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Results for “Competency framework”

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PubMed2003

The application of social and adult learning theory to training in community pediatrics, social justice, and child advocacy.

Perhaps the greatest challenge we face today in medical education is how to establish a conceptual framework for conveying the context of community pediatrics and issues related to child health equity and social justice to practicing pediatricians and pediatricians in training. This will require a new infrastructure and approach to training to allow pediatricians to think and practice differently. The application of social and adult learning theory to the development and implementation of community pediatrics curricula will be necessary to succeed in these endeavors. In particular, we also will need to understand the educational processes required to motivate adult learners to acquire knowledge, attitudes, and skills outside the context and framework of their previous experiences and perceived professional needs.

Adult↗

PubMedDate not supplied

Caring as an imperative for nursing education.

Caring is a universal need that is an important component in the delivery of nursing care. Nurse educators face the challenge of teaching the value of caring as a necessary part of nursing. Watson's theoretical framework, which focuses on interpersonal and transpersonal processes in human care, presents an effective model in understanding the concept of caring (1). Krathwohl, Bloom, and Masia's model of affective domain provides a taxonomy of affective competencies that guides the process of value development (2). Both models enhance our understanding of caring and provide the theoretical foundation for integrating caring into nursing education. This article describes an associate degree program's effort to thread the concept of caring across its curriculum. It includes an overview of the steps used for integrating caring in individual clinical courses and emphasizes teaching/learning and assessment strategies used in the educational process.

Affect↗

PubMed2004

Developing and implementing the role of the nurse bronchoscopist.

Recent years have seen a growing range of new roles being created for nurses, often in areas previously considered to be part of the medical domain. This paper discusses the development of the nurse bronchoscopist role and a training programme and service framework to support it in order to develop a nurse-led service for patients requiring this procedure.

Accreditation↗

PubMed1991

Use of grounded theory methodology in a descriptive research design.

The purpose of this descriptive study is to illustrate how grounded theory methodology can be used for a descriptive survey study and also explains the implementation of the stepwise procedure. The focus of this study was on self-reported decisions made by new graduates from three different types of nursing programs (baccalaureate, associate degree and diploma) while assessing, planning, implementing and evaluating nursing care on medical-surgical units. The subjects' responses were analyzed using six steps of grounded theory methodology to classify the type and complexity of decisions (Glaser & Strauss, 1967). Harrison's model of decision making was used as a theoretical framework because it provides a typology for decision making that may be applied to various levels within the hospital setting.

Clinical Competence↗

PubMed1991

Construction, expression and characterization of humanized antibodies directed against the human alpha/beta T cell receptor.

Completely humanized antibodies with specificity for the human alpha/beta TCR have been produced by genetic engineering. The L and H chain V region exons encoding the murine mAb BMA 031 CD regions and human EU framework regions were synthesized and replaced into previously isolated genomic fragments. These fragments were inserted into mammalian expression vectors containing the human kappa and gamma 1 C region exons. Two variants were constructed each containing selected BMA 031 amino acids within the human frameworks. The humanized genes were transfected into Sp2/0 hybridoma cells by electroporation and transfectomas secreting humanized antibody were isolated. Levels of antibody expression up to 7 pg/cell/24 h were obtained. The humanized antibody, BMA 031-EUCIV2, competed poorly with murine BMA 031 for binding to T cells. BMA 031-EUCIV3, however, bound specifically to T cells and competed effectively with both the murine BMA 031 antibody and a previously constructed chimeric BMA 031 antibody for binding to these cells. The relative affinity of BMA 031-EUCIV3 was about 2.5 times lower than BMA 031. The ability to promote antibody dependent cell-mediated cytolysis was significantly enhanced with the engineered antibodies as compared to murine BMA 031. Humanized BMA 031 is a clinically relevant, genetically engineered antibody with potential uses in transplantation, graft vs host disease, and autoimmunity.

Amino Acid Sequence↗

PubMedDate not supplied

A patient care training program for volunteers.

Properly trained and interested volunteers can perform basic nursing skills in a clinical setting. Staff development educators should 1) assess the needs of the area; 2) assess the skills of the volunteers available to them; 3) construct goals and objectives for a thorough orientation program geared to people with nonmedical backgrounds; 4) select appropriate course content and methods of presentation based on the framework provided by the goals and objectives and on the regulations governing the institution in which the volunteer will work; 5) implement the course; and 6) evaluate the adequacy and thoroughness of the program and the competency of the volunteers trained. The potential service that qualified and adequately trained volunteers could offer in patient care areas that are understaffed in nursing personnel is great. Similar programs can be used to supply needed assistance in facilities with limited nursing personnel.

Ambulatory Care↗

PubMed1995

Is that absolutely true? Reflections on reality in general practice.

Biomedical scientific knowledge appeared to me, as a medical student, to be carved in stone. After many years in general practice it seemed more like it was carved in the shifting sands of time. A feeling of insecurity in diagnosis and treatment followed. There was also a perceived superiority of scientific knowledge over knowledge gained by other means. This did not sit well with my experience in everyday general practice. This article explores a rational framework for change in medical science and a justification for giving equal importance to other forms of knowledge in general practice.

Clinical Competence↗

PubMedDate not supplied

A framework for the development of nurse manager negotiation skills.

Effective negotiation skills have been identified as an essential component of the nurse manager role. Application of the negotiation process in today's dynamic and competitive health care environment is frequently difficult and stressful for the novice nurse manager. The authors describe a Conceptual Model for Negotiation that can be used as a management development framework for the novice nurse manager.

Conflict, Psychological↗

PubMed2004

Assessing the burden of injuries: competing measures.

OBJECTIVES: This paper compares the different types of injury burden measures in common use and examines criteria that may be useful to consider when selecting between alternative measures. METHODS: A review was conducted of relevant literature relating to burden of injury measures, important characteristics of data information systems and ethical frameworks for normative analysis in the health sector. RESULTS: Four broad types of burden of injury measures can be distinguished: mortality-related indices; morbidity-related indices; composite measures combining mortality and morbidity; and monetary costs. Each type of measure uses its own construct of injury burden. For example, mortality data defines the injury burden as comprising only fatalities whereas comprehensive costs attempt to capture the total wellbeing lost through injury. Different measures of the burden of injury present differential rankings of the causes and intent of injury, thus the question arises as to what criteria should be used in selecting the best measure. Each measure of the burden of injury has merits and limitations. In selecting between injury measures, consideration should be given to the nature of the policy question, the construct of injury burden that each measure assesses, the availability of data for the measure and its quality and the ethical values inherent in each measure. CONCLUSIONS: Measures of the burden of injury play a useful role in positioning injury as a major public health problem and in policy work relating to injury prevention and control. No single measure of the burden of injury is ideal and several measures can be used together if necessary to provide different perspectives on an injury problem.

Cost of Illness↗

PubMed2000

Action research to improve the pre-registration midwifery curriculum Part. 3: Can fitness for practice be guaranteed? The challenges of designing and implementing an effective assessment in practice scheme.

OBJECTIVE: To design and implement a robust assessment scheme to more effectively identify student midwives' fitness for midwifery practice. DESIGN: Five inter-related action research cycles. Methods included: documentary analysis, interviews, observation, questionnaires, focus groups. SETTING: A large university in England. PARTICIPANTS: Student midwives, practising midwives and midwife teachers, childbearing women, course planning team and EME project team collaborators. FINDINGS: Whilst there was evidence that the majority of students are fit for midwifery practice by the end of the course, assessment schemes were found to be unreliable. In particular there was the potential for 'borderline' students to register as midwives if assessors were inadequately prepared for their responsibilities; assessment documentation was not 'user' friendly; evidence of competence was inadequately recorded or there was a lack of systematic monitoring by university teachers and examiners of the assessment in practice scheme. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The gap between curriculum aspirations and actual implementation needs to close. The assessment matrix, developed as part of the national evaluation study, could usefully be used as a framework when designing assessment schemes. The difficulties for midwife assessors in each locality need to be identified and solutions incorporated into workable but robust strategies. University midwife teachers/lectures have a responsibility to work in partnership with assessors and students to monitor assessment in practice schemes and, where local circumstances and confidence in reliability permit, grade and award credits for practice-based assessment of student capability.

Clinical Competence↗

PubMed2005

Functional therapy for children with cerebral palsy: an ecological approach.

The aim of this pilot study was to evaluate functional training for children with cerebral palsy (CP). The outcomes examined were goal-achievement, gross motor function, performance of everyday activities, caregiver assistance, parents' perception of family-centredness, and preschool assistants' feeling of competence in the care of the children. The outcome measures used were goal attainment scaling, Gross Motor Function Measure, Pediatric Evaluation of Disability Inventory (functional skills and caregiver assistance scales), Measure of Processes of Care, and a questionnaire. The intervention was carried out in the context of daily life settings, i.e. in an ecological framework. Fourteen children (three females, 11 males; age range 1y 6mo to 6y) with diplegia and tetraplegia, classified at Gross Motor Function Classification System levels II-V, participated in the five-month intervention. Frequency of training towards a specific goal varied between twice a day and 23 times a day, depending on the type of goal. Seventy-seven per cent of goals were fully attained. Gross motor function and performance of daily activities, including social function, improved significantly. A decrease in caregiver assistance was noted in relation to the children's mobility. Parents' perception of family-centredness improved in all domains. Furthermore, the children's preschool assistants felt more competent in their care of the children.

Activities of Daily Living↗

PubMed1999

Evaluation, feedback, and remediation in anesthesiology residency training: a survey of 124 United States programs.

STUDY OBJECTIVE: To provide a review of evaluation, feedback, and remediation methods in United States residency programs during 1995 to 1996. The information gathered is to serve as a framework for discussions within and among programs regarding ways to enhance their current processes of evaluation, feedback, and remediation, and to serve as a baseline for future assessments. DESIGN, SETTING AND SUBJECTS: A three-page survey was mailed to program directors of each of the 145 anesthesiology programs listed in the Accreditation Council for Graduate Medical Education (ACGME/NRMP) Directory. MEASUREMENTS AND MAIN RESULTS: Quantitative and qualitative responses were sought about the resident evaluation process (including techniques of gathering information, frequency of evaluations, faculty compliance, and modes of offering feedback), departmental clinical competence committee, probation and remediation policies for problem residents, and the use of formal examinations. There was an 85.5% response rate. Frequency of evaluation of residents ranged from daily to quarterly: evaluations used both narrative comments and rating scales in 89% of institutions. Faculty compliance in the evaluation process was greater than 75% in 45.1% of programs. Only 25 (20.2%) programs offered formal training about resident evaluation to their faculty. Clinical competence committee meetings averaged five times annually. Ninety-five percent of committees were chaired by someone other than the department chairperson and 27% had resident members. A written policy regarding problem residents was used by 67.7% of programs, a formal probation policy by 82.2%. Standardized tests to provide feedback and guidance to residents existed in 48.3% of programs. CONCLUSIONS: There is a tremendous variety of techniques and methodologies employed among anesthesiology residency programs with regard to evaluation, feedback, and remediation, within the framework of the ACGME guidelines. Faculty training in the assessment of and feedback to residents is one area in which many programs can begin to strengthen their current procedures.

Accreditation↗

PubMed2005

Dysprosodic speech following basal ganglia insult: toward a conceptual framework for the study of the cerebral representation of prosody.

Progress in understanding brain/behavior relationships in adult-acquired dysprosody has led to models of cortical hemispheric representation of prosodic processing based on functional (linguistic vs affective) or physical (timing vs pitch) parameters. These explanatory perspectives have not been reconciled, and also a number of neurobehavior syndromes that include dysprosody among their neurological signs have not yet been integrated. In addition to expanding the functional perspective on prosody, some of these syndromes have implicated a significant role of subcortical nuclei in prosodic competence. In this article, two patients with acquired dysprosodic speech following damage to basal ganglia nuclei were evaluated using behavioral, acoustic, cognitive, and radiographic approaches. Selective quantitative measures were performed on each individual's performance to provide detailed verification and clarification of clinical observations, and to test hypotheses regarding prosodic function. These studies, combined with a review of related clinical research findings, exemplify the value of a broader perspective on the neurobehavioral dysfunction underlying acquired adult dysprosodic speech, and lead to a new, proposed conceptual framework for the cerebral representation of prosody.

Adult↗

PubMedDate not supplied

Management of laryngeal radionecrosis: animal and clinical experience.

Radiation necrosis of the laryngeal cartilages is an uncommon complication of radiotherapy for laryngeal carcinoma. It is a devastating process for which there is no one acceptable treatment. Medical management offers only temporary, symptomatic relief, which further necessitates surgical treatment. Surgical management may start with a tracheotomy; however, it often ends with a total laryngectomy. Physiologically, the necrotic cartilages are the source of the problem. It is a general surgical principle that nonviable tissue must be excised to promote healing. Therefore, if the affected laryngeal cartilages were removed, the larynx should heal. Total or near total removal of the thyroid and cricoid cartilages with preservation of the endolaryngeal soft tissues has not been reported in the literature. Theoretically, if the entire cartilaginous framework is removed, there would be no structural support for the airway. We have found using animal models, that submucosal resection of the laryngeal cartilages, leaving the perichondrium and endolaryngeal soft tissues intact can result in a competent airway. Animal and clinical experience will be presented.

Animals↗

PubMed2006

A quantitative approach to the study of cell shapes and interactions during early chordate embryogenesis.

BACKGROUND: The prospects of deciphering the genetic program underlying embryonic development were recently boosted by the generation of large sets of precisely organized quantitative molecular data. In contrast, although the precise arrangement, interactions, and shapes of cells are crucial for the fulfilment of this program, their description remains coarse and qualitative. To bridge this gap, we developed a generic software, 3D Virtual Embryo, to quantify the geometry and interactions of cells in interactive three-dimensional embryo models. We applied this approach to early ascidian embryos, chosen because of their simplicity and their phylogenetic proximity to vertebrates. RESULTS: We generated a collection of 19 interactive ascidian embryos between the 2- and 44-cell stages. We characterized the evolution with time, and in different cell lineages, of the volume of cells and of eight mathematical descriptors of their geometry, and we measured the surface of contact between neighboring blastomeres. These analyses first revealed that early embryonic blastomeres adopt a surprising variety of shapes, which appeared to be under strict and dynamic developmental control. Second, we found novel asymmetric cell divisions in the posterior vegetal lineages, which gave birth to sister cells with different fates. Third, during neural induction, differences in the area of contact between individual competent animal cells and inducing vegetal blastomeres appeared important to select the induced cells. CONCLUSIONS: In addition to novel insight into both cell-autonomous and inductive processes controlling early ascidian development, we establish a generic conceptual framework for the quantitative analysis of embryo geometry that can be applied to other model organisms.

Animals↗

PubMed2006

Selective scenarios for the emergence of natural language.

The recent blossoming of evolutionary linguistics has resulted in a variety of theories that attempt to provide a selective scenario for the evolution of early language. However, their overabundance makes many researchers sceptical of such theorising. Here, we suggest that a more rigorous approach is needed towards their construction although, despite justified scepticism, there is no agreement as to the criteria that should be used to determine the validity of the various competing theories. We attempt to fill this gap by providing criteria upon which the various historical narratives can be judged. Although individually none of these criteria are highly constraining, taken together they could provide a useful evolutionary framework for thinking about the evolution of human language.

Biological Evolution↗

PubMed2000

From kidnapping to corruption: some trials and tribulations in the implementation of rapid assessment studies.

In between the description of the methodology and the discussion of assessment results, lies a crucial area, namely that of implementation. If assessment methods cannot be implemented, there will be no assessment report, and no recommendations for intervention or policy development. Implementation is a critical, yet neglected, area of drug policy delivery. This paper describes some of the problems associated with the implementation of rapid assessment studies commissioned by the United Nations International Drug Control Programme (UNDCP) over the last 5 years. Drawing on the author's experience of commissioning rapid assessments on the extent and nature of drug use in a variety of international settings and political contexts, the paper draws eight main lessons for rapid assessments commissioned within the context of international development programmes. These are: (1) the need to get high level political support; (2) the need to employ competent social scientists to run the assessment; (3) the need to define exactly the object of the assessment; (4) the necessity of spelling out the methodology and the time scale; (5) the careful establishment of the financial framework; (6) the importance of cultivating contacts; (7) the necessity of actually getting a report; and (8) the danger of accepting an unseen or unread consultant's report as the basis for programme implementation. The paper emphasises the critical importance of planning prior to implementation and flexibility during it.

Journal Article↗

PubMed1982

Cognition and language development in autism.

A nonverbal assessment procedure was designed to characterize cognition using a Piagetian framework. Six autistic children, five echolalic and one nonverbal, ranging in age from 4:8 to 15:2, participated in this study. Cognitive and language performance was assessed using a developmental stage model. All six children evidenced competence beyond sensorimotor Stage VI, and demonstrated cognitive functioning between the periods of early preoperational and concrete operations. For five of the six children, the stage of cognitive development exceeded that of language development. The application of a developmental model for assessment purposes and theoretical implications of the results are discussed.

Adolescent↗