PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Competency framework”

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 1,207 records · Page 67Linked to original sources
PubMed2006

Broadening perspectives on clinical performance assessment: rethinking the nature of in-training assessment.

CONTEXT: In-training assessment (ITA), defined as multiple assessments of performance in the setting of day-to-day practice, is an invaluable tool in assessment programmes which aim to assess professional competence in a comprehensive and valid way. Research on clinical performance ratings, however, consistently shows weaknesses concerning accuracy, reliability and validity. Attempts to improve the psychometric characteristics of ITA focusing on standardisation and objectivity of measurement thus far result in limited improvement of ITA-practices. PURPOSE: The aim of the paper is to demonstrate that the psychometric framework may limit more meaningful educational approaches to performance assessment, because it does not take into account key issues in the mechanics of the assessment process. Based on insights from other disciplines, we propose an approach to ITA that takes a constructivist, social-psychological perspective and integrates elements of theories of cognition, motivation and decision making. A central assumption in the proposed framework is that performance assessment is a judgment and decision making process, in which rating outcomes are influenced by interactions between individuals and the social context in which assessment occurs. DISCUSSION: The issues raised in the article and the proposed assessment framework bring forward a number of implications for current performance assessment practice. It is argued that focusing on the context of performance assessment may be more effective in improving ITA practices than focusing strictly on raters and rating instruments. Furthermore, the constructivist approach towards assessment has important implications for assessment procedures as well as the evaluation of assessment quality. Finally, it is argued that further research into performance assessment should contribute towards a better understanding of the factors that influence rating outcomes, such as rater motivation, assessment procedures and other contextual variables.

Clinical Competence↗
PubMed2001

Shared decision making observed in clinical practice: visual displays of communication sequence and patterns.

UNLABELLED: The aim of the study was to examine the communication strategies of general practitioners attempting to involve patients in treatment or management decisions. This empirical data was then compared with theoretical 'competences' derived for 'shared decision making'. The subjects were four general practitioners, who taped conducted consultations with the specific intent of involving patients in the decision-making process. The consultations were transcribed, coded into skill categorizations and presented as visual display using a specifically devised sequential banding METHOD: The empirical data from these purposively selected consultation from clinicians who are experienced in shared decision making did not match suggested theoretical frameworks. The views of patients about treatment possibilities and their preferred role in decision making were not explored. The interactions were initiated by a problem-defining phase, statements of 'equipoise' consistently appeared and the portrayal of option information was often intermingled with opportunities to allow patients to question and reflect. A decision-making stage occurred consistently after approximately 80% of the total consultation duration and arrangements were consistently made for follow-up and review. Eight of the 10 consultations took more than 11 min - these specific consultations were characterized by significant proportions of time provided for information exchange and patient interaction. The results demonstrate that some theoretical competences are not distinguishable in practice and other stages, not previously described, such as the 'portrayal of equipoise', are observed. The suggested ideal of a shared decision-making interaction will either require more time than currently allocated, or alternative strategies to enable information exchange outside the consultation.

Adult↗
PubMed2003

Twelve tips for developing professional attitudes in training.

This article is based on a workshop run at AMEE Lisbon, building on work from previous conferences and reported in Medical Teacher (Howe, 2002a). The 30 workshop participants were particularly asked to address the question 'What would you consider essential to include in a medical education curriculum that wishes to teach and assess professional development?'. This question was posed without further constraints, ie. regardless of whether undergraduate or postgraduate, the country or situation of the participant, and the type of setting in which they worked. Participants were invited to consider all aspects of the question, and no assumption was made about the need to reach a consensus. The workshop divided into two groups and shared ideas. This paper presents the main emergent points from discussion, for interest and further collaboration; the level of agreement was considerable, consistent with the peer reviewed literature (Howe, 2002b). The conclusions are therefore shared in the 'Twelve Tips' format as a pragmatic framework for those wishing to review their own curriculum with reference to professional development (PD) issues, or when setting up new opportunities.

Attitude of Health Personnel↗
PubMed1999

Advanced directives, the right to die and the common law: recent problems with blood transfusions.

The Australian common law suffers from a lack of judicial authority on the right to die, in particular the right of patients to make anticipatory decisions to refuse treatment. Recent cases concerning the right of patients to refuse life-saving blood transfusions have highlighted the need for a substantial judicial clarification of this area. This article critically examines one of the most recent Australian cases in detail and compares its approach with those from other common countries. After taking this comparative analysis the article puts forth a common law model of anticipatory decision-making and examines how that model might work in the context of current legislative frameworks.

Advance Directive Adherence↗
PubMed2006

Development of an evaluation of medical student competence in evidence-based medicine using a computer-based OSCE station.

BACKGROUND: Instruction in evidence-based medicine (EBM) has been widely incorporated into medical school curricula with little evidence of its effectiveness. Our goal was to create, implement, and validate a computer-based assessment tool that measured medical students' EBM skills. DESCRIPTION: As part of a required objective structured clinical examination, we developed a specific case scenario in which students (a) asked a structured clinical question using a standard framework, (b) generated effective MEDLINE search terms to answer a specific question, and (c) elected the most appropriate of 3 abstracts generated from a search justifying which best applies to the patient scenario. EVALUATION: Between the 3 blinded raters, there was very good interrater reliability with 84, 94, and 96% agreement on the scoring for each component, respectively (k = .64, .82, and .91, respectively). In addition, students found the station appropriately difficult for their level of training. CONCLUSIONS: This computer-based tool appears to measure several EBM skills independently and combines simple administration and scoring. Its generalizability to other cases and settings requires further study.

Clinical Competence↗
PubMed2006

Genome ecosystem and transposable elements species.

Transposable elements are known to be "selfish DNA" sequences able to spread and be maintained in all genomes analyzed so far. Their evolution depends on the interaction they have with the other components of the genome, including genes and other transposable elements. These relationships are complex and have often been compared to those of species living and competing in an ecosystem. The aim of this current work is a proposition to fill the conceptual gap existing between genome biology and ecology, assuming that genomic components, such as transposable elements families, can be compared to species interacting in an ecosystem. Using this framework, some of the main models defined in the population genetics of transposable elements can then been reformulated, and some new kinds of realistic relationships, such as symbiosis between different genomic components, can then be modelled and explored.

Animals↗
PubMed1997

Dissociation as complex adaptation.

In this article the general theory of complex adaptive systems, substantiated by non-linear dynamics, will be used to put the dissociative disorders into a theoretical framework and clarify their genesis and presentation. When a system is far out of equilibrium, dissipative structures may be formed ('order out of chaos', as Prigogine (1) has put it). These structures provide the starting point for further evolution and co-evolution of competing groups of functional schemata divided on a bifurcation surface. Complex adaptation is almost inevitable in a complicated system (such as the brain) driven by non-linear dynamics. Dissociation is thus regarded as a consequence of adaptation to a chaotic environment rich in contrasts. In a sufficiently complex environment a person with dissociative identity disorder is more adapted and thus more likely to occur than a 'normal' monopersonality individual.

Adaptation, Psychological↗
PubMed2002

Recommendations for improving the assessment of postgraduate dental education.

This paper makes recommendations for the improvement of assessment in postgraduate dental education. The recommendations are based on a twelve-month study conducted in 1998/99 which evaluated the strengths and weaknesses of the existing assessment systems. Evidence was taken from examination syllabi, assessments and records. Semi-structured interviews were conducted with representatives from national bodies and with trainers and trainees in the West Midlands. Strengths in parts of the system include: commitment and professional experience; commissioned work; opportunity to share experience; a monitoring framework; procedures for maintaining standards and examples of broadbased assessments. Weaknesses include: lack of assessment of quality; existence of some forms of unregulated assessment; lack of transparency and lack of clarity between training and assessment. Development is recommended in three broad areas: a competence-based model of assessment; distinguishing assessment from the analysis of educational needs and quality assurance. The introduction of a competence-based model is the most significant and is addressed in some detail. Specific proposals for consideration by national regulatory bodies and education providers include: strengthening the management of assessment; national leadership in the development of a competence model of assessment; widening the assessment base; clearer criteria for inspection; revisions to how vocational training, HO/SHO training and general professional training are assessed and training for trainers.

Competency-Based Education↗
PubMed2003

Strengths and secondary trauma in family violence work.

The strengths perspective has been a unique contribution by the field of social work to the understanding of the helper-client relationship. This article explores the utility of the strengths perspective as a conceptual framework for research in a qualitative study of secondary trauma with counselors of battered women. An emphasis on strengths allowed the researcher to identify strategies and resources that prevented symptoms of secondary trauma in the majority of counselors. These strengths include a sense of competence about their coping, maintaining an objective motivation for their work, resolving their own personal traumas, drawing on early positive role models of coping, and having buffering personal beliefs. Implications for social work practice, education, and research are discussed.

Adult↗
PubMedDate not supplied

The nature and effectiveness of program models for adolescents at risk of entering the formal child protection system.

This article compares rationales and outcome research for five areas of programming for adolescents: adolescent competence and skill development programs, family- and parent-focused programs, social integration programs, multiple component programs, and neighborhood transformation programs. The article examines program evidence for maltreated teens as well as teens coping with a variety of other challenges. The study uses a framework based on common developmental challenges and risk factors for adolescents to select and review programs.

Adolescent↗
PubMed1995

The star of general practice.

These dimensions are not mutually exclusive. They all inter-relate. Their purpose is to provide a series of focal points to group the various knowledge, attitudes and skills required of a general practitioner, which can be diagrammatically represented by a five pointed star (Figure 1). The description of the domains in Table 2, is not exhaustive. It is intended to demonstrate how the knowledge, attitudes and skills of a general practitioner can be concisely described by a small number of categories. This framework is offered as a means of organising the long and detailed lists that describe what GPs do. These domains can be a vehicle for examining a GP curriculum or be used for program evaluation. They provide a description of the skills of a competent GP that can be used in many situations but also could be used to describe the skills of other professional groups, for example, teaching. This paper has presented a description of the six domains or skills required by a general practitioner. The purpose is to provide a description that is both easy to remember and yet sufficiently comprehensive to cover all the key competencies, and objective to encourage debate in this area.

Clinical Competence↗
PubMed2000

The interface of anthropology and nursing guiding culturally competent care in psychiatric nursing.

Nurses and all health care providers are called on to involve patients and families in health care decision-making and to accommodate culturally diverse populations. This article describes the Interface of Anthropology and Nursing Model (IAN), which is derived from the works of Kleinman and Peplau, classical theorists from anthropology and nursing, respectively. This model provides a framework for nurses to uncover cultural information through the elicitation, analysis, transfer, restructure, and feedback of explanatory models within the interpersonal nurse-patient relationship. Such integration of theory enhances a holistic nursing practice incorporating good communication, mutual decision making, and fostering patient agency.

Anthropology, Cultural↗
PubMedDate not supplied

A conceptual framework for a clinical nurse leader program.

Developing a map to guide the design of a novel educational program for nursing students can assist educators in piecing together identified conceptual variables in a logical and reasonable manner. We developed a conceptual model for a clinical nurse leader (CNL) program to present to a school of nursing faculty and a state board of nursing for approval and adoption. The concept map was created following a literature review and analysis of the American Association of Colleges of Nursing description of the CNL. Following the identification of certain variables, such as theories underpinning nursing practice, clinical processes, and education, each team member researched identified variables of the conceptual diagram, wrote a thoughtful explanation of the components, and frequently met with the others to discuss each element of the model and the relationships among the variables. Over time, an emerging model developed and was adopted by the school of nursing and approved by the state board of nursing. An explanation of the components of the conceptual framework and their relationship to the CNL role may assist educators in developing and implementing other emerging CNL programs.

Clinical Competence↗
PubMed2005

Stability analysis of three-dimensional colloidal domains: quadratic fluctuations.

Three-dimensional domain patterns can self-assemble in a charged colloidal suspension with competing short-range attraction and long-range Yukawa repulsion. Following the investigation of the ground-state domain shapes in our previous paper, we study the stability of isolated spherical, cylindrical, and lamellar domains with respect to shape fluctuations on boundaries. In the framework of the continuum model, we expand the free energy variation to quadratic terms under the constraint of constant volume. For the three shapes (sphere, cylinder, and lamella) discussed, domains with equilibrium sizes are stable with respect to shape fluctuations, and the stability of domains decreases as the spatial symmetry decreases.

Journal Article↗
PubMed2000

Drawing up and administering intramuscular injections: a review of the literature.

Drawing up and administering intramuscular injections: a review of the literature Intramuscular (IM) injections have been an integral part of drug administration in nursing practice for almost half a century. However, there are some conflicting practices which warrant investigation to determine their effectiveness in this aspect of patient care. To this end, this paper presents the results of a literature review which was carried out in order to establish current understanding of present day knowledge, procedures and guidelines for the administration of IM injections. Areas addressed within this review include injection sites used, injuries associated with IM injections, issues surrounding needle selection and volume administered through IM injections, injection techniques and nursing skills associated with IM injections. Synthesis of the research reviewed allows the development of research-based guidelines for this skill. These guidelines offer a framework for nurses who wish to provide practice in line with current research into the process of drawing up and administration of intramuscular injections.

Clinical Competence↗
PubMed1999

Towards practice development--a vision in reality or a reality without vision?

This paper describes the development of a conceptual framework for practice development. Drawing on the authors' combined experiences of facilitating developments in practice, a conceptual framework is proposed. It is argued that much practice development in health care today lacks a systematic approach and is often undertaken by individual practitioners who are poorly prepared for their roles. A short history of practice development is outlined to contextualize current development activities. The proposed framework is located in a critical social science philosophy and it is suggested that such a philosophy enables individual growth and development, empowerment of practitioners and the generation of cultural change that sustains continuous growth and innovation in practice. An example of the framework in use is described and recommendations proposed to enable organizations to embrace a systematic approach to practice development.

Clinical Competence↗