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PubMed2001

[Evaluation of clinical competence in gynecology obstetrics: an innovative approach using the Objective Structured Clinical Examination].

OBJECTIVE: The evaluation of medical student clinical competence in Obstetrics and Gynaecology using Objective Structured Clinical Examination (OSCE). MATERIAL AND METHODS: Development of OSCE with definition of an assessment of subject, choice of clinical stations sampling, identification of components of clinical competence to be evaluated, the level of performance required, development of specification table, editing of OSCE presentation page and assessment of praticability and results exploitation. RESULTS: Eleven station stimuli with simulated patient participation were carried out, 2 stations with a mannequin model and 1 questionnaire station. CONCLUSION: Our experience suggests OSCE feasibility for Obstetrics and Gynaecology during the initial course of education presents adequate psychometric characteristics. This gold standard can no longer be overlooked and should be considered as a useful tool to assess medical student competence. Nevertheless, OSCE remains to be further evaluated in France.

Clinical Competence↗
PubMed2002

Clinical competence assessment in nursing: a systematic review of the literature.

BACKGROUND: The assessment of clinical competence has returned to centre stage of nurse education. However, there is little evidence to support the use of clinical competence and a wide variety of methods for its use. RESEARCH QUESTION: The present study was designed to investigate the evidence for the use of clinical competence assessment in nursing. DESIGN: A review using systematic methods of literature pertaining to clinical competence in nursing was conducted using defined dates, databases and search terms. RESULTS: There is still considerable confusion about the definition of clinical competence and most of the methods in use to define or measure competence have not been developed systematically and issues of reliability and validity have barely been addressed. CONCLUSION: The assessment of clinical competence remains almost universally accepted in the nurse education literature as a laudable pursuit yet there are aspects of it that remain at odds with the higher education of nurses.

Clinical Competence↗
PubMed1983

The presence of distinct and stable skills among students assessed for clinical competence in oncology.

Several aspects of clinical competence in oncology were assessed among sixty-one fourth-year medical students, and results correlated with success in other areas of the curriculum as well as the extent of previous exposure to cancer patients. The inter-relationships identified by factor analysis among the outcome and predictor measures suggest that several distinct competencies were being assessed. In addition, certain skills, such as the ability to generate appropriate diagnostic hypotheses and to perform well on multiple-choice exams, appear to have been stable across time. These findings imply that there are distinct components to clinical competence, and that various methods of evaluation reflect these competencies differently.

Clinical Competence↗
PubMed1998

Assessing clinical competence of medical students in women's health care: use of the objective structured clinical examination.

OBJECTIVE: To assess clinical competency of third-year medical students completing a problem-oriented, primary care emphasis clerkship in obstetrics and gynecology using an objective structured clinical examination, and to determine the feasibility of implementing the objective structured clinical examination in the curriculum. METHODS: Sixteen groups of third-year medical students were evaluated prospectively on their exit performances with a six-station objective structured clinical examination designed to test clinical competency in basic primary care obstetrics-gynecology. Consistency of scores across stations, differences in performance for separate groups, and relationship of objective structured clinical examination scores compared with other indicators of medical proficiency, such as written examinations and faculty evaluations, were assessed. RESULTS: One hundred ninety-eight students were evaluated over 25 months. Test reliability across stations revealed alpha values ranging between .50 and .56. Correlations between performance on the objective structured clinical examination and the written test (r = .10) were low, demonstrating that the objective structured clinical examination clearly tests a separate domain of student capability. Cost of the objective structured clinical examination was $81.66 per student. CONCLUSION: The objective structured clinical examination is a reliable and valid test of the clinical competence of medical students in the primary health care of women. It provides information that is not obtained by more traditional assessment modalities at a reasonable cost.

Clinical Clerkship↗
PubMed1997

Differences unrelated to clinical competence in the results of repeated multiple-station tests of clinical skills.

PURPOSE: To determine the extent to which systematic differences not related to group differences in clinical competence could be observed in the results of six administrations of the same multiple-station test of clinical skills. METHOD: The same 16 stations were administered as part of the Ontario International Medical Graduates Program clinical skills screening examination on three different occasions, and on each occasion in two sessions. The interval between the first (fall 1986) and second (March 1990) administrations was four years, and that between the second and third (July 1990) administrations, four months. International medical graduates were the candidates in the first two administrations; the third administration was to a combined sample of fourth-year clinical clerks and interns. A different item functioning (DIF) approach with sessions within administration as the grouping variable was used to describe the extent of differences unrelated to clinical competence in the results of the different test administrations. For the generalizability and DIF calculations the designs were balanced by sampling down to 33 cases in each session. RESULTS: Station DIF values varied considerably from station to station. DIF effects between sessions with administrations were less than those between administrations, and were less between the two administrations separated by four months than between the two administrations separated by four years. CONCLUSION: Hypotheses concerning the relative magnitudes of station DIF and total-test aggregated values of DIF, as a function of the time intervals between test occasions, were substantiated, demonstrating that the greater the time interval between test administrations, the greater the magnitude of DIF.

Clinical Competence↗
PubMedDate not supplied

[Clinical competence in systemic arterial hypertension of undergraduate students at 2 schools of medicine].

OBJECTIVES: A) To develop and validate a questionnaire for exploring clinical competence of medical students in Hypertensive Vascular Disease. B) To know and compare clinical competence among medical students of two medical schools, who are about to be caring for hypertensive patients. DESIGN: Cross-sectional study. METHODS: The questionnaire was developed with actual clinical cases and 150 items for exploring clinical abilities; experts, medical attendants in the Mexican Social Security Institute validated it. The questionnaire had to be answered by students from two medical universities about to graduate. RESULTS: We obtained a Kuder Richardson coefficient of 0.89. There were significant differences between students when we compared total scores, especially in three of the nine indicators explored. In the group 1, 94% of its students has clinical competence qualifying as low and very low, and; 87% of group 2 has clinical competence qualifying as intermediate or low. When we explored the items corresponding to treatment there is no significant difference and almost all the students are in clinical competence low and very low or as if they hadn't studied medicine. CONCLUSIONS: We consider that the questionnaire was valid and reliable. The clinical competence of the students included from universities that were included in this study, is deficient in resolving the clinical cases presented in the questionnaire. Therefore, it is probably that they will not give adequate clinical care to patients with hypertension, so it is important to improve the clinical competence of the future general practitioners, at least during their year of social service.

Clinical Competence↗
PubMed1996

Developing clinical competence: a mastery pathway.

Developing clinical competence in physiotherapy students is a particularly challenging task due to the complexities and uncertainties of the clinical task and the clinical environment. Supervisors experience difficulty with the rival demands of patient service and student education as well as the assessment of competence. Students demand supportive supervision with regular, constructive feedback. In 1993, when The University of Melbourne School of Physiotherapy first allocated students into clinical placements, a pathway was developed to guide practice and assessment of clinical competency. The pathway follows the principles of progressive mastery, individual pacing and part-to-whole sequencing. It encourages collaborative learning and provides a grid for visually representing progressive development. This article reports the rationale, reliability, validity and evaluation of this pathway.

Journal Article↗
PubMedDate not supplied

[Clinical competence of the family doctor in systemic arterial hypertension].

OBJECTIVE: To establish clinical competence of family physicians to diagnose systemic arterial hypertension and to analyze it's associations with some variables related to working conditions and prior training. METHODS: The clinical competence was established in a non probabilistic sample of 165 family physicians working in 12 units of the Instituto Mexicano del Seguro Social (IMSS) in Mexico City. We used questionnaire of 160 items (true/false/don't know) to evaluate clinical competence. Association of the scores were explored for work shift (morning/afternoon), working conditions (very favorable/favorable/little favorable/unfavorable) and having been trained in a familiar medicine residency of the IMSS (yes/no). RESULTS: There were a general low competence to diagnose systemic arterial hypertension (median score of 36 of a possible 160). There were associations of competence with more favorable working conditions (p = 0.005 Kruskal-Wallis test) and with having been trained previously (p = 0.0123 U Mann-Whitney test). CONCLUSIONS: Our results support the need to continue in this area of research to improve measuring instruments and to identify the modifiers of clinical competence to overcome the deficiencies detected in the present study.

Appointments and Schedules↗
PubMed2003

Medical student interviewing: a randomized trial of patient-centredness and clinical competence.

BACKGROUND: It is widely accepted that the quality of doctor interviewing skills is an important determinant of health care outcomes. Two interviewing skills contributing significantly to optimal health outcomes are the clinical competence of the interviewer and the use of patient-centred techniques. However, the relative importance of these to health outcomes is unknown. OBJECTIVE: The purpose of this study was to examine the relative effect on maternal recall and satisfaction of medical student clinical competence and use of patient-centred interview techniques. METHODS: Sixty-nine mothers of children attending the Paediatric Medical Out-patient Clinic, Women's and Children's Hospital, South Australia agreed to participate in the study, with 60 successfully completing the study. They viewed two of four standardized 'medical student' interview videotapes in which the level of clinical competence and patient-centredness were varied independently. All other interview variables were controlled. Each mother rated the interviews by questionnaire (balanced incomplete block design, each interview rated by 30 mothers). Maternal satisfaction with the 'student' interview was measured using the Medical Interview Satisfaction Scale (MISS) and the Interpersonal Skills Rating Scale (IPS). Maternal recall of interview information was assessed by questionnaire, with maternal answers coded independently before analysis. RESULTS: Significant, independent effects of clinical competence and patient-centredness were observed with both MISS (F = 42.1, P < 0.0001) and IPS (F = 49.3, P < 0.0001) scores. The effect of clinical competence was stronger than that of patient-centredness. Maternal recall for specific information was greater for some items following the more clinically competent interviews, but was lower for others. There was no association between maternal recall and the level of patient-centredness demonstrated by the 'student'. CONCLUSION: Clinical competence was a more significant determinant of maternal evaluations of medical student interviews and maternal recall of information than was patient-centredness. High levels of both patient-centredness and clinical competence were associated with the highest maternal satisfaction.

Chi-Square Distribution↗
PubMed1987

Direct, standardized assessment of clinical competence.

Doctor ratings of clerkship performance are often discounted as not accurately reflecting clinical competence. Such ratings are influenced by the following uncontrolled variables: case difficulty; differing rater focus and standards; lack of agreement on what constitutes acceptable performance; and collective patient care responsibility masks individual contributions. Standardized direct measures of clinical competence were developed to control these factors and allow direct comparisons of student performance. Students saw 18 patients representing frequently occurring and important patient problems. Student actions and decisions were recorded and subsequent responses to questions revealed knowledge of pathophysiology, basis for actions, use and interpretation of laboratory investigations, and management. Actions and responses were graded using a pre-set key. The examination covered 73% of designated clinical competencies. Examinations scores corresponded with independent measures of clinical competence. Reliability studies indicated that new cases can be substituted in subsequent years with confidence that scores will maintain similar meaning. Costs are +6.95 per student per case, which is modest considering the quality and quantity of information acquired. Methods described are practical for evaluation of clerks and residents and for licensing and specialty certification examinations.

Clinical Clerkship↗
PubMed1993

The assessment of clinical competence in obstetrics and gynaecology in two medical schools by an objective structured clinical examination.

OBJECTIVE: To compare and assess clinical competence among final year students in two British medical schools using a standardised objective structured clinical examination (OSCE) in obstetrics and gynaecology. DESIGN: A comparative study of an OSCE with stations designed to test student abilities in history-taking, physical examination, interpretation of data or results, interpersonal skills, practical procedures, as well as factual knowledge. SUBJECTS: Two groups of final year medical students from two British medical schools. METHODS: An OSCE of 26 stations. RESULTS: The standardised OSCE was simple to organise and conduct once the content had been decided. Analysis of the results revealed significant differences in mean marks between the two sets of students in six stations, and in eight stations the mean score was less than five for one or other sets of students. The reasons for the differences between the medical schools and the poor performance of the students at some stations were investigated and possible causative factors identified. CONCLUSIONS: We have shown that an OSCE is suitable for testing clinical competence of students within and across medical schools, is able to highlight differences in standards between institutions, and can identify areas where teaching methods and/or course content are deficient.

Attitude↗
PubMed2000

[Design of a method for the evaluation of clinical competence in primary care].

OBJECTIVE: To measure clinical competence in primary care (PC). DESIGN: Descriptive cross-sectional study. SETTING: Six PC teams in Barcelona. PARTICIPANTS: 25 family doctors volunteering out of a total of 60. MEASUREMENTS AND MAIN RESULTS: Three simulated visits took place on three different days, allocated at random as a prior appointment for hypertension. Clinical competence was measured through the Miller criteria, a method with open short-reply questions combining the clinical interview with standardised patients (SP), review of clinical histories (CH) and doctor's self-evaluation (DS). The following components of competence (CC) were evaluated: anamnesis, physical examination, further tests, differential diagnosis, management, clinical history and communication. 22 doctors completed the study. Each CC was weighted by a group of experts, who also agreed two minimum levels of competence, 50% and 60%. Each doctor's final score was the result of the addition of each of the three cases divided by the maximum score possible. The CC values were always higher with SP than otherwise. 63.3% of doctors surpassed the 60% mark, and 90.9% the 50% mark. Internal consistency, measured with Cronbach's alpha, was 0.94, 0.73 and 0.67 for each clinical case. The kappa reproduction test was 0.25. CONCLUSIONS: The use of SP is a good method of evaluation, as it enables anamnesis, management of the patient, physical examination and communication to be assessed. The study is very reliable, with low reproduction, which is probably due to the few cases used.

Clinical Competence↗
PubMed1997

Baccalaureate nurse educators' and critical care nurse managers' perceptions of clinical competencies necessary for new graduate baccalaureate critical care nurses.

BACKGROUND: Although nurse educators and nurse managers have disagreed about which clinical competencies are necessary for new graduates to begin working in critical care, the competencies are in need of revision and reassessment. OBJECTIVES: To validate a list of beginning-level competencies and to compare baccalaureate nurse educators' and critical care nurse manager's current perceptions of beginning clinical competencies for new baccalaureate graduates in critical care settings. METHODS: An expert panel of nurses from across the United States critiqued a questionnaire about which clinical competencies were considered relevant to critical care nursing practice. The revised questionnaire, containing 105 clinical competencies, was mailed to a randomly selected sample across the United States. Forty-one baccalaureate nurse educators and 41 critical care nurse managers completed the mail survey questionnaire (94% response rate) by rating the necessity ("essential," "desired," or "not required") of the clinical competencies for new baccalaureate nurses. RESULTS: A high degree of agreement was generally seen between nurse educators and nurse managers on the necessity ratings of the 105 competencies. The majority of nurse educators and nurse managers rated 81 of the 105 competencies as either "essential" or "desirable." Only five competencies showed considerable disagreement between nurse educators and nurse managers, and none of these competencies were rated "essential" by more than a few raters in either group. CONCLUSIONS: The agreement between nurse educators and nurse managers supports a competency list for baccalaureate nursing curricula and hospital inservice programs to integrate new graduates into critical care.

Clinical Competence↗
PubMed1993

ECFMG assessment of clinical competence of graduates of foreign medical schools. Educational Commission for Foreign Medical Graduates.

OBJECTIVE: To develop an assessment of clinical competence of graduates of foreign medical schools and to determine the reliability and validity of the assessment and the feasibility of large-scale administration. DESIGN: The Educational Commission for Foreign Medical Graduates (ECFMG) clinical competence study included (1) clinical encounters with standardized patients to assess history taking, physical examination, and communication skills; (2) laser videodisk pictorials to assess identification and interpretation of diagnostic procedures; (3) written clinical vignettes to assess diagnosis and management skills; and (4) assessment of spoken English. A uniform method of operating the test centers and of training the standardized patients was developed. SETTING: Medical schools and their primary teaching hospitals and affiliated hospitals. PARTICIPANTS: Six hundred twenty-four first-year residents, of whom 525 are graduates of foreign medical schools. MAIN OUTCOME MEASURES: Scores, reliability coefficients, validity measures, feasibility of multisite administration, trends of scores over time, and acceptability by examinees. RESULTS: The ECFMG clinical competence assessment was conducted at four geographically separate test centers. Reliability coefficients were high (.85) for the integrated clinical encounter and were in a reasonable range (.71 to .82) for all test components. The assessment adds to the predictability of the residents' performance in the hospital over that of current ECFMG certification examinations. Test security was addressed by demonstrating no consistent pattern of change in scores over testing dates. Virtually all examinees thought the assessment was appropriate. Standardized patients were able to assess spoken English accurately. CONCLUSION: The feasibility of conducting a reliable and valid test of clinical competence for graduates of foreign medical schools was demonstrated for this test population.

Clinical Competence↗
PubMed2003

Assessing student nurse clinical competency: will we ever get it right?

In 1997, a revised system was introduced at the University of Glamorgan, Wales, to assess student nurse clinical competency. This was firstly as a result of concerns that the previous system was based on limited documentary evidence, and, secondly as the Welsh National Board for Nursing and Midwifery issued new competency statements. This article reports an evaluative research study which aimed to determine whether the revised system was an effective measure of clinical competency. A series of focus groups were conducted with students, tutors and clinical preceptors to discuss their experiences of using the revised system. A content analysis was conducted of all evidence written by students to support the achievement of clinical competency. The findings of the focus groups indicated that each group had some initial problems with the assessment process. The main concern for all groups was lack of consistency and uncertainty in the assessment process. Although the introduction of written evidence to support clinical competency was welcomed, many felt that too much evidence was required. Content analysis of competency documentation aimed to compare student evidence and to determine whether there were inconsistencies in the assessment process. There were many variations in the evidence obtained from students, in particular the amount of evidence written by each student. The findings clearly indicate that further revisions are necessary to ensure that the system is implemented in the most effective way. The Fitness for Practice report (UKCC, 1999) has ensured that competency-based assessment is here to stay in the UK. Evaluative research of this type is important to ensure that we adopt the most suitable approach to assessing clinical competency.

Clinical Competence↗
PubMed2001

Assessing dental hygiene clinical competence for initial licensure: a Delphi study of dental hygiene program directors.

PURPOSE: The purpose of this study was to describe the best way to determine clinical competence prior to issuing the dental hygiene license. METHODS: Directors of dental hygiene programs in the United States, Puerto Rico, and the Virgin Islands were asked to describe the best way to determine clinical competence prior to issuing the dental hygiene license. Three rounds of the Delphi process were used to seek a level of consensus among panel members. A total of 44 directors (19% of the population) from dental hygiene schools participated in at least one round of the study. Sixteen directors participated in all three rounds. Likert scale and ranking questionnaires followed the initial open-ended question. RESULTS: A level of consensus was achieved on 47% of the initial statements describing the determination of clinical competence. A list of the top 10 most agreed upon responses to the initial question was generated. Ongoing process evaluations within the accredited dental hygiene program, was suggested as the best determination of clinical competence for dental hygiene licensure. CONCLUSION: The findings suggest that dental hygiene clinical competence is best determined throughout a continuum of process and product examinations, rather than in a one-time product evaluation. Accreditation was acknowledged as an important element in standardizing the assessment of clinical competence. Organized dental hygiene should develop a protocol for licensing new dental hygienists and work with state boards of dentistry on its implementation.

Administrative Personnel↗