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PubMedDate not supplied

Evaluating clinical competence of physical therapy students. Part 2: assessing the reliability, validity and usability of a new instrument.

This study was conducted to establish the reliablity and validity of an instrument designed to evaluate the clinical competence of physical therapy (PT) students. A criterion-referenced evaluation instrument--the Evaluation of Clinical Competence (ECC)--was developed by the investigator according to the procedures recommended in the measurement literature. This behaviourally-anchored, four-point rating scale was tested on two groups of PT students from the University of Alberta, Edmonton, Canada. In order to obtain data by which to analyze and revise the ECC, the ECC was administered to fourth-year PT students (n = 29) during their clinical placement in November 1982, according to specified instructions. The revised ECC was administered to third-year (n = 23) and fourth-year PT students (n = 25) during their clinical placements in February and March of 1983. The same instructions were followed in order to collect the necessary data to establish inter-rater reliability, concurrent validity, and construct validity of the ECC. The results of the study suggest that the ECC is a fairly reliable, valid, and practical instrument with which to assess the clinical competence of PT students.

Clinical Competence↗

PubMed1987

Ratings of residents' clinical competence and performance on certification examination.

The American Board of Internal Medicine (ABIM) requires directors of internal medicine residency programs to rate their residents in overall clinical competence and its essential components. In the study reported here, the authors investigated the relationships among these ratings and compared them with the residents' performance on the ABIM's certification examination in the years 1980 through 1985. The ratings of the individual components of clinical competence were correlated moderately with examination performance and very highly with each other. The individual components that were less dependent on medical knowledge (for example, interpersonal skills or humanism) had slightly smaller correlations with examination performance. The ratings of overall clinical competence were also related moderately to examination performance. Changes in the pattern of the ratings over time indicated that fewer candidates were receiving lower ratings while more were receiving higher ratings. The pass rates for each rating level were the same or lower; for example, the pass rate for candidates rated 5 was 68 percent in 1980 and 56 percent in 1985. The similar ranking of examinees by the program directors and the examination provides evidence for the validity of the examination.

Certification↗

PubMed2001

[First experiences in evaluating the clinical competence of family doctors in Catalonia].

OBJECTIVES: To construct a valid instrument to evaluate the clinical competence of family doctors and establish professional standards. DESIGN: Construction of an objective and structured clinical evaluation test by the Test Committee of the Catalan Society of Family and Community Medicine (SCMFiC) with 27 representative clinical situations of primary care practice. This used various evaluative instruments and lasted 5 hours and 30 minutes. SETTING: 2 Barcelona health districts for the two runnings of the test. PARTICIPANTS: Family doctors, SCMFiC members, who took part voluntarily after having been invited by letter. MEASUREMENTS AND MAIN RESULTS: 23 doctors took part in the first running of the test. Their average age was 36.6 (SD 6.9) and 52.2% of them were women. 46 doctors took part in the second test. Their average age was 30.9 (SD 2.1) and 76.1 were women. The test had an overall reliability coefficient (Cronbach's alpha) of 0.83 the first time and 0.65 the second time. The overall mean score of the participants the first time was 56.9 (SD 19.2), with 100 the top score possible, and 62.1 (SD 4.1) the second time. CONCLUSIONS: This SCMFiC experiment is the first time the clinical competence of family doctors has been assessed in our area. It was a reliable and valid test to assess the competence of our health professionals.

Adult↗

PubMed2006

Assessing clinical competence: a pilot project to evaluate the feasibility of a standardized patient -- based practical examination as a component of the Swiss certification process.

PURPOSE: advances in the assessment of clinical competence have prompted medical schools and licensing authorities to complement written and oral tests with practical ones. The purposes of this project were to (1) determine how clinical competencies not effectively addressed on the present Swiss federal examinations can be assessed adequately on a standardised patient-based practical examination (SCE) and (2) evaluate the SCE validity, reliability and feasibility. METHOD: a bilingual, three-hour standardised patient-based clinical examination was pilot tested in 2003 with 48 volunteered fifth and sixth-year students from the five Swiss medical schools. All students took the same eight 15-minute patient cases. To ensure the test content validity, test cases were selected by a multi-disciplinary and -institutional committee of clinical faculty on the basis of predefined exam blueprint criteria and in reference to the Swiss catalogue of learning objectives. RESULTS: moderate correlations between the SCE and the existing Federal final written examinations (0.46) and the newly pilot-tested structured oral examination or SOE (0.56) [3] suggested that they were complementary to one another and that each might emphasise aspects of the clinical competence which others might not. The reliability (a coefficient) of the SCE scores ranged from 0.73 to 0.77. CONCLUSIONS: limited experiences gathered throughout the SCE pilot project demonstrated its feasibility. Preliminary results suggested that SCE scores had a good level of construct validity and reliability and seemed to complement scores obtained on the final certification written examinations and the newly tested SOE. These results, however, need to be further confirmed with larger samples studies.

Certification↗

PubMed2004

Do repeated clinical competency ratings stereotype students?

A stereotype is a generalization that protects itself from critique by limiting or distorting new information. The potential for stereotyping exists where faculty members repeatedly rate students' clinical competency. Stereotyping is difficult to study because of methodological problems. If, for example, a student's score remains low over repeated ratings, it may be because the faculty member has pegged the student as a poor performer or because the student is in fact a consistently low performer. An existing dataset of clinical competency ratings for almost 300 students was divided so that ratings given by faculty members who had evaluated students previously could be compared to ratings of the same students by faculty members who had not previously evaluated these students. This study supports the following conclusions: 1) repeating faculty members use both current information and carryover information from previous rating periods; 2) the amount of information carried over increases from quarter to quarter; and 3) faculty evaluators who use more carryover information are more accurate in predicting students' graduation competency level than are faculty members on their initial ratings of students. In conclusion, there is no evidence in this study that repeated clinical competency ratings promote stereotyping of students by faculty members.

Clinical Competence↗

PubMed2001

Standardized or real patients to test clinical competence? The long case revisited.

BACKGROUND: In undergraduate clinical examinations, the use of real patients as long cases is being replaced by objective structured clinical examinations (OSCEs) which use simulated scenarios, although we lack published psychometric data on long cases to support the move from real to simulated patients. AIM: To assess candidate performance across two history-taking long cases to estimate the number of cases required for a reliable assessment. Results are compared with psychometric data from an OSCE. SETTING: A final-year qualifying undergraduate clinical examination. METHOD: Two observed history-taking long cases were included, alongside an OSCE. Candidates interviewed two unstandardized real patients. The history-taking part (14 minutes) was observed, uninterrupted, by examiner(s) who assessed data gathering, interviewing, and diagnostic and management skills. The presentation (7 minutes) was unstructured; the examiner(s) intervened as appropriate. Marks were expressed as a percentage of the total possible score and analysed using generalizability theory to estimate intercase reliability. RESULTS: Two examiner pairs independently rated both long cases for 79 (36.7%) of the 214 candidates. Projections based on generalizability theory showed that 10 20-minute cases would give reliabilities of 0.84 for single-marked and 0.88 for double-marked candidates, compared with a projected reliability of 0.73 for the same 214 candidates taking the OSCE. CONCLUSION: If history-taking long cases are observed, three-and-a-half hours of testing time using 10 unstandardized patients would produce a reliable test. Long cases therefore are, in terms of reliability, no worse and no better than OSCEs in assessing clinical competence.

Clinical Competence↗

PubMed1989

A factor analytic study of clinical competence in undergraduate psychiatry.

This study used factor analysis to define the components of clinical competence of medical students during their undergraduate psychiatric training. Four factors were defined; factor 1 related to cognitive and psychological problem-solving; factor 2 tapped the interpersonal and observational skills students showed with patients; factor 3 was characterized by knowledge in the examination setting, and factor 4 related to students' capacity to demonstrate their ability in an interpersonal setting. These are similar to the component skills of clinical competence demonstrated by students in other areas of the medical curriculum. They also correspond to the skills which Walton (1986) has suggested should be focused upon in undergraduate psychiatric education.

Clinical Clerkship↗

PubMedDate not supplied

[The challenge of evaluating clinical competence].

The study is divided in two parts. The first one deals with theoretical aspects of evaluation. In the second part, the development of an instrument intended to explore clinical competence is presented. The importance of considering evaluation as part of a research process is emphasized in the first part. The diverse theoretical and action trends in the field of education are synthetized in two main tendencies: the active-participating and the passive-receptive. The influence of these two tendencies in the selection the objects for evaluation is also discussed. An evaluation instrument developed by us to explore clinical competence is placed within the active-participating tendency of education; the present state of this instrument is given in the second part. The instrument consists of multiple choice options of the true, false, don't know type. The instrument in its present version is the result of a long validation process. It explores particularly iatrogenic behaviors by omission or commission. The sample studied were 457 applicants for specialization courses in medicine. Of these, 127 were foreign applicants. The instrument was applied to the whole sample in one single session. The results showed a low general clinical competence, with similar results in mexican and foreign applicants. A clear difference was found in commission iatrogenia which was significantly more frequent than omission iatrogenia. The theoretical superiority of our test in relation the others is discussed.

Clinical Competence↗

PubMed1993

Assessment of clinical competence of medical students by using standardized patients with musculoskeletal problems.

OBJECTIVE: To assess medical students' clinical competence in addressing musculoskeletal problems. METHODS: Nineteen junior medical students completed 2 standardized patient-based tests structured to capture their clinical decisions from undiagnosed chief complaint to management. RESULTS: No student approached the highest possible score on either test, and the students as a group received less than half the possible points on 5 important aspects of diagnostic reasoning. CONCLUSION: Standardized patient-based tests can be structured to provide enlightening information about medical students' clinical competence with regard to musculoskeletal problems.

Arthritis, Rheumatoid↗

PubMed2001

Responsive assessment: assessing student nurses' clinical competence.

This paper argues for a new approach to continuous assessment of students of nursing clinical competence, which I call responsive assessment. Its argument for this is based on a research study highlighting the problems and concerns students and practitioners identified in relation to the assessment of their nursing practice and clinical competence. It puts forward a case for challenging role boundaries by implementing contract assignments: as an integral part of adult learning and continuous assessment (Neary 1992a, 1998) and for developing a conceptual model called responsive assessment, in which the students' readiness for assessment and their response to patient/client needs is identified.The arguments are developed against the background of Benner's movement from novice to expert (Benner 1984) and Stake's (Stake 1977) three stages of antecedents, transaction and outcome as a process for professional students development.

Clinical Competence↗

PubMed2006

Clinical competence: general ability or case-specific?

BACKGROUND: Before the 1970s, research into the development of clinical competence was mainly focused on general problem-solving abilities. The scope of research changed when Elstein and colleagues discovered that individual ability to solve clinical problems varies considerably across cases. It was concluded that problem solving abilities are highly dependent on domain-specific knowledge rather than on general problem solving skills. Elstein called this phenomenon "case specificity." PURPOSE: The finding of content specificity will be contrasted with the existence of a general clinical problem solving ability, and the relationship between preclinical knowledge and a problem solving ability will be investigated. METHODS: A correlation matrix was calculated with clerkship final scores from 10 disciplines to examine the magnitude of the interrelations. A confirmatory factor analysis was applied to the corresponding covariances using structural equation modeling to investigate whether scores on finals shared any common variance across clerkships. Finally, two additional models were tested to examine the nature of the relationship between preclinical knowledge and problem solving. RESULTS: Low to moderate correlations across clerkship disciplines were found, supporting the original findings of content specificity. Further investigation showed that in addition to specific knowledge, a general, content-independent ability is needed to perform on these examinations. CONCLUSIONS: Clinical competence, as measured in this study, is based on a combination of specific preclinical knowledge and a problem-solving ability. Case specificity fits perfectly well in this interactional perspective on clinical problem solving but does not explain it. The phenomenon "case specificity" is therefore not solely a result of content knowledge, but of level of experience and level of case difficulty.

Clinical Clerkship↗

PubMed1998

Methods for evaluating the clinical competence of residents in internal medicine: a review.

This paper reviews methods commonly used to assess the clinical competence of residents in internal medicine, including the In-Training Examination, medical record audits, rating scales, clinical evaluation exercises, and the use of standardized patients. Studies were identified through a MEDLINE search (1966 to present) and from the bibliographies of relevant articles and were selected for inclusion according to consensus between the authors. Whenever possible, original studies were chosen over reviews and editorials. No single assessment method can successfully evaluate the clinical competence of residents in internal medicine, and educators need to be cognizant of the most appropriate applications and the advantages and disadvantages of the available evaluation tools. A combination of assessment tools provides the best opportunity to evaluate and educate physicians-in-training.

Clinical Competence↗

PubMed2005

Predicting academic performance and clinical competency for international dental students: seeking the most efficient and effective measures.

Measures used in the selection of international dental students to a U.S. D.D.S. program were examined to identify the grouping that most effectively and efficiently predicted academic performance and clinical competency. Archival records from the International Dental Program (IDP) at Loma Linda University provided data on 171 students who had trained in countries outside the United States. The students sought admission to the D.D.S. degree program, successful completion of which qualified them to sit for U.S. licensure. As with most dental schools, competition is high for admission to the D.D.S. program. The study's goal was to identify what measures contributed to a fair and accurate selection process for dental school applicants from other nations. Multiple regression analyses identified National Board Part II and dexterity measures as significant predictors of academic performance and clinical competency. National Board Part I, TOEFL, and faculty interviews added no significant additional help in predicting eventual academic performance and clinical competency.

Achievement↗

PubMed2001

Widening the lens on standardized patient assessment: what the encounter can reveal about the development of clinical competence.

The standardized patient (SP) examination is used in a majority of medical schools to test clinical skills. This examination usually yields both numerical ratings of clinical skill and narrative comments by patients or observers, yet most empirical studies of SP assessment focus on the numerical ratings only. This quantitative focus can lead to a narrow conceptualization of the nature and development of clinical competence. The authors suggest that in addition to utilizing SP numerical ratings, medical educators also use the rich qualitative material produced in the SP examination (e.g., patient comments, videotapes of the examination) to explore students' development of clinical competence, which involves the purposive integration of basic science, technical skill, empathy, communication, professional role, and personal history.

Attitude of Health Personnel↗

PubMed2000

Specific clinical competencies for managing care: views of residency directors and managed care medical directors.

CONTEXT: Although medical educators recognize the need to prepare physicians to work effectively in managed care environments, managed care is often perceived negatively by academic physicians. Curricular reform has been hampered by a failure to seek agreement about specific clinical competencies that are important to both managed care directors and medical educators. OBJECTIVES: To identify specific clinical competencies in the managed care setting and to assess agreement between residency directors and managed care medical directors on the importance of these competencies. DESIGN, SETTING, AND PARTICIPANTS: Surveys (1998-1999) of a national sample of 59 residency directors involved in managed care training programs (response rate, 94%); a sample of 186 residents in these programs and 258 matched control residents (response rate, 77%); and national samples of 147 managed care organization (MCO) medical directors (response rate, 67%) and 140 primary care residency program directors in areas of high MCO penetration (response rate, 73%). MAIN OUTCOME MEASURES: Specific clinical managed care tasks as defined by residency directors; self-reported confidence in performing these tasks by sample residents vs control residents; and importance of these tasks as rated by MCO medical directors and residency program directors. RESULTS: Twenty-six specific clinical managed care tasks were identified by the residency directors. Residents who participated in managed care training were significantly more confident than their counterparts in performing 20 of the 26 tasks (P<.01 for all). Residency directors and MCO medical directors viewed 65% of these tasks as important to patient care during the next 5 years. Of the 10 tasks most highly rated by residency directors and MCO medical directors, 9 were the same, addressing time management, ethics, case management, practice guidelines, cost-effective clinical decision making, referral management, disease management, patient satisfaction, and clinical epidemiology. CONCLUSIONS: Our data indicate that residency directors and managed care medical directors value mastery of many of the same specific clinical competencies in managed care. Previously documented negative attitudes toward managed care among academic physicians may obscure an underlying concordance about the skills essential to managing the health of populations. JAMA. 2000;284:1093-1098

Administrative Personnel↗

PubMed1976

An examination model for monitoring clinical competency in operative dentistry.

A model for a clinical competency examination has been presented. Extensive efforts were exerted in standardizing the procedures, the criteria, and the examiners. In addition, the examination was designed to permit isolation and documentation of errors in various phases of a class II amalgam restoration.

Clinical Competence↗

PubMed2004

Perceptions of the clinical competence of newly registered nurses in the North West province.

The clinical competence of newly registered nurses relating to the care of individual Clients, depends on their ability to correlate theoretical knowledge learned in the classroom with practice and the development of clinical skills. Its foundation lies in the ability to identify and solve problems that emanate from critical thinking, analytical reasoning and reflective practice. It is clear that the quality of clinical exposure plays a leading role in the development of nursing professionals. Nursing skills alone cannot ensure quality care of clients without the application of theory. Facilitation of this theory to practice therefore remains an essential component of nursing education. This study was aimed at identifying areas of incompetence of newly registered nurses (1998--2001) in the clinical area by determining the newly registered nurses' and professional nurses' perceptions of the competence of the newly registered nurses. A quantitative, non-experimental, descriptive survey was used to collect the data regarding the clinical competence of newly registered nurses (1998--2001). An in depth literature study was conducted to generate information that was used as basis for the study. For data collection two types of structured questionnaires were used to obtain information from the professional nurses and the newly registered nurses in identified hospitals in the North West Province. The professional nurses' sample consisted of (n=151) respondents and the newly registered nurses' sample of (n=67) respondents. An analysis of the data obtained from the study revealed that the shortage of staff, equipment and supplies negatively affect the competency of newly registered nurses. There is a discrepancy between what the newly registered nurses learned in the classroom and what they observe in the clinical area. Orientation programmes need to be reviewed and are often neglected due to staff shortages. Findings with regard to the newly registered nurses revealed that these nurses have sufficient theoretical knowledge but lack competency in basic nursing skills due to an inability to correlate theory to practice. Conclusions that can be drawn from this study are that there are many factors that impact negatively on the competency of the newly qualified nurses. These emanate from the clinical area, as well as during the education and development of newly registered nurses. Recommendations regarding the education and training of newly registered nurses and the clinical practice area have been made.

Attitude of Health Personnel↗

PubMed1995

Family nurse practitioner clinical competencies in alcohol and substance use.

The prevalence of substance use among patients presenting to primary health care settings mandates clinical competency in the area for nurse practitioners (NPs). An educational intervention with an evaluation component is described. The effect of incorporating substance use content into a Family Nurse Practitioner (FNP) curriculum was tested with a convenience sample of 16 FNP students and 8 practicing NPs. Students' knowledge increased significantly; however, differences in students' and practicing NPs' knowledge did not reach significance. Students' clinical competency increased significantly, as demonstrated by standardized patient clinical evaluations, and was significantly better than the practicing NPs in the skill domains of evaluation and record keeping. Educational intervention can improve NP identification of substance-abusing patients in primary health care settings.

Alcoholism↗