yields similar criteria. METHODS: A modified Delphi approach, based on the RAND consensus panel method, was used to produce minimum criteria for reviewing the recorded management of heart failure and angina in NZ general practice. The criteria for angina were compared with those produced in the UK, including assessment of the extent to which each set describes actions that the other panel agrees are necessary to record. RESULTS: For each condition we report minimum criteria describing actions rated as (a) necessary to record and (b) inappropriate to take but, if taken, necessary to record. Although strong scientific evidence underpins approximately one quarter and one third, respectively, of the final sets of NZ and UK angina criteria for actions necessary to record, the NZ criteria agree strongly with the UK criteria (33 of 39 criteria, 85%) but there is less UK agreement with the NZ angina criteria (28 of 40 criteria, 70%). CONCLUSION: Despite the lack of scientific evidence for up to three quarters of angina care in general practice, the RAND based approach to criteria development was used in NZ to reproduce most of the UK angina criteria for actions rated as necessary to record in general practice. It is important to make explicit whether ratings of necessity and appropriateness apply to the recording of actions or to the actions themselves.

Angina Pectoris↗

PubMed2006

[Inter-professional relationship between primary health care (PHC) and secondary care (hospital) in 1992 and 2000. A Delphi study].

AIM: To evaluate the trends in the inter-professional relationship between primary health care (PHC) and secondary care (hospital) at 2 different moments of the health reform, at its start in 1992 and after a phase of consolidation (2001). DESIGN: Observational study based on modified Delphi technique. SETTING: Valencia Community, Spain. PARTICIPANTS: One hundred and ninety six professionals from Valencia Community were selected (103 PH centre administrators, 43 hospital and PC medical directors, and 50 heads of internal medicine or emergency services). RESULTS: One hundred and ninety six questionnaires were sent out, with a response rate of 38%. In PHC problems remained the same, but the following got worse: "lack of motivation" (+1.34), "lack of overall vision of patients" (+1.10), and "overuse of medical services" (+1.06). The existence of non-integrated out-patient specialists got better (-1.32). In hospitals, "lack of overall vision of patients" got worse (+0.51), but in general problems got better, especially in "lack of communication and dialogue" (-1.14). PC increased its demand for "a single computerized clinical record" (+1.50), drawing up of common protocols (+0.86), and periodic rotations of PC doctors through hospitals (+0.85), but bureaucratic referrals to PC (-0.60) and the need for specialists in PC as consultants (-0.36) diminished. In hospitals all solutions showed lower scores, particularly access of PC doctors to monitoring of admitted patients (-2.44) and PC doctors doing hospital cover (-2.30). CONCLUSIONS: Problems and solutions from PHC and hospitals remain the same, but there is a trend to the worse in PHC, whereas in hospitals the trend is more positive.

Delphi Technique↗