SEARCH · PubMed Health

Results for “Clinical Competence”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources

PubMed2002

Conceptualization and measurement of clinical competence of residents: a brief rating form and its psychometric properties.

Conceptualization and measurement of clinical competence of residents are of interest to medical educators. Yet there is a scarcity of operational tools with satisfactory psychometric support for measuring clinical competence. In this study, we investigated the underlying structure, criterion-related validity and alpha reliability of a brief rating form (20 items) developed to assess clinical competence of residents. The study sample consisted of 882 physicians (654 men, 228 women) in postgraduate training at Thomas Jefferson University Hospital between 1998 and 2000. Construct validity of the form was supported by factor analysis. Two relevant factors emerged: 'Knowledge, Data-Gathering and Processing Skills', and 'Interpersonal Skills and Attitudes'. Criterion-related validity was supported by significant linear associations between factor scores and performance on the medical licensing examinations. Alpha reliability coefficients for the two factors were 0.98 and 0.97, respectively. This brief rating form can be employed as one measure to evaluate clinical competence of residents with reasonable confidence in its measurement properties.

Clinical Competence↗

PubMed2002

Empathy in medical students as related to academic performance, clinical competence and gender.

CONTEXT: Empathy is a major component of a satisfactory doctor-patient relationship and the cultivation of empathy is a learning objective proposed by the Association of American Medical Colleges (AAMC) for all American medical schools. Therefore, it is important to address the measurement of empathy, its development and its correlates in medical schools. OBJECTIVES: We designed this study to test two hypotheses: firstly, that medical students with higher empathy scores would obtain higher ratings of clinical competence in core clinical clerkships; and secondly, that women would obtain higher empathy scores than men. MATERIALS AND SUBJECTS: A 20-item empathy scale developed by the authors (Jefferson Scale of Physician Empathy) was completed by 371 third-year medical students (198 men, 173 women). METHODS: Associations between empathy scores and ratings of clinical competence in six core clerkships, gender, and performance on objective examinations were studied by using t-test, analysis of variance, chi-square and correlation coefficients. RESULTS: Both research hypotheses were confirmed. Empathy scores were associated with ratings of clinical competence and gender, but not with performance in objective examinations such as the Medical College Admission Test (MCAT), and Steps 1 and 2 of the US Medical Licensing Examinations (USMLE). CONCLUSIONS: Empathy scores are associated with ratings of clinical competence and gender. The operational measure of empathy used in this study provides opportunities to further examine educational and clinical correlates of empathy, as well as stability and changes in empathy at different stages of undergraduate and graduate medical education.

Analysis of Variance↗

PubMed2002

[Evaluation of clinical competence in the postgraduate family medicine course, by means of the Structured Objective Clinical Test].

OBJECTIVE: To evaluate the clinical competence of first-year residents on the course specialising in family medicine, by applying a structured objective clinical test (SOCT) for simultaneous assessment of cognitive, affective and psychomotor areas. DESIGN: Observational and descriptive. SETTING: Family medicine clinics in the metropolitan area of Mexico City.Participants. 89 doctors on the specialist course in Family Medicine at the Autonomous University of Mexico (UNAM). MAIN MEASUREMENTS: After prior design of comparison lists, expert validation of content, and design of support material for the evaluation and pilot study, a SOCT with ten themes or sections, eight dynamic and two static, was administered. The cut-off point for competent performance was 60 out of 100, both in each section and in the overall average. The statistical analysis was univariate, using descriptive statistics. RESULTS: The overall average of scores in all sections was under 60. The highest average was 73, in the section for monitoring healthy children. In the five highest-scoring sections, the scattering was lower than in the other five. There were low scores in the family study section. CONCLUSIONS: Academic performance, as evaluated by a SOCT measuring clinical competence, was low. This kind of test enabled clinical competence to be assessed more objectively. Interval evaluation scales need to be tested so as to evaluate better the quality of the performance of clinical activities.

Clinical Competence↗

PubMed2006

Growth of self-perceived clinical competence in postgraduate training for general practice and its relation to potentially influencing factors.

OBJECTIVE: To examine the increase in self-perceived clinical competence during a three-year postgraduate training in general practice and to explore the relation between the growth of self-perceived competence and several background variables. DESIGN: Cohort, 1995-1998. SETTING: Three-year Postgraduate Training for General practice in the Netherlands PARTICIPANTS: All Dutch trainees who followed postgraduate training from September 1995 to September 1998 (N=191). INTERVENTION: We asked the trainees at the start and at the end of their postgraduate training to complete a questionnaire, which assessed their self-perceived knowledge, clinical skills and consultations skills. We collected information about potentially influencing background variables. Amongst these were variables such as: age, gender, prior medical experience, the effort someone has spent upon her/his education, insight in weak and strong areas of clinical competence and knowledge and skills levels. MAIN OUTCOME MEASURE: Self-perceived competence. RESULTS: A total of 127 trainees completed both questionnaires (190 at the first administration and 128 at the second one). We found statistically significant growth of self-perceived clinical competence. Self-perceived consultation skills increased more than self-perceived knowledge and clinical skills. The afore mentioned background variables did not relate in any way with the growth of self-perceived clinical competence. CONCLUSION: This study shows that a 3-year postgraduate training in general practice enhances self-perceived clinical competence. However, we still do not know how to explain this improvement. Further study into the theoretical concept of self-assessment in medical education and into the factors contributing to the feeling of being competent, is required.

Age Factors↗

PubMed2000

Development of a tool to measure clinical competence in occupational therapy: a pilot study?

Clinical competence is generally defined as a combination of knowledge, skill and professional behaviour. It is typically assessed using written tests, direct observation, chart audit, client satisfaction surveys and supervisor ratings. This paper describes the development and evaluation of a chart-stimulated recall (CSR) measure that combines the methods of chart audit and clinician interview to assess the clinical competence of practicing occupational therapists. The CSR tool was developed using the Canadian Guidelines for Client-Centred Practice and taps global domains of competence: use of theory, assessment, program planning, intervention, discharge planning, follow-up, program evaluation, clinical reasoning and professional behaviours. This pilot study involved two independent raters/interviewers who assessed twelve occupational therapy clinicians on two occasions using a random sample of client cases/records on each occasion Results indicate that the CSR tool is not only reliable and valid, but also sufficiently generic to be used in a variety of practice settings as a global measure of on-the-job performance.

Canada↗

PubMed1999

Relationship between clinical competence and interpersonal and communication skills in standardized-patient assessment.

PURPOSE: To evaluate the relationship between clinical competence and interpersonal and communication skills, in an attempt to clarify current thinking about these two dimensions as measured with standardized-patient (SP) examinations. METHOD: Simple Pearson correlations were computed between total examination scores for clinical competence and interpersonal and communication skills. Three sets of different types of data involving 15 separate examinations were used to explore the generality of the findings. To control for a within-case halo effect and measurement error, corrected cross-half correlations and corrected cross-case correlations were also computed. RESULTS: The simple correlations and the corrected cross-half and cross-case correlations showed moderate and above relationships between these two dimensions in the clinical context. The simple correlations centered around .50, and the corrected cross-half and cross-case correlations were slightly higher, centering around .65 and .70, respectively. CONCLUSION: The authors' thinking is that the moderate relationship between clinical competence and interpersonal and communication skills is not due to a flaw in the measurement of clinical competence, as has been suggested, but rather is a natural consequence of the clinical encounter, which exacts an interdependence of these two dimensions. At least, this possibility must be seriously considered so medical educators can think and act appropriately in the assessment of clinical performance.

Adult↗

PubMed1999

Developing a clinical competency examination in radiology: part II--test results.

BACKGROUND: This is the second of two articles introducing a clinical competency examination in radiology. The first article described the structure, administration, and postexamination student comments for two versions of the radiology competency examination. This article reports the results obtained from these two administrations of the examinations. OBJECTIVE: To measure and identify potential outcome predictors of student aptitude in clinical film interpretation. DESIGN: Experimental. METHODS: An examination was developed to simulate the radiologic interpretive skills needed in clinical chiropractic practice. Two versions of the examination were given to a class of 210 ninth trimester students in a 10-trimester chiropractic program. Linear regression and bivariate correlations were performed on possible predictors of student success and test scores on the version 2 examination. RESULTS: On version 1 of the examination, students were able to identify an average of 59.6% of the normal cases as normal and 51.6% of abnormal cases as abnormal. On version 2, 55.6% of the normal cases were recognized as normal and 58.2% of abnormal cases as abnormal. On both versions, students were less successful at correctly categorizing, managing, or naming pathologic conditions they found. Of the predictors evaluated, only the students' grades in the third radiology course (tumors, arthritides, and extremity trauma) and the scores on the diagnostic imaging section of National Boards part II were significant predictors. DISCUSSION: Our results should cause some concern for educators who use content-based radiology curricula. Students demonstrated poor abilities to recognize, categorize, manage, and identify common radiographic pathologic conditions. Educators cannot rely on National Board scores and course grades to determine student clinical competency. More radiology clinical competency exercises that emphasize film interpretation need to be incorporated into content-based curricula.

Aptitude↗

PubMed1981

Assessment of clinical competence on the Emergency Medicine Specialty Certification Examination: the validity of examiner ratings of simulated clinical encounters.

To evaluate the reliability and validity of examiner ratings of simulated clinical encounters (SCEs), 94 subjects representing four distinct groups in training, experience, and ability to deliver emergency medical care were administered SCEs by two examiners. Inter-rater reliabilities of performance on specific SCEs varied from 0.61 to 0.89, with an average of 0.79 for all SCEs in the library. Identified sources of examiner error in determining clinical competence included case-specific variability of candidate performance, differences in standards used by different examiners, a halo effect several different ratings were made, and random errors in determining exact rating scores. However, this research indicates that examiner ratings clearly discriminate groups with known differences in clinical competence and correlated well (0.83) with objective test scores.

Certification↗

PubMed1995

[The COMBELL project. Analysis of the medical clinical competence].

BACKGROUND: The most frequent tests for evaluate medical education in Spain, do not analyze clinical competence. The aims of this project was to introduce a method for the assessment of clinical skills using the simulation methodology with standardized patients. METHODS: All 83 first-year medical residents were evaluated. Three evaluation exercises were used in all study. The first was 10 standardized patients encounters, the second was 100 multiple choice questions, and the third 60 clinical images. Sixty-four last year medical students were evaluated using the same 10 standardized patients. RESULTS: The global mean score for the residents was 56.7% for all the encounters, and was lower in physical examination and patients notes. The global mean score for the students was 57.1% and was also lower in physical examination. We did not find correlations between clinical competence assessment, multiple choice-questions, MIR exam and clinical images. CONCLUSIONS: Our results show that: this assessment method was successful; the clinical competence levels of our residents and students, and the lack of statistical correlation between this method and other methods, which, basically analyze cognitive capacities.

Clinical Competence↗

PubMed1999

Assessment of clinical competence.

Despite endless efforts in the quest for credible methods for evaluating clinical competence, the objective remains elusive. The components of competence include both clinical (interview skills, physical examination, differential diagnosis and therapeutic modalities) and technical skills. Written and oral examinations and, more recently, objective structured clinical examinations have been used as instruments for assessing the progress of trainees as well as for college or board certification and licensure to practice medicine. The American Board of Anesthesiology has adopted a more rigorous process for evaluating residents in training (Certificates of Clinical Competence). Newer methods have attempted to measure the competence of practicing physicians, including the analysis of data from physician-submitted 'report cards', 're-certification' examinations, and patient outcome studies. Whole-body computerized patient simulators have become a major area of research for teaching clinical skills and assessing behavior as well as patient management during critical incidents. This review examines the significant literature in each of the areas cited.

Journal Article↗

PubMed2006

Quality of care associated with number of cases seen and self-reports of clinical competence for Japanese physicians-in-training in internal medicine.

BACKGROUND: The extent of clinical exposure needed to ensure quality care has not been well determined during internal medicine training. We aimed to determine the association between clinical exposure (number of cases seen), self- reports of clinical competence, and type of institution (predictor variables) and quality of care (outcome variable) as measured by clinical vignettes. METHODS: Cross-sectional study using univariate and multivariate linear analyses in 11 teaching hospitals in Japan. Participants were physicians-in-training in internal medicine departments. Main outcome measure was standardized t-scores (quality of care) derived from responses to five clinical vignettes. RESULTS: Of the 375 eligible participants, 263 (70.1%) completed the vignettes. Most were in their first (57.8%) and second year (28.5%) of training; on average, the participants were 1.8 years (range = 1-8) after graduation. Two thirds of the participants (68.8%) worked in university-affiliated teaching hospitals. The median number of cases seen was 210 (range = 10-11400). Greater exposure to cases (p = 0.0005), higher self-reports of clinical competence (p = 0.0095), and type of institution (p < 0.0001) were significantly associated with higher quality of care, using a multivariate linear model and adjusting for the remaining factors. Quality of care rapidly increased for the first 100 to 200 cases seen and tapered thereafter. CONCLUSION: The amount of clinical exposure and levels of self-reports of clinical competence, not years after graduation, were positively associated with quality of care, adjusting for the remaining factors. The learning curve tapered after about 200 cases.

Clinical Competence↗

PubMed1978

Measuring clinical competence of medical students.

Evidence of clinical competence for medical students entering the clinical clerkships at the University of Kansas College of Health Sciences is established by passing two different examinations: a 100 item multiple choice examination and a videotaped history and physical examination by each student of a simulated patient, being rated by that patient and two examiners. In 1976 the class of 196 medical students took an average 1.85 written examinations per student. With 70% or better constituting a passing score, 30.6% passed on the first attempt, 55.6% the second, 11.2% the third and 2.5% the fourth. Each student passed the televised practical examination and had the opportunity to review his or her videotape with a critiqued data base and the examiners' and simulated patient's evaluations in hand. Correlation coefficients for all 196 students between scores of written examinations, medicine tutors, examiners and professional patients revealed weak but significant correlations between the assessments of examiners and medical tutors and assessments of examiners and written examination scores, but not between other evaluations. This scheme of proof of competence appears to be objective and direct, and serves the convenience of both students and teaching staff.

Clinical Competence↗

PubMed1999

Critical thinking and clinical competence: a study of their relationship in BSN seniors.

National nursing organizations and nurses in the workplace identify critical thinking skills as essential to competent nursing practice. This study sets out to test the relationship between critical thinking skills and clinical competence because it seems that competent practice depends on critical thinking abilities. This study focuses on one school of nursing's response to the challenge of defining and measuring critical thinking and clinical competence and examining their relationship. An exploratory nonexperimental design was used with a heterogeneous sample consisting of two graduating nursing classes (N = 143). While the group of participants was able to think critically and practice competently according to set standards, there were no statistically significant correlations between critical thinking and clinical competence total scores. One conclusion for these findings is that critical thinking may not emerge as an associated factor with clinical competence until some time after nursing students become practicing nurses.

Adult↗

PubMed1994

Appraisal of the clinical competence of registered nurses in relation to their designated levels in the Western Australian nursing career structure.

This cross-sectional survey examined the relationship of the competence of 529 nurses to their designated career structure levels. The extent of the relationships between nursing education and experience with clinical competence was determined, and attitudes of nurses toward their work environment were measured. Results indicated a wide dispersion in clinical nursing skills and that nurses' designation in the Western Australian Career Structure did not reflect their clinical competence. Clinical experience and education independently exerted a significant effect on competence, but there was no interaction between these variables on increasing competence. Attitudes of the nurses were found to be affected by their work environment.

Career Mobility↗

PubMed2003

New graduate perception of clinical competence: testing a causal model.

The purpose of this study was to test relationships among variables hypothesized to affect new graduate perceptions of clinical competence. The proposed model was developed based on several theories in sociology, education and nursing. Seven variables were selected for their potential contributions to graduates' perceptions of clinical competence. The sample included 468 new graduates from six baccalaureate nursing programs in Thailand. Path analysis indicated that student effort, perception of clinical learning environment (CLE) and program grade point average had direct effects on perception of clinical competence whereas hardiness had an indirect effect on the outcome variables through its impacts on student effort, perception of CLE and perception of student-faculty relationship. The model explained 8-12% of variance in the subscales of clinical competence.

Adult↗

PubMed1997

The development of an evaluation tool for grading clinical competence.

A perceived difficulty in grading clinical practice has meant that over the past two decades, educators in nursing have focused on non-graded results for clinical practicum. However, students expect rewards for achievement. Hospitals and universities require a means of differentiating levels of performance for employment and further study. This exploratory study uses quantitative and qualitative methods to evaluate a tool for grading clinical competence. The aims of the study were to determine the distribution of clinical grades, compare the clinical grades with the cumulative theoretical grades and compare the clinicians' and students' perceptions of competence. Study findings show that students and clinicians rated clinical performance well above the expected level. These grades for clinical performance exceeded comparative results in theoretical work for the practicum topic. In addition, content analysis of the qualitative data indicates that clinicians may have difficulty in using the ANCI Competencies to rate a student's performance for registration as a nurse.

Clinical Competence↗

PubMed1995

The clinical competency of community health workers in the eastern highlands province of Papua New Guinea.

A case study of the clinical competency of community health workers employed in the Eastern Highlands Province of Papua New Guinea was conducted in March 1993. Of the 79 who graduated from the Onamuga Community Health Worker Training School between 1989 and 1992, only 24 were currently employed in the province. Current knowledge and clinical competency were compared with results on completion of basic community health worker training. Results showed that 22 of the 24 maintained their knowledge competency, and 15 maintained clinical competency. It was found that those community health workers (CHWs) employed at a health subcentre use 40% to 50% of their skills, whilst those at a district health centre or provincial hospital use only 20% to 30% of their skills. Only 8% of the CHWs studied used all the skills obtained in their basic training. This study indicates that the CHW is being viewed by some health managers as a replacement for the nurse aide. If CHWs' skills are to be maintained, certainly good supervision, inservice training and adequate logistic support are needed, but so also is a change in management thinking. The CHW has been trained specifically to improve the access to essential primary health care services of people living in rural areas, especially in preventive and maternal and child health care. If in practice the CHW is not given the opportunity to practise and hence maintain these skills, the whole logic of the CHW training scheme will need to be reexamined.

Adult↗

PubMed2004

Asssessment of practice in intensive care: students' perceptions of a clinical competence assessment tool.

Part I of this paper (literature review) identified some of the challenges around the development of suitable assessment tools to measure clinical competence. The lack of research on competence assessment, especially within an intensive care environment was also high lighted. In this, part 2, findings from a qualitative study aimed at exploring student nurses' perceptions of a new clinical competence assessment tool, recently introduced into a postgraduate intensive care nursing course are presented. Semi- structured interviews and a focus group interview were used to collect the data. Eleven students were involved in the study. The findings are presented in narrative form and in the context of literature on assessment and competence. Although the clinical competence assessment tool was in its infancy at the time of this study, the findings suggest that students not only had difficulty interpreting the language of the tool, but considered that because of its generic nature, it failed to capture the specialist skills required for intensive care nursing.

Attitude of Health Personnel↗