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PubMedDate not supplied

[New approaches to the measurement of clinical competence].

A new phase in the development of an instrument designed for the measurement of clinical competence is presented. The instrument (exam type) was previously validated; we report its use in three generations of students of a specialization course in internal medicine: those recently admitted to the course (group I); those finishing their first training year (group II) and those finishing the second year (group III). In the exam 304 out of the 600 questions included were classified as "experimental" (dealing with knowledge in internal medicine) and the remaining 296 questions corresponded to "control" questions (dealing with knowledge in other specialties). The variables considered in the exam were: 1) global result; 2) usage of diagnostic indicators; 3) omission of necessary procedures without a iatrogenic effect; 4) commission of unnecessary procedures without a iatrogenic effect; 5) omission of necessary procedures with resulting iatrogenic consequences; 6) commission of unnecessary procedures with resulting iatrogenic consequences; 7) global omission (variables 3 and 5); 8) global commission (variables 4 and 6); 9) global iatrogenesis (variables 5 and 6); 10) knowledge in nosology. Scores obtained by the three groups on the experimental questions differed in accordance with the respective time of clinical experience (group I obtained the lowest scores, group II showed intermediate scores, and group III showed the highest scores). Analysis of variance was significant (p less than 0.05) in variables 1, 2, 6, 8 and 9. The scores obtained by the three groups on the control questions were similar. In conclusion, we believe that this instrument is capable of detecting learning dependent on the time of clinical experience.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Competence↗
PubMed2005

Update on the fellowship exam and its relation to modern educational principles and clinical competency.

The Australasian College for Emergency Medicine is committed to a long term process of quality improvement in the fellowship examination and the training programme leading up to it. The process of quality improvement and the rationale for current and future processes are not always clear to the fellowship as a whole. The present article attempts to update the fellowship on the current thinking with regard to the fellowship exam and the work that is being done surrounding this and relevant areas. This is related to some modern educational assessment principles and terminology. More research is required into the relevance of each component of the fellowship exam and its relation to clinical competency, key competencies and good clinical practice. Any subsequent changes to the exam structure must take into account the evidence and be balanced by what is practicable, reasonable and deliverable.

Australasia↗
PubMed1978

A problem-based criterion-referenced examination of clinical competence.

A model has been developed for a problem-based criterion-referenced test of clinical competence. The model, designed to increase the reliability and validity of traditional final year examinations for medical students, aims to provide a profile of student performance over a range of defined competence categories. The level of competence has been referenced to that expected of an intern. Both the content of the examination and the selection of test methods are based on patient problem blueprints which identify key areas that require testing. The content and test methods were incorporated, as appropriate, into either th;e written section or the practical section of the examination. The approach was found to be feasible and acceptable to staff and students.

Australia↗
PubMed2000

Identifying clinical competencies that support rehabilitation and empowerment in individuals with severe mental illness.

Individuals with severe mental illness often do not receive appropriate treatment or rehabilitation. One approach to improving their care begins by identifying competencies that clinicians should possess. This project developed a set of core clinical competencies that pertain to community-based care and support the goals of empowerment and rehabilitation. Development of the competency set began with review of existing literature and competency statements, and focus groups and interviews with clients, family members, clinicians, managers, experts, and advocates. Representatives from each of these groups participated in a national panel and used a structured process to identify 37 final competencies. Panel members agreed that these competencies are very important in determining outcomes and often are not present in current clinicians. This project demonstrates that it is possible to develop a core competency set that can be strongly supported by diverse groups of stakeholders. These competencies may be useful in clinician training, recruitment, and credentialing efforts.

Clinical Competence↗
PubMedDate not supplied

Educational leave for lecturers to regain clinical competence: 2.

The way in which nurse lecturers can use paid educational leave (sabbaticals) to develop their own clinical competence is addressed in this article, the second of two parts. The first part (Vol 9(7): 440-4) used Johns' (1998) model of structured reflection to explain the nature of an actual clinical sabbatical. This second part will address the other elements of the model. It focuses on the factors that influenced the decisions made, alternative strategies and the learning that occurred during the author's 3-month leave.

Clinical Competence↗
PubMed2001

Monitoring doctors' clinical competence: a Queensland focus.

The medical profession is held accountable in numerous ways, many of which are concerned with clinical competence. However, while Australia's State medical boards are statutorily charged with protecting the public from incompetent practice, they have never instituted programs aimed at maintaining the standards of all practitioners. The article describes recent legislative changes and developments in undergraduate medical education, which aim to increase physicians' accountability in relation to competence, and compares developments in Queensland and other States with those in the United Kingdom, Quebec and New Zealand. The investigation of clinical incompetence as currently undertaken by the Medical Board of Queensland should, and will, be adopted in other States. However, responding to incompetence is necessarily piecemeal, and the article further argues that the States should develop inclusive revalidation strategies. Both the community and leading voices within the profession are demanding greater commitment to a self-regulation culture that is more transparent and has sharper teeth.

Clinical Competence↗
PubMed2000

Clinical competency: the right assessment tools?

Effective assessment of competency of student nurses in clinical practice is vital. Use of simulation rather than real life settings can be used to assess competency. Development of information technology and its use in teaching clinical skills offers opportunities for assessment. Clinical governance increases the need to scrutinize the assessment of practice. Ongoing assessment of clinical competency for qualified nurses is also important.

Clinical Competence↗
PubMed1993

Use of an Objective Structured Clinical Examination (OSCE) to measure improvement in clinical competence during the surgical internship.

BACKGROUND: Traditional ward ratings and multiple-choice tests do not reliably assess clinical competence. This study determined the reliability of the Objective Structured Clinical Examination (OSCE) and its sensitivity in detecting the performance gains and deficits in surgical interns. METHODS: A comprehensive 35-station OSCE was administered to 23 incoming interns and seven outgoing interns. The OSCE comprised 17 two-part clinical problems, relying primarily on actual or simulated patients. The reliability of the examination was assessed by coefficient alpha. Significant differences in performance between the two intern groups, between parts A and B, and among the 17 problems were determined by a three-way ANOVA: OSCE performance was also correlated with National Board of Medical Examiners Part II scores. RESULTS: The reliabilities of part A, part B, and parts A and B combined were 0.72, 0.70, and 0.82, respectively. Overall, the outgoing interns performed significantly better than the incoming interns: 58% +/- 1% mean OSCE score versus 47% +/- 1% (p = 0.0001). The 17 clinical problems differed significantly in difficulty; major performance deficits were seen in both groups of trainees. The correlation of OSCE scores with National Board of Medical Examiners Part II scores was not significant (r = 0.11, p = 0.633). CONCLUSIONS: We conclude that the OSCE is an innovative, reliable tool for evaluating resident competence. Although outgoing interns performed better than did incoming interns, the OSCE scores clearly indicated major performance deficits in all interns.

Clinical Competence↗
PubMed1999

[Laboratory automation and information technology in clinical microbiology--computerized support system and clinical competence of laboratory physician].

Laboratory automation and new information technology have considerable potential to improve care through protocols that reduce errors and guide diagnosis and therapy. Computer-based decision-support systems are now in place in many hospitals in the USA. For example, optimal decisions about the use of antibiotics in critically ill patients require access to a large amount of complex information, therefore a computerized decision-support program linked to computer-based patient records can assist physicians in the use of antiinfective agents and improve the quality of care. The support systems can educate physicians, guide their clinical reasoning, and measure the quality of the care that they provide. The installation of the computer components of the system is relatively easy, but the human components of the system may be much more difficult to transfer from hospital to hospital. The successful operation of the system should require a high level of clinical competence in every staff member of the hospital. The project should encompass a broad range of complex clinical conditions and decision algorithms. It must not be focused solely on the sophistication of laboratory methods. We, laboratory physicians/clinical pathologists must modify our behavior effectively and accept the value and limitations of laboratory automation and information technology. We must work more closely with physicians and other health care professionals as the best clients of our clinical laboratories and establish a good collaborative partnership with them.

Clinical Competence↗
PubMedDate not supplied

Rewarding clinical competence in the ICU: using outcomes to reward performance.

The rising acuity of hospitalized patients requires that critical care nurses maintain a high level of clinical expertise. Expert skill levels (critical thinking, technical skills, and interpersonal skills) of clinicians improve patient outcomes that translates into savings for the institution through shorter length of stay and decreased frequency of re-admissions. The authors outline the steps to follow in developing a theory-based career advancement plan that encourages and rewards clinical competence.

Career Mobility↗
PubMed1993

Training and clinical competency in musculoskeletal medicine. Identifying the problem.

Injuries and diseases of the musculoskeletal system account for more than 20% of patient visits to primary care and emergency medical practitioners. However, less than 3% of the pre-clinical medical school curriculum is devoted to teaching all aspects of musculoskeletal disease, and only 12% of medical schools require mandatory training in musculoskeletal medicine during the clinical years of undergraduate medical education in Canada. Available elective training in musculoskeletal injuries and diseases is commonly taught by hospital-affiliated physicians and surgeons, with the result that this teaching case load is typically skewed towards serious and/or surgical problems. The disparity between the clinical competence required for musculoskeletal problems in clinical practice and the content and format of medical education has not yet been addressed by changes in medical school curricula. One of the reasons for this is that the available morbidity statistics, which provide data regarding the frequency of specific musculoskeletal diagnoses, are based on diagnostic codes which are imprecise and incomplete. This prohibits the accurate selection of course content in this area, which is among the first steps in the development of a curriculum.

Clinical Competence↗