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PubMed1999

Developing a clinical competency examination in radiology: part I--test structure.

BACKGROUND: There is a need for radiology educational outcome measures that evaluate clinical competency. This is the first of two articles introducing a clinical competency examination in radiology. This first article describes the evolution and structure of the examination. The second article presents the results of two administrations of the examination and evaluates possible outcome predictors. OBJECTIVE: To develop a measure of clinical competency in radiology. DESIGN: Descriptive. METHODS: A test was developed to simulate the radiologic interpretive skills needed in clinical chiropractic practice. Students were timed as they responded to questions regarding the localization, categorization, management, and identification of pathologic conditions presented on plain film images of the spine and chest. Twenty-five radiographic cases were displayed at individual viewbox stations, and student responses to the 4 questions were compared with the consensus responses of 2 radiology instructors. RESULTS: Two versions of the test, using different cases, were given to the same ninth trimester class of 210 chiropractic students in a 10-trimester program. Of the 210 students, 116 (55.2%; 86 men and 30 women) took version 1 of the examination, and 1 month later 181 (86.2%: 138 men and 43 women) took version 2 of the examination. Student comments after each examination were favorable. CONCLUSION: The test structure uniquely provides information related to the student's ability to localize, categorize, manage, and identify pathologic conditions on imaging studies. At present the examination is instructor time intensive; further refinement is needed before wide implementation can occur.

Chiropractic↗
PubMedDate not supplied

Methods used in the evaluation of clinical competency of physical medicine and rehabilitation residents.

A 17-item questionnaire was designed to determine how physical medicine and rehabilitation (PM&R) training directors assess their residents' clinical competency. A response rate of 83% (62/75) was obtained. Seventy-nine percent (49/62) have a written resident supervision policy, and 73% (45/62) have a written resident probation policy. Ninety-four percent (58/62) believe that their system of evaluating residents' clinical competency is effective, although many commented that it could be improved. 76% (47/62) of the residency training directors made the final decision regarding residents' clinical competency. Fifty-two percent (32/62) have a departmental written examination, and 23% (14/62) have formal oral examinations. Eighteen percent (11/62) use an objective structured clinical examination (OSCE), 8% (5/62) use standardized patients and 3% (2/62) use videotaped patient encounters. Forty percent (25/62) use medical record audits. Fifty percent of the programs have rated at least one resident unsatisfactory during a clinical rotation in the past 3 yr, and 11% (7/62) have reported to the American Board of Physical Medicine and Rehabilitation that the overall clinical evaluation of one resident was unsatisfactory in the past 3 yr. Forty-seven percent (29/62) of the programs have asked at least one resident to leave their program in the past 3 yr. The OSCE is emerging as the state-of-the-art method for assessing clinical skills, although it is expensive. The measurement of clinical competency is important in the certification and recertification process, and our specialty needs better methods to assess these performance skills.

Clinical Competence↗
PubMed2003

Evaluating the Accreditation Council on Graduate Medical Education core clinical competencies: techniques and feasibility in a urology training program.

PURPOSE: We describe several traditional and novel techniques for teaching and evaluating the Accreditation Council on Graduate Medical Education (ACGME) core clinical competencies in a urology residency training program. MATERIALS AND METHODS: The evolution and underpinnings of the ACGME Outcome Project were reviewed. Several publications related to the evaluation of clinical competencies as well as current assessment techniques at our institution were also analyzed. RESULTS: Several tools for the assessment of clinical competencies have been developed and refined in response to the ACGME Outcome project. Standardized patient encounters and expanded patient satisfaction surveys may prove useful with regard to assessing resident professionalism, patient care and communication skills. A feasible and possibly undervalued technique for evaluating a number of core competencies is the implementation of formal written appraisals of the nature and quality of resident performance at departmental conferences. The assessment of competency in practice based learning and systems based practice may be achieved through innovative exercises, such as practice guideline development, that assess the evidence for various urologic interventions as well as the financial and administrative aspects of such care. CONCLUSIONS: We describe several contemporary methods for teaching and evaluating the core clinical competencies in a urology training program. While the techniques described are neither comprehensive nor feasible for every program, they nevertheless provide an important starting point for a meaningful exchange of ideas in the urological graduate medical education community.

Accreditation↗
PubMed2003

An exploration of the role that expert knowledge plays in the assessment of undergraduate clinical competence: registered nurses' experiences.

INTRODUCTION: This phenomenological study, conducted in rural Australia, explored the experiences of registered nurses (RNs) responsible for assessing the clinical competence of undergraduate nursing students. The purpose of the study was to gain insight into the experiences of a group of registered nurses who assess student competence by exploring how they perform the assessment process. A key assumption on which this study was based is that the participants are 'expert nurses', as defined by Benner. METHOD: Participants were recruited using purposive sampling from a population of registered nurses who assessed the clinical performance of undergraduate nursing students studying at a rural university in New South Wales, Australia. Individual unstructured interviews were conducted and audiotaped with the participants' permission. The analysed data were given to all participants to check for accuracy and validation and a thematic analysis of the data was conducted. RESULTS: Four themes were identified; the major theme, described in this article, was identified in all the narratives. The participants all acknowledged that they use their expert nursing knowledge to assist them when assessing the clinical competence of nursing students. The participants used a variety of terms to describe this type of knowledge such as intuition, instinct, gut feeling and 'just knowing'. CONCLUSION: While the findings of this study confirmed that experienced nurses unconsciously use their expert nursing knowledge when making decisions about students' competence, the findings also indicated a lack of awareness or underestimation of the value of expert clinical knowledge. These findings reinforce the need for further investigation to determine the role of expert nursing knowledge in the clinical competency assessment process. This is particularly significant for rural registered nurses employed in small health-care facilities, who often assume the role of assessors of student clinical competence.

Journal Article↗
PubMed2006

Assessing core clinical competencies required of medical graduates in Taiwan.

Medical students are assumed to be competent to provide basic patient care independently on graduation. However, there is a gap between what students are expected to learn and what they have actually learned. This may be due to the lack of clearly defined learning objectives, well-organized curriculum, and properly administered assessment. In an attempt to tackle this problem, we conducted a three-step study. Firstly, we identified the core clinical competencies required of medical graduates in Taiwan. Secondly, we incorporated these clinical competencies into a new medical curriculum. Finally, we identified the most appropriate assessment methods for each clinical competency. In 2004, a set of minimally required clinical competencies for medical undergraduates in Taiwan was developed, which included 92 clinical skills, four communication skills, and seven kinds of attitudes. In order to prepare 3rd and 4th year medical students at Kaohsiung Medical University (KMU) for later clinical work, the medical curriculum committee integrated the teaching and assessment of the core clinical skills identified previously into relevant organ-system blocks of the new curriculum. To identify appropriate assessment methods for each clinical skill, a structured questionnaire of assessment methods based on the Toolbox of Assessment Methods (Accreditation Council for Graduate Medical Education) and The Scottish Doctor (Scottish Deans' Medical Curriculum Group) was developed and distributed to 40 senior clinical faculty members at KMU. Simulations and Models, Standardized Patient Examination (SP), and Objective Structured Clinical Examination (OSCE) were suggested to be most suitable to assess two-thirds of the core clinical skills. These assessment methods are commonly used in American and European medical schools. We believe that the implementation of the new curriculum at KMU accompanied by the use of Simulations and Models, SP, OSCE, and other teaching and assessment methods will help 3rd and 4th year students to prepare better for clinical practice in clerkships.

Clinical Competence↗
PubMed1976

The evaluation of clinical competence.

This review examined new approaches to the definition and evaluation of clinical competence. Competence may be defined in terms of the components of the process of clinical performance or in terms of the outcomes of clinical performance. No single test method is capable of providing a valid and reliable evaluation of all defined aspects of clinical competence. Both in this country and overseas, new test methods and examinations are being developed and the implications which they will have for Australian medical schools are discussed.

Australia↗
PubMed1992

Assessing clinical competence at the undergraduate level.

This booklet aims to provide relevant background information and guidelines for medical school teachers in clinical departments charged with assessing the clinical competence of undergraduate students. It starts by emphasizing the difference between clinical competence and clinical performance. An approach to defining what should be assessed is outlined. The technical considerations of validity, reliability and practicability are discussed with reference to the ward- or practice-based setting and to the examination setting. The various methods available to assess aspects of competence are described and their strengths and weaknesses reviewed. The paper concludes with a discussion of the important issues of scoring and standard setting. The conclusion is reached that the quality of many current assessments could be improved. To do so will require a multi-format approach using both the practice and examination settings. Some of the traditional methods will have to be abandoned or modified and new methods introduced.

Clinical Competence↗
PubMed1996

Assessment of clinical competence. The state of the art.

Clinical competence (CC) can be defined as the professional skills required to act and represents the fundamental background required for the performance. From a taxonomic standpoint, CC regards the field of knowledges, gestures, behaviours and decision-making skills in patient management on the basis of a cost-benefit analysis. "Methods for the assessment of CC". Since the 50s, the National Board of Medical Examiners started to replace open-ended oral examinations with the "Multiple Choice Questions", which proved to be more objective, reliable and effective and were soon accepted worldwide. New educational tools were successively suggested as computer-aided simulation ("Computer Aided Instruction") for both learning and assessment phases. All the above mentioned methods are limited by the fact that they are unable to evaluate the field of gestures and behaviours of the future physician. In consideration of this limitation, new assessment tools as the "Standardized Patient" utilized in the context of "Objective Structured Clinical Examination" or "Simulated Clinical Encounter", were recently developed. There are still some problems regarding the elaboration of assessment standards able to provide uniformity in scoring. In addition the assessment tools utilized so far for the individual student do not provide predictivity on his/her outcome in the future medical practice. Nevertheless, there are still some perplexities on the use of a chart audit for the purpose of assessing individual competence and predicting future performance skill.

Clinical Competence↗
PubMed2003

Assessing clinical competence in physical medicine & rehabilitation residency programs.

OBJECTIVE: Evaluation of resident clinical competence is a complex task. A multimodal approach is necessary to capture all of the dimensions of competence. Recent guidelines from the Accreditation Council for Graduate Medical Education delineate six general competencies that physicians should posses. Application of these guidelines presents challenges to residency program directors in defining educational experiences and evaluation methods. DESIGN: We surveyed 81 physical medicine and rehabilitation program directors regarding assessment tools used in their programs. Seventy-five percent responded. The most frequently used assessment tools included: In-training self-assessment examinations, faculty evaluations, direct observation, and conference participation. Program directors assigned the highest values to direct observation, faculty evaluations, self-assessment examinations, and oral examinations. RESULTS: Of the general competencies, more than 90% of program directors believed they did an adequate job rating dimensions of patient care, medical knowledge, professionalism, and communication skills. Approximately one-third, however, thought they did a less than fair job rating practice-based learning and improvement and systems-based practice. The majority of programs reported that they were able to identify a resident with difficulties during the first year of training, 44% within the first 6 months. Program directors reported that their residents spend a significant amount of their time with nurses and therapists during their inpatient rotations; however, this was not reflected in their evaluation practices, in which only one-fourth of programs reported the use of nurses and therapists in evaluating residents. CONCLUSIONS: Survey results indicate that physical medicine and rehabilitation program directors apply a variety of assessment tools in evaluating resident clinical competence. Although perceptions about the relative value of these tools vary, most programs report a high value to direct observation of residents by faculty. Of the six general competencies, program directors struggle the most with their evaluation of practice-based learning and improvement and systems-based practice.

Clinical Competence↗
PubMed1995

Use of an objective structured clinical examination to determine clinical competence.

PURPOSE: To describe the performance of second-year internal medicine residents on an objective structured clinical examination (OSCE) and to analyze the role of the OSCE in the evaluation of clinical competence. METHOD: In 1993-94, 51 second-year residents in an internal medicine training program at the Mayo Clinic participated in an OSCE. The OSCE was administered in four sessions, with 12 or 13 students in each session. The OSCE was composed of nine physical diagnosis stations, with two or three test-interpretation stations per session. Student's t-test and one-way analysis of variance were used to compare scores on the basis of the residents' gender, medical school training (international medical graduates versus those trained in the United States and Canada), and OSCE session. In addition, the residents' scores were correlated with scores on the American Board of Internal Medicine's in-training exam (ITE) and with the training program's clinical rotation scores (CRSs). RESULTS: The residents' scores were significantly higher for test interpretation stations than for physical diagnosis stations (p < .0001). There was no significant difference in average scores based on gender, medical school training, or OSCE session. The OSCE scores correlated with the ITE scores (r = .30) and the CRSs (r = .40). CONCLUSION: The OSCE's moderate correlation with the ITE and CRS suggests that the OSCE, which consists largely of physical diagnosis stations, may test a component of clinical skills not evaluated by the other measures. Thus, the OSCE is an important addition to the assessment of clinical competence.

Analysis of Variance↗
PubMed2001

How discriminatory is the objective structured clinical examination (OSCE) in the assessment of clinical competence of medical students?

A prospective collection and analysis of examination marks for three consecutive academic years was undertaken to determine the correlation between the objective structured clinical examination (OSCE) and various other components of medical students' examination, and also to examine how discriminatory the OSCE examination is in the assessment of clinical competence. Out of 388 students, 96.3% passed the examination at the first attempt. Of those who passed, 15.5% had merit while 1.0% had a distinction. When the OSCE component was excluded from the analysis, 11.6% and 2.8% had merits and distinctions, respectively, but when the clinical examination was excluded, there were 17.8% and 6.2% merits and distinctions, respectively. Correlations between the various components of the examination were significant except for that between the clinical examination and the project. Although the OSCE and clinical components of examinations for clinical students are complementary, the OSCE component awards more merit and distinction categories. Although there were statistically significant correlations between the various components of the examination, only 11% of the variability in clinical examination scores could be explained by the performance in OSCE suggesting that the different components are testing different aspects of the student's clinical competence. Completely replacing clinicals with an OSCE may not necessarily be the best way of assessing medical students' clinical competence.

Journal Article↗
PubMed2000

Watching anaesthetists work: using the professional judgement of consultants to assess the developing clinical competence of trainees.

One of the responsibilities of a consultant is to identify the clinical competence of trainees by observing them at work. The attributes of clinical competence in anaesthesia were defined by interviewing a group of consultants and trainees. Observation of practice was believed to be important in monitoring competence and the supervising consultants all believed that they could recognize competent performance. The account of the structure of observation provided by the anaesthetists is used as the basis of advice on how to conduct an assessment of trainees' developing professionalism by use of the specialist's professional judgement.

Anesthesiology↗
PubMed1985

Reliability, validity and efficiency of multiple choice question and patient management problem item formats in assessment of clinical competence.

Despite a lack of face validity, there continues to be heavy reliance on objective paper-and-pencil measures of clinical competence. Among these measures, the most common item formats are patient management problems (PMPs) and three types of multiple choice questions (MCQs): one-best-answer (A-types); matching questions (M-types); and multiple true/false questions (X-types). The purpose of this study is to compare the reliability, validity and efficiency of these item formats with particular focus on whether MCQs and PMPs measure different aspects of clinical competence. Analyses revealed reliabilities of 0.72 or better for all item formats; the MCQ formats were most reliable. Similarly, efficiency analyses (reliability per unit of testing time) demonstrated the superiority of MCQs. Evidence for validity obtained through correlations of both programme directors' ratings and criterion group membership with item format scores also favoured MCQs. More important, however, is whether MCQs and PMPs measure the same or different aspects of clinical competence. Regression analyses of the scores on the validity measures (programme directors' ratings and criterion group membership) indicated that MCQs and PMPs seem to be measuring predominantly the same thing. MCQs contribute a small unique variance component over and above PMPs, while PMPs make the smallest unique contribution. As a whole, these results indicate that MCQs are more efficient, reliable and valid than PMPs.

Clinical Competence↗
PubMed1998

The Diagnosis Script Questionnaire: A New Tool to Assess a Specific Dimension of Clinical Competence.

The Diagnosis Script Questionnaire (DSQ) assesses a specific skill of clinical competence: the ability to weigh collected information in light of entertained hypotheses. The questionnaire presents a clinical vignette for which several hypotheses are relevant. The model of the questions is: if you are thinking of hypothesis A and you find sign Z, what is the effect on your hypothesis? Answers are placed on a 7-point Likert scale, with values ranging from "it can only be this hypothesis" to "this hypothesis is definitely rejected." The scoring process is innovative and reflects the variability of answers among experts.The questionnaire was administered in gynecology-obstetrics; 103 respondents, divided into three groups, 15 faculty, 12 residents, and 76 clerkship students volunteered. Mean global scores were 45.3 for faculty, 40.5 for residents, and 35.8 for students. The differences between the three groups were statistically significant with Welch ANOVA (p < 0.001). The Bonferroni post-hoc correction however indicated that the only significant difference was between student and faculty groups (p < 0.001). Cronbach's alpha was 0.822 for the total group; for the student and resident groups, 0.794 and 0.812 respectively. The proportion of the total variance explained by the interaction items/participants as estimated by generalizability was 42.1%, 65.4% and 73.4% for the faculty, resident and student groups respectively.Results agree with the theories of development of clinical competence which states that knowledge structures specifically adapted to diagnostic tasks appear with clinical experience. This new assessment tool appears promising and warrants future development.

Journal Article↗
PubMed2004

Toward meaningful evaluation of clinical competence: the role of direct observation in clerkship ratings.

PROBLEM STATEMENT AND PURPOSE: The lack of direct observation by faculty may affect meaningful judgments of clinical competence. The purpose of this study was to explore the influence of direct observation on reliability and validity evidence for family medicine clerkship ratings of clinical performance. METHOD: Preceptors rating family medicine clerks (n = 172) on a 16-item evaluation instrument noted the data-source for each rating: note review, case discussion, and/or direct observation. Mean data-source scores were computed and categorized as low, medium or high, with the high-score group including the most direct observation. Analyses examined the influence of data-source on interrater agreement and associations between clerkship clinical scores (CCS) and scores from the National Board of Medical Examiners (NBME(R)) subject examination as well as a fourth-year standardized patient-based clinical competence examination (M4CCE). RESULTS: Interrater reliability increased as a function of data-source; for the low, medium, and high groups, intraclass correlation coefficients were.29,.50, and.74, respectively. For the high-score group, there were significant positive correlations between CCS and NBME score (r =.311, p =.054); and between CCS and M4CCE (r =.423, p =.009). CONCLUSION: Reliability and validity evidence for clinical competence is enhanced when more direct observation is included as a basis for clerkship ratings.

Certification↗
PubMed1991

Effect of extern experiences on clinical competence of graduate nurses.

The purpose of this study was to examine the effect of externships, offered collaboratively between schools of nursing and hospitals, on the clinical competence of new graduates in their first nursing position. The scores of 24 pairs of graduate nurses and their preceptors (N = 48) on the Clinical Competency Rating Scale (CCRS; Scheetz, 1989) were compared in three areas: problem solving, applying theory to practice, and psychomotor skills. New graduates rated themselves higher than their preceptors on all items in the CCRS. Analyses via t tests indicated significant differences between the nurses' own ratings and those of their preceptors on problem solving, applying theory to practice, and psychomotor performance as well as total CCRS. The clinical competence of new graduates who had been externs during their nursing programs was compared to that of graduates who did not have this clinical experience. Nurses who had been externs rated themselves significantly higher than nonexterns on psychomotor performance (t = 2.72, P = .013) and the total CCRS score (t = 2.22, P = .04). Preceptor ratings, however, indicated no differences between these groups.

Adult↗
PubMed1999

The effect of an extramural education program on the perceived clinical competence of dental hygiene students.

The purpose of this study is to evaluate the effect of an extramural rotation on dental hygiene student self-perceptions of competence in specific clinical areas. Dental hygiene students attending one midwestern university from 1992 through 1998 rated their perceived level of competence on nineteen dimensions of dental hygiene practice prior to beginning a four-week extramural rotation and again at the completion of the rotation. Results indicated that student perceptions of competence improved significantly on six of the nineteen dimensions in each of the study years. Study results suggest that an extramural rotation is a valuable component of a dental hygiene curriculum to enhance student self-perceptions of clinical competence.

Clinical Competence↗