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PubMed1996

Dimensions of clinical competence as conceptualized by medical school faculty.

This study identified dimensions of clinical competence underlying faculty ratings of fourth-year student performance in a standardized patient examination and assessed the impact of these dimensions on faculty pass/fail decisions. Content review coupled with exploratory factor analysis was used to group 17 of 25 specific behavioral rating categories into four homogeneous clusters. Confirmatory factor analysis refined the clusters into four unidimensional scales that included 14 of the original ratings. The dimensions reflected relating to the patient, problem-solving skills, medical history skills, and physical examination skills. The factor structure was cross-validated in a separate data set. Logistic regression indicated problem solving was the only independent predictor of a student passing the exercise.

Adult↗

PubMed2006

Assuring the quality of high-stakes undergraduate assessments of clinical competence.

In the UK, and in many Commonwealth countries, a university degree is accepted by registration bodies as an indication of competence to practice as a PRHO or intern. Concerns have been raised that the quality of university examinations may not always be sufficient for such high-stakes decision-making. Assessments of clinical competence are subject to many potential sources of error. The search for standardization, and high validity and reliability, demands the identification and reduction of measurement errors and biases due to poor test design or variation in test items, judges, patients or examination procedures. Generalizability and other research studies have identified where the likely sources of error might arise and have been taken into account in the development of published guidelines on international best practice, which institutions should strive to follow. The purpose of this paper is to describe the development of the integrated final-year assessment of clinical competence at the University of Sheffield. The aim was to introduce a range of strategies to ensure the examination met the best practice guidelines. These included blueprinting the assessment to achieve a high degree of content validity; lengthening the examination by adding a written component to the OSCE component to ensure an adequate level of reliability; providing training and feedback for examiners and simulated patients; paying attention to item development; and providing statistical information to assist the examination committee in standard setting and decision-making. This evidence-based approach should be readily achievable by all medical schools.

Clinical Competence↗

PubMed1989

Clinical competence: the use of simulators/models in diagnosis of visceral conditions.

As primary contact practitioners, chiropractors must be competent to screen patients for the presence of visceral disease. Special "clinical" preparation is required to provide students with adequate diagnostic skills in this area in view of the "select" group of patients frequenting chiropractic clinics--the vast majority of chiropractic patients present with musculoskeletal disorders or pain syndromes. The use of sound simulators and life-form models in a problem-based teaching format ensures that students are equipped to cope with any primary contact clinical eventuality in this area. The use of these sound simulators and models in the assessment of clinical competence furthermore enables the implementation of improved standardization and clinical relevance in clinical assessment.

Chiropractic↗

PubMed1994

Nurse teachers in higher education--without clinical competence, do they have a future?

The practice-theory divide between that which is taught in the classroom and which is performed in practice, is well documented. The role of the Registered Clinical Nurse Teacher was an attempt to overcome this, which failed. In many areas practitioners are being encouraged to become more educationally aware. However, many of the institutions which influence nursing in the United Kingdom expect teachers to be more clinically aware. This has led to a debate about the level of clinical competence or credibility a teacher requires. In this paper, two methods of achieving this are examined. First, the role of the Lecturer Practitioner, which provides clinical competence for a minority but which may not be appropriate for the majority, and can lead to isolation from other teachers. Second, the role of Link Teacher, which can provide clinical credibility, but where there are several reasons why the role is not being fulfilled adequately. The impending changes in the organisation of nurse education will affect teachers ability to bridge the practice-theory divide, as has already occurred in America. It is suggested that the role of the nurse teacher in the UK is being eroded by highly qualified specialists in higher education and more knowledgeable, articulate practitioners. Teachers need to establish their unique role which must lie in showing how academic knowledge can be integrated and applied to nursing practice. However, if nurse teachers do not maintain their clinical ability they will not be able to support their claim to do this, and not only will the practice-theory divide increase, but in the very near future nurse teachers will find it extremely difficult to justify their existence.

Education, Nursing, Baccalaureate↗

PubMed1989

Recruiting and retaining competent clinical nurses. The Clinical Promotion Project Victoria General Hospital, Halifax, Nova Scotia.

A career advancement program for nurses has been developed and implemented at the Victoria General Hospital, Halifax, as part of a manpower planning strategy for recruitment and retention of clinical nurses. A competency based performance appraisal system was developed and implemented as part of the program. This system identifies four levels of clinical expertise. Progression through each level indicates that a nurse has achieved a certain level of skill, knowledge and abilities. Demonstrated competence in one level is a prerequisite to promotion to the next level of practice. Implementation of this system provides clinical career opportunities for nurses in direct patient care. This article will provide the nurse administrator with an insight into the development and implementation of a clinical career advancement program. Future articles will described the research evaluation of the Clinical Performance Appraisal System and clinical nurses' reactions to the new system.

Career Mobility↗

PubMedDate not supplied

Responsive assessment of clinical competence: Part 2.

AIM: To highlight the concerns that students and practitioners might have about the process of assessment of their nursing practice, and to suggest an alternative method. METHOD: Questionnaires were given to 300 student nurses and 155 nurse practitioners throughout a Common Foundation Programme and interviews were conducted with 70 students and 80 assessors from three colleges of nursing. RESULTS: Although students generally favoured structured assessment of their progress, they would like some flexibility. Students acknowledged stress caused by continuous assessment. Assessment of clinical competence was seen to be as important as academic assessment. It was felt that time should be allowed to discuss progress during and after practical experience. Students appreciated the need for continuous assessment, but favoured a change in the way assessment booklets were used. CONCLUSION: The author suggests a new concept of continuous assessment of students of nursing clinical competence. This new model is called responsive assessment, in which the assessment process focuses on the worth and merit of the care given by students to clients/patients, as well as set learning objectives.

Clinical Competence↗

PubMedDate not supplied

Responsive assessment of clinical competence: Part 1.

AIM: To highlight the concerns that students and practitioners might have about the process of assessment of their nursing practice, and to suggest an alternative method. METHOD: Questionnaires were given to 300 student nurses and 155 nurse practitioners throughout a Common Foundation Programme and interviews were conducted with 70 students and 80 assessors from three colleges of nursing. RESULTS: Although students generally favoured structured assessment of their progress, they would like some flexibility. Students acknowledged stress caused by continuous assessment. Assessment of clinical competence was seen to be as important as academic assessment. It was felt that time should be allowed to discuss progress during and after practical experience. Students appreciated the need for continuous assessment, but favoured a change in the way assessment booklets were used. CONCLUSION: The author suggests a new concept of continuous assessment of the clinical competence of students of nursing. This new model is called responsive assessment, in which the assessment process focuses on the worth and merit of the care given by students to clients/patients, as well as set learning objectives.

Clinical Competence↗

PubMed1984

The reliability and utility of clinical competency assessments for drug monograph preparation by pharmacy students.

This educational research project evaluated the utility and reliability of an evaluation system designed to assess the clinical competency of pharmacy students in the preparation and presentation of a comparative drug monograph. The educational program consisted of a mini-course to review drug information resources and skills and a drug information clinical clerkship. The evaluation system for student performance (competency) included 15 criteria (competency areas), a set of descriptors for each criterion, and a scaling mechanism. This competency assessment system for monograph services quantified the overall level of competency and identified specific strong and weak competency areas. The reliability of the system was good in general (standardized alpha-coefficient = 0.701), over time, and among several preceptors. Students indicated that the system was fair and provided them with feedback. Clinical competency assessment should be structured to minimize subjectivity and must be tested for reliability; then, such evaluations can become more consistent and equitable.

Clinical Clerkship↗

PubMed2004

Using children as standardised patients for assessing clinical competence in paediatrics.

BACKGROUND: Standardised patients (SPs) have been widely used to assess physicians' clinical competence. However, in paediatrics, the use of children in such a way has long been questioned with regard to ethics and the examination quality (in terms of validity, reliability, and feasibility). AIMS: To summarise the current state of the use of child SPs, and to highlight the difficulties inherent in the use of children for this purpose. METHODS: Nineteen articles dealing with the use of child SPs for clinical assessment were reviewed. RESULTS: Child SPs, ranging in age from infancy to adolescence, were present in varied proportions of paediatric objective structured clinical examination stations (12-27%). In most of these reports, there were several children with cases who could substitute for one another. Child SPs successfully portrayed various roles, although only older children had to learn a scenario. In general, clinical examinations using child SPs were found to be valid and generated reliable scores. Child SPs also provided effective feedback. The experience tended to be considered negative for younger children but was quite positive for a number of older children. The use of young SPs should be avoided for ethical reasons, and the use of child SPs should be limited to assessments that cannot be satisfactorily measured by other methods. CONCLUSION: Through meticulous attention to detail and careful planning, a clinical examination using children as SPs can be practical, valid, and reliable.

Child↗

PubMed1992

Evaluation of tools to assess clinical competence.

Assessment of student nurses' clinical skills is an important issue in nurse education. However suitable instruments are difficult to locate, and also to design. In the course of this article the need for scientifically designed and tested assessment instruments is discussed. The thoroughness with which 11 clinical assessment documents were developed was evaluated using specific criteria. It was found that in the majority of cases use of a systematic research process to guide development was not evident. However it must be noted that the assessment documents were only evaluated via their presentation in journal articles. Full details of the entire project had perhaps not been published. The implications of the results, some of the difficulties inherent in instrument design and the limitations of this small review are considered.

Clinical Competence↗

PubMed1995

Clinical competence of interns. Programme Evaluation Committee (PEC).

A clinical supervisors rating form addressing 13 competencies was used to assess the clinical competence of graduates one year after qualification in New South Wales (NSW), Australia. Data from 485 interns (97.2%) showed that graduates from the problem-based medical school were rated significantly better than their peers with respect to their interpersonal relationships, 'reliability' and 'self-directed learning'. Interns from one of the two traditional NSW medical schools had significantly higher ratings on 'teaching', 'diagnostic skills' and 'understanding of basic mechanisms'. Graduates from international medical schools performed worse than their peers on all competencies. These results were adjusted for age and gender. Additionally, women graduates and younger interns tended to have better ratings. Junior doctors have differing educational and other background experiences and their performance should be monitored.

Adult↗

PubMed1985

Clinical competencies of graduating medical students.

In a survey conducted by the authors, the goals of medical school curricula regarding the clinical competencies of graduating students were explored. Inventories listing 83 clinical skills were sent to 123 U.S. medical schools and to 462 volunteer clinical faculty members at the University of Utah School of Medicine. The responding medical schools singled out 43 clinical skills as definite goals of their curricula, and the practicing physicians identified 49 clinical skills in which graduating medical students should be competent. The study provided an easy mechanism to compare the clinical expectations of practicing physicians and of medical schools regarding medical students.

Clinical Competence↗

PubMed2001

Clinical competence assessment in radiology: introduction of an objective structured clinical examination in the medical school curriculum.

RATIONALE AND OBJECTIVES: Traditional oral and written examinations can be limited in predicting future clinical performance. Therefore Objective Structured Clinical Examinations (OSCEs) have been introduced in other specialties. The authors assessed their value in radiology. MATERIALS AND METHODS: The study includes 122 Harvard medical students who undertook 1-month compulsory clerkships at one of three hospitals (A, B, or C) in their 3rd and 4th year and a compulsory OSCE in their 4th year. The OSCE was constructed from five cases. Each had eight or nine standardized questions designed to test, within a set time, the perception of essential findings, their interpretation, and clinical judgment (maximum possible score, 100). Clerkship grades were high honors (score of 3), honors (score of 2), satisfactory (score of 1), and fail (score of 0). Predictors of OSCE scores-clerkship grade and affiliated hospital-were modeled as linear functions. Time elapsed between clerkship and OSCE was modeled as a nonlinear function. RESULTS: Although there was a positive relation between clerkship grade and OSCE grade, it accounted for an increase of only 5.7% in OSCE score per clerkship grade and did not predict performance of individual students. Students who trained in hospital B showed significantly higher OSCE grades. OSCE scores were highest when the examination was taken 8 months after the clerkship. CONCLUSION: The OSCE may be useful to uncover deficits in individuals and groups beyond the ones detected with traditional clerkship evaluations and provide guidance for remediation. The improved performance after additional clinical exposure suggests that the OSCE may be well suited to test the integration of radiologic and clinical knowledge.

Clinical Clerkship↗

PubMed1989