65 results
Search Results
2. A realist synthesis of prospective entrustment decision making by entrustment or clinical competency committees.
- Author
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Schumacher, Daniel J., Michelson, Catherine, Winn, Ariel S., Turner, David A., Martini, Abigail, and Kinnear, Benjamin
- Subjects
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MEDICAL education , *CINAHL database , *DECISION making , *DESCRIPTIVE statistics , *SYSTEMATIC reviews , *MEDLINE , *PROFESSIONS , *CLINICAL competence , *TRUST , *OUTCOME-based education , *ONLINE information services , *COMMITTEES , *PSYCHOLOGY information storage & retrieval systems , *ERIC (Information retrieval system) - Abstract
Introduction: The real‐world mechanisms underlying prospective entrustment decision making (PEDM) by entrustment or clinical competency committees (E/CCCs) are poorly understood. To advance understanding in this area, the authors conducted a realist synthesis of the published literature to address the following research question: In E/CCC efforts to make defensible prospective entrustment decisions (PEDs), what works, for whom, under what circumstances and why? Methods: Realist work seeks to understand the contexts (C), mechanisms (M) and outcomes (O) that explain how and why things work (or do not). In the authors' study, contexts included individual E/CCC members, E/CCC structures and processes, and training programmes. The outcome (i.e. desired outcome) was a PED. Mechanisms were a substantial focus of the analysis and informed the core findings. To define a final corpus of 52 included papers, the authors searched four databases, screened all results from those searches and performed a full‐text review of a subset of screened papers. Data extraction focused on developing context–mechanism–outcome configurations from the papers, which were used to create a theory for how PEDM leads to PEDs. Results: PEDM is often driven by default (non‐deliberate) decision making rather than a deliberate process of deciding whether a trainee should be entrusted or not. When defaulting, some E/CCCs find red flags that sometimes lead to being more deliberate with decision making. E/CCCs that seek to be deliberate describe PEDM that can be effortful (when data are insufficient or incongruent) or effortless (when data are robust and tell a congruent story about a trainee). Both information about trainee trustworthiness and the sufficiency of data about trainee performance influence PEDM. Several moderators influence what is considered to be sufficient data, how trustworthiness data are viewed and how PEDM is carried out. These include perceived consequences and associated risks, E/CCC member trust propensity, E/CCC member personal knowledge of and experience with trainees and E/CCC structures and processes. Discussion: PEDM is rarely deliberate but should be. Data about trainee trustworthiness are foundational to making PEDs. Bias, equity and fairness are nearly absent from the papers in this synthesis, and future efforts must seek to advance understanding and practice regarding the roles of bias, equity and fairness in PEDM. Entrustment decisions made by committees are rarely deliberate, but should be. These authors provide practical advice, based in the literature, for improvement. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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- View/download PDF
3. Perspectives of speech and language therapists in paediatric palliative care: an international exploratory study.
- Author
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Krikheli, Lillian, Erickson, Shane, Carey, Lindsay B., Carey‐Sargeant, Christa L., and Mathisen, Bernice A.
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CLINICAL competence ,PALLIATIVE treatment ,PEDIATRICS ,INDUSTRIAL psychology ,RESEARCH ,RESEARCH funding ,STATISTICAL sampling ,SPEECH evaluation ,SPEECH therapists ,PHYSICIAN practice patterns ,OCCUPATIONAL roles ,CROSS-sectional method ,ATTITUDES of medical personnel ,DESCRIPTIVE statistics - Abstract
Background: The involvement of speech and language therapists (SLTs) within paediatric palliative care (PPC) settings has been recognized within the extant literature. However, there is little understanding of SLT's specific roles and practices when working with this vulnerable cohort of children and their families. As part of a larger body of work to develop consensus‐based recommendations for SLTs working in PPC, it is important to investigate demographic and caseload characteristics. Aims: This exploratory study aimed to gather previously undocumented international demographic data pertaining to SLT service provision, caseload and training in PPC. Additionally, it sought to ascertain the current treatment and assessment approaches of SLTs, and if variations exist in beliefs and practices. Methods & Procedures: An anonymous cross‐sectional survey was designed and reported according to the Checklist for Reporting Results of Internet E‐Surveys (CHERRIES). The online survey consisted of 40 items spanning four domains: (1) demographic information, (2) caseload information, (3) service provision and (4) training and education. SLTs from Australia, Canada, New Zealand, the UK, Ireland and the United States were recruited using a purposive snowball sampling approach. Descriptive analysis of closed‐ended survey responses and content analysis of open‐ended responses are presented. Outcomes & Results: A total of 52 respondents completed the survey. SLTs worked in a variety of PPC settings, with patients of varying age and disease groups. Over 50% of participants reported working in PPC for ≤ 4 years. Genetic disorders (34%), oncology (27%) and neurological conditions (21%) made up a significant portion of respondents' caseloads. Reported treatments and assessment approaches used by SLTs are not unique to a PPC population. Barriers and enablers for practice were identified. A portion of participants did not feel trained and prepared to assess (19.2%) or treat (15.4%) PPC clients. Conclusions & Implications: This study confirms that SLTs internationally have a role in the management of communication and swallowing impairments in a PPC context. However, whether current training and resources adequately support SLTs in this role remains questionable. This paper helps to provide SLTs, administrators, professional associations and tertiary institutions with foundational data to help inform workforce planning, advocacy efforts and training priorities. What this paper addsWhat is already known on the subjectThe published multidisciplinary literature has identified that SLTs have a role in PPC. However, there has been no targeted research investigating the professional characteristics of clinicians in this context, nor any detailed information regarding associated clinician beliefs or management approaches.What this paper adds to existing knowledgeThis study is a snapshot of attributes, practice patterns and beliefs of SLTs who work with a PPC population. It highlights SLT perspectives of education and training, as well as meta‐perceptions of themselves within the multidisciplinary team.What are the potential or actual clinical implications of this work?Data presented in this paper will help to enable SLTs, organizations and associations to augment service provision and determine future professional development priorities within the field of PPC. [ABSTRACT FROM AUTHOR]
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- 2020
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4. Matching a Graduate Curriculum in Public/Community Health Nursing to Practice Competencies: The Rush University Experience.
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Swider, Susan, Levin, Pamela, Ailey, Sarah, Breakwell, Susan, Cowell, Julia, McNaughton, Diane, and O'Rourke, Marilyn
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PUBLIC health nursing ,COMMUNITY health nursing ,COMMUNITY health services ,NURSING education ,PUBLIC health - Abstract
An evidence-based approach to Public/Community Health Nursing (P/CHN) requires that P/CHN educators prepare practitioners with the relevant skills, attitudes, and knowledge. Such education should be competency-based and have measurable outcomes to demonstrate student preparation. In 2003, the Quad Council competencies were developed to be applied at two levels of public health nursing practice: the staff nurse/generalist role and the manager/specialist/consultant role. This paper describes a process for evaluation and revision of a graduate curriculum to prepare Advanced Practice Clinical Nurse Specialists (CNS) in P/CHN, to ensure that the educational program addresses and develops knowledge and proficiency in all relevant competencies. This paper documents the process of integrating the competencies throughout the P/CHN graduate curriculum at varying levels, guiding students to achieve proficiency in each competency by the end of the program. Measurement of achievement in these competencies will be discussed, and examples provided. Advanced Practice Public Health Nurses educated via this competency-based approach will be prepared to sit for national certification as a CNS in Public/Community Health, and to assume leadership roles in public health nursing. [ABSTRACT FROM AUTHOR]
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- 2006
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5. Improving cultural competence education: the utility of an intersectional framework.
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Powell Sears, Karen
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PATIENT education ,CONCEPTUAL structures ,CURRICULUM planning ,MEDICAL care ,STUDY & teaching of medicine ,PHYSICIANS ,CULTURAL pluralism ,SELF-perception ,CLINICAL competence ,EDUCATION - Abstract
Medical Education 2012: 46: 545-551 Context Most US medical schools have instituted cultural competence education in the undergraduate curriculum. This training is intended to improve the quality of care that doctors, the majority of whom are White, deliver to ethnic and racial minority patients. Research into the outcomes of cultural competence training programmes reveals that they have been largely ineffective in improving doctors' skills. In varied curricular formats, programmes tend to teach group-specific cultural knowledge, despite the vast heterogeneity of racial and ethnic groups. This cultural essentialism diminishes training effectiveness. Methods This paper proposes key curriculum content changes and suggests the inclusion of an intersectional framework in the cultural competence curriculum. This framework maintains that racial and ethnic minority groups hold multiple social statuses, called social locations, which interact with one another to uniquely shape the health views, needs and experiences of the individuals within the groups. Social locations include those defined by race, ethnicity, gender, social class and sexuality, which are experienced multiplicatively, not additively, within a particular social context. Cultural competence education must go beyond simplified cultural understandings to explore these more complex meanings. Doctors' ability to understand, communicate with and treat diverse groups can be vastly improved by applying an intersectional framework in academic research, self-awareness exercises and clinical training. Results Integrating an intersectional framework into cultural competency education can better prepare doctors for caring for racial and ethnic minority patients. This paper recommends curriculum elements for the classroom and clinical training that can improve doctor knowledge and skills for caring for diverse groups. Medical schools can use the proposed model to facilitate the development of new educational strategies and learning experiences. These improvements can lead to more equitable care and ultimately diminish disparities in health care. Although these recommendations are designed with US schools in mind, they may improve doctor understanding and care of marginal populations across the world. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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6. Is Post-Graduate Training Essential for Practice Readiness?
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Robinson D and Speedie M
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- Education, Pharmacy, Graduate, Humans, United States, Clinical Competence, Patient Care, Pharmaceutical Services standards, Professional Practice
- Abstract
Few things are more fundamental to the purpose of health professions training than to prepare practice-ready health professionals. The Accreditation Council of Pharmacy Education (ACPE) Standards 2016 address graduate readiness to 1) provide direct patient care in a variety of health care settings (practice-ready) and 2) contribute as a member of an interprofessional collaborative patient care team (team-ready). ACPE Standards 2007 states that graduates should be prepared to deliver direct patient care. This includes the ability to design, implement, monitor, evaluate, and adjust pharmacy care plans that are patient specific and to function effectively as a member of an interprofessional team. Yet, controversy remains within the profession regarding the practice-readiness of PharmD graduates, which has been further fueled by the recent ACCP White Paper on Collaborative Drug Therapy Management and Comprehensive Medication Management - 2015. This commentary makes the case that PharmD graduates are practice-ready and it offers a solution that may settle this lingering controversy., (© 2015 Pharmacotherapy Publications, Inc.)
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- 2015
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7. An exploratory international study into occupational therapy students' perceptions of professional identity.
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Ashby, Samantha E., Adler, Jessica, and Herbert, Lisa
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CHI-squared test ,CONFIDENCE intervals ,CURRICULUM ,FIELDWORK (Educational method) ,SENSORY perception ,PROBABILITY theory ,QUESTIONNAIRES ,RESEARCH ,SOCIALIZATION ,SURVEYS ,CLINICAL competence ,JUDGMENT sampling ,PROFESSIONAL identity ,CROSS-sectional method ,DATA analysis software ,DESCRIPTIVE statistics ,KRUSKAL-Wallis Test ,OCCUPATIONAL therapy students ,EDUCATION - Abstract
Background/aim The successful development and maintenance of professional identity is associated with professional development and retention in the health workforce. This paper explores students' perspectives on the ways pre-entry experiences and curricula content shape professional identity. Methods An online cross-sectional survey was sent to students enrolled in the final year of entry-level programmes in five countries. Descriptive statistical analyses of data were completed. Results The results reflect the perceptions of 319 respondents from five countries. Respondents identified professional education (98%) and professional socialisation during placement (92%) as curricula components with the greatest influence on professional identity formation. Discipline-specific knowledge such as, occupation-focussed models and occupational science were ranked lower than these aspects of practice. The students' length of programme and level of entry-level programme did not impact on these results. Conclusion When designing curricula educators need to be mindful that students perceive practice education and professional socialisation have the greatest affect on professional identity formation. The findings reinforce the need for curricula to provide students with a range of practice experiences, which allow the observation and application of occupation-based practices. It highlights a need for educators to provide university-based curricula activities, which better prepare students for a potential dissonance between explicit occupation-based curricula and observed practice education experiences. The study indicates the need for further research into the role curricula content, and in particular practice education, plays in the multidimensional formation of professional development within entry-level programmes. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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8. Ensuring high-quality patient care: the role of accreditation, licensure, specialty certification and revalidation in medicine.
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Boulet, John and Zanten, Marta
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ADULTS ,HIGHER education ,PROFESSIONAL standards ,QUALITY assurance ,CLINICAL competence ,LABOR mobility ,MEDICAL quality control ,STUDY & teaching of medicine ,GRADUATE education ,COST analysis ,CERTIFICATION ,PROFESSIONAL licenses ,EDUCATIONAL mobility ,ACCREDITATION - Abstract
Context The accreditation of medical school programmes and the licensing and revalidation (or recertification) of doctors are thought to be important for ensuring the quality of health care. Whereas regulation of the medical profession is mandated in most jurisdictions around the world, the processes by which doctors become licensed, and maintain their licences, are quite varied. With respect to educational programmes, there has been a recent push to expand accreditation activities. Here too, the quality standards on which medical schools are judged can vary from one region to another. Objectives Given the perceived importance placed by the public and other stakeholders on oversight in medicine, both at the medical school and individual practitioner levels, it is important to document and discuss the regulatory practices employed throughout the world. Methods This paper describes current issues in regulation, provides a brief summary of research in the field, and discusses the need for further investigations to better quantify relationships among regulatory activities and improved patient outcomes. Discussion Although there is some evidence to support the value of medical school accreditation, the direct impact of this quality assurance initiative on patient care is not yet known. For both licensure and revalidation, some investigations have linked specific processes to quality indicators; however, additional evaluations should be conducted across the medical education and practice continuum to better elucidate the relationships among regulatory activities and patient outcomes. More importantly, the value of accreditation, licensure and revalidation programmes around the world, including the effectiveness of specific protocols employed in these diverse systems, needs to be better quantified and disseminated. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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9. Integrating cultural competency into the undergraduate medical curriculum.
- Author
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Rapp DE
- Subjects
- Cultural Diversity, Curriculum, Education, Medical, Undergraduate standards, Learning, United States, Clinical Competence standards, Education, Medical, Undergraduate organization & administration
- Abstract
Context: A significant movement is underway to develop standardised curricula that provide medical students with a fundamental knowledge of cultural sensitivity., Methods: This paper reviews the recent initiative to integrate cultural competency training into the curricula of American undergraduate medical institutions., Results: Despite these initiatives, few medical institutions have achieved a comprehensive curriculum providing for continued cultural experiences and assessment of related skill sets. The article proposes a framework for the introduction of continued instruction in and assessment of cultural competency within the undergraduate medical education., Conclusions: The described components of cultural competency education in the undergraduate medical curricula provide a framework to facilitate early and continued exposure to experiences designed to promote cultural sensitivity.
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- 2006
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10. Refugees and medical student training: results of a programme in primary care.
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Griswold K, Kernan JB, Servoss TJ, Saad FG, Wagner CM, and Zayas LE
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- Adult, Attitude of Health Personnel, Cultural Diversity, Female, Humans, Male, Physician-Patient Relations, United States, Clinical Competence standards, Education, Medical, Undergraduate methods, Primary Health Care standards, Refugees
- Abstract
Context: Medical schools have responded to the increasing diversity of the population of the USA by incorporating cultural competency training into their curricula. This paper presents results from pre- and post-programme surveys of medical students who participated in a training programme that included evening clinical sessions for refugee patients and related educational workshops., Methods: A self-assessment survey was administered at the beginning and end of the academic year to measure the cultural awareness of participating medical students., Results: Over the 3 years of the programme, over 133 students participated and 95 (73%) completed pre- and post-programme surveys. Participants rated themselves significantly higher in all 3 domains of the cultural awareness survey after completion of the programme., Conclusions: The opportunity for medical students to work with refugees in the provision of health care presents many opportunities for students, including lessons in communication, and scope to learn about other cultures and practise basic health care skills. An important issue to consider is the power differential between those working in medicine and patients who are refugees. To avoid reinforcing stereotypes, medical programmes and medical school curricula can incorporate efforts to promote reflection on provider attitudes, beliefs and biases.
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- 2006
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11. Fostering internationalization: an American- Danish semester-long undergraduate nursing student exchange program.
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Baernholdt, M., Drake, E., Maron, F., and Neymark, K.
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EXCHANGE of persons programs ,INTERPROFESSIONAL relations ,CLINICAL competence ,NURSING licensure ,CULTURAL competence ,HUMAN services programs ,EVALUATION of human services programs ,BACCALAUREATE nursing education ,EDUCATION - Abstract
Aim This paper describes the development, implementation and evaluation of a semester-long exchange program between two Bachelor of Science in Nursing programs in the USA and Denmark. Background Nurses globally need to provide culturally sensitive care for an ethnically diverse population. Competencies on how to do so should start in basic nursing programs. A useful strategy is through immersion into another culture through an exchange program. Little is known about successful strategies for two-way or 360° exchange programs between schools from different countries. Guided by experiential learning theory, we developed an exchange program with the objective of enhancing nursing students' cultural competence through knowledge building, attitudes and behaviour development. Lessons learned and implications for educational institutions and policy are discussed. Conclusion In internationalization of nursing education, an awareness of underlying cultural values regarding nursing competence and taking appropriate action are important for success. Other areas for a successful exchange program include matching of courses or content across schools, clear objectives and evaluation plans. Finally, flexibility and open communication are key components when setting up a 360° exchange program. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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12. Mental health: Knowledge, attitudes and training of professionals on dual diagnosis of intellectual disability and psychiatric disorder.
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Werner, S. and Stawski, M.
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CLINICAL competence ,ATTITUDE (Psychology) ,CINAHL database ,DUAL diagnosis ,ERIC (Information retrieval system) ,MEDICAL information storage & retrieval systems ,INTELLECT ,MEDICAL personnel ,MEDLINE ,MENTAL health ,MENTAL illness ,INTELLECTUAL disabilities ,PSYCHIATRISTS ,RESEARCH funding ,SYSTEMATIC reviews - Abstract
Background Dual diagnosis (DD) refers to the coexistence of intellectual disability and psychiatric disorder. In order to provide individuals with DD with adequate care, it is essential for mental health workers to have adequate knowledge and positive attitudes. These may be achieved through proper training. Aims To summarise the available literature examining the knowledge, attitudes and training of psychiatrists and other professional caregivers in regard to serving people with DD. Methods A search strategy was developed to find manuscripts published in English since 1995. Results Twenty-seven studies on knowledge, attitudes and training in the field of DD were identified and reviewed in this paper. Conclusion The findings of this review stress the need to improve the knowledge, competence and attitudes of practitioners within the DD field via training and practice opportunities. In light of this review, recommendations for improving training opportunities and for conducting future research are made. [ABSTRACT FROM AUTHOR]
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- 2012
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13. Scholarly Tracks in Emergency Medicine.
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Regan, Linda, Stahmer, Sarah, Nyce, Andrew, Nelson, Bret P., Moscati, Ronald, Gisondi, Michael A., and Hopson, Laura R.
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CONFERENCES & conventions ,CURRICULUM ,EMERGENCY medical services ,EMERGENCY medicine ,HOSPITAL medical staff ,INTERNSHIP programs ,MEDICAL schools ,MEDICAL education ,STUDY & teaching of medicine ,VOCATIONAL guidance ,CLINICAL competence ,EDUCATION - Abstract
Over the past decade, some residency programs in emergency medicine (EM) have implemented scholarly tracks into their curricula. The goal of the scholarly track is to identify a niche in which each trainee focuses his or her scholarly work during residency. The object of this paper is to discuss the current use, structure, and success of resident scholarly tracks. A working group of residency program leaders who had implemented scholarly tracks into their residency programs collated their approaches, implementation, and early outcomes through a survey disseminated through the Council of Emergency Medicine Residency Directors (CORD) list-serve. At the 2009 CORD Academic Assembly, a session was held and attended by approximately 80 CORD members where the results were disseminated and discussed. The group examined the literature, discussed the successes and challenges faced during implementation and maintenance of the tracks, and developed a list of recommendations for successful incorporation of the scholarly track structure into a residency program. Our information comes from the experience at eight training programs (five 3-year and three 4-year programs), ranging from 8 to 14 residents per year. Two programs have been working with academic tracks for 8 years. Recommendations included creating clear goals and objectives for each track, matching track topics with faculty expertise, protecting time for both faculty and residents, and providing adequate mentorship for the residents. In summary, scholarly tracks encourage the trainee to develop an academic or clinical niche within EM during residency training. The benefits include increased overall resident satisfaction, increased success at obtaining faculty and fellowship positions after residency, and increased production of scholarly work. We believe that this model will also encourage increased numbers of trainees to choose careers in academic medicine. ACADEMIC EMERGENCY MEDICINE 2010; 17:S87-S94 © 2010 by the Society for Academic Emergency Medicine [ABSTRACT FROM AUTHOR]
- Published
- 2010
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14. Development of Public Health Nursing Competencies: An Oral History.
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King, Marilyn Givens and Erickson, Grace P.
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PUBLIC health nursing ,COMMUNITY health nursing ,COMMUNITY health services ,PUBLIC health ,ASSOCIATIONS, institutions, etc. - Abstract
This paper identifies the external and internal forces that led to the initiation and completion of a set of Public Health Nursing (PHN) competencies by nursing representatives from the Quad Council (QC) organizations: the Association of Community Health Nursing Educators, the American Public Health Association/Public Health Nursing Section, the Association of State and Territorial Directors of Nursing, and the American Nurses Association Congress on Nursing Practice and Economics. Discussion on the need for competencies began in 1988 with the Institute of Medicine report, The Future of Public Health, which cited a widening gap between the education and practice of public health (PH). PH leaders promptly responded by initiating many interactions to improve academic programs and enhance workforce development, including the development of competencies for PH professionals. PHN responded through the Quad Council of Public Health Nursing Organizations, which completed development of a set of national PHN competencies in 2003. The unfolding of that process is reported from the content-specific oral histories of five PHN leaders who served on the QC and participated in developing the PHN competencies. [ABSTRACT FROM AUTHOR]
- Published
- 2006
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15. US critical care pharmacy practices and clinical information systems: a Hospira® Pharmacist Award Grant Report.
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Choo, Chui‐Lynn
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CLINICAL competence ,CONTINUING education ,DIFFUSION of innovations ,HOSPITAL pharmacies ,HOSPITAL information systems ,PHARMACY databases ,INTENSIVE care units ,ORGANIZATIONAL effectiveness ,PHARMACY education ,RESEARCH funding ,DECISION making in clinical medicine - Abstract
This is a grant report on a study preceptorship undertaken in intensive care units at the Johns Hopkins Hospital (Baltimore); University of Chicago Medical Center; University of Chicago Medicine Comer Children's Hospital; RUSH University Medical Center (Chicago); Indiana University Health University and Methodist Hospitals (Indianapolis); St Vincent's Hospital (Indianapolis); and Eskenazi Health (Indianapolis). Key learning points from US critical care pharmacy practice models, Residency Programs, Specialist Board Certification and clinical information systems are highlighted. Comparisons between US and Australian practices are discussed. Hospira
® and the Society of Hospital Pharmacists of Australia are acknowledged for funding this study preceptorship. [ABSTRACT FROM AUTHOR]- Published
- 2015
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16. Reliability, validity and efficiency of multiple choice question and patient management problem item formats in assessment of clinical competence.
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Norcini JJ, Swanson DB, Grosso LJ, and Webster GD
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- Humans, Internal Medicine education, Psychometrics, United States, Clinical Competence, Education, Medical, Graduate, Educational Measurement methods
- Abstract
Despite a lack of face validity, there continues to be heavy reliance on objective paper-and-pencil measures of clinical competence. Among these measures, the most common item formats are patient management problems (PMPs) and three types of multiple choice questions (MCQs): one-best-answer (A-types); matching questions (M-types); and multiple true/false questions (X-types). The purpose of this study is to compare the reliability, validity and efficiency of these item formats with particular focus on whether MCQs and PMPs measure different aspects of clinical competence. Analyses revealed reliabilities of 0.72 or better for all item formats; the MCQ formats were most reliable. Similarly, efficiency analyses (reliability per unit of testing time) demonstrated the superiority of MCQs. Evidence for validity obtained through correlations of both programme directors' ratings and criterion group membership with item format scores also favoured MCQs. More important, however, is whether MCQs and PMPs measure the same or different aspects of clinical competence. Regression analyses of the scores on the validity measures (programme directors' ratings and criterion group membership) indicated that MCQs and PMPs seem to be measuring predominantly the same thing. MCQs contribute a small unique variance component over and above PMPs, while PMPs make the smallest unique contribution. As a whole, these results indicate that MCQs are more efficient, reliable and valid than PMPs.
- Published
- 1985
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17. Reinforcing medical authority: clinical ethics consultation and the resolution of conflicts in treatment decisions.
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Hauschildt, Katrina and De Vries, Raymond
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MEDICAL ethics ,AUTHORITY ,CLINICAL competence ,COMMUNICATION ,CONFLICT (Psychology) ,MEDICAL care ,MEDICAL referrals ,PATIENTS ,PHYSICIAN-patient relations ,PHYSICIANS ,DECISION making in clinical medicine ,ETHICAL decision making ,OCCUPATIONAL roles ,PHYSICIANS' attitudes ,TERTIARY care ,PATIENT autonomy - Abstract
Despite substantial efforts in the past 15 years to professionalise the field of clinical ethics consultation, sociologists have not re‐examined past hypotheses about the role of such services in medical decision‐making and their effect on physician authority. In relation to those hypotheses, we explore two questions: (i) What kinds of issues does ethics consultation resolve? and (ii) what is the nature of the resolution afforded by these consults? We examined ethics consultation records created between 2011 and mid‐2015 at a large tertiary care US hospital and found that in most cases, the problems addressed are not novel ethical dilemmas as classically conceived, but are instead disagreements between clinicians and patients or their surrogates about treatment. The resolution offered by a typical ethics consultation involves strategies to improve communication rather than the parsing of ethical obligations. In cases where disagreements persist, the proposed solution is most often based on technical clinical judgements, reinforcing the role of physician authority in patient care and the ethical decisions made about that care. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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18. Should There Be A Part II ABPMR Examination?: A Psychometric Inquiry.
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Chiodo, Anthony, Raddatz, Mikaela, Driscoll, Sherilyn W., Sliwa, James A., Clark, Gary S., and Robinson, Lawrence R.
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MULTIPLE choice examinations ,PRINCIPAL components analysis ,ANALYSIS of variance ,INTERPERSONAL communication ,REGRESSION analysis ,CLINICAL competence ,EDUCATIONAL tests & measurements ,PHYSICAL medicine ,PSYCHOMETRICS ,CERTIFICATION ,RETROSPECTIVE studies - Abstract
Background: Certification by the American Board of Physical Medicine and Rehabilitation (ABPMR) requires passing both a written multiple choice examination (Part I) and an oral examination (Part II), but it has been unclear whether the two examinations measure the same or different dimensions of knowledge.Objective: To evaluate the concordance between the Part I and Part II examinations for ABPMR initial certification with regard to candidate performance on the examinations and their subsets. Our question is whether the Part II examination provides additional assessment of a candidate beyond what Part I provides.Design: Retrospective psychometric evaluation of deidentified board examination scores.Setting: ABPMR database of Part I and Part II examination scores.Participants: Candidates for the ABPMR Part I and Part II examinations after 2005, with a more detailed analysis of candidates for the Part I examination from 2014 to 2016. Examination scores of candidates who took the Part II examination both before and after the examination was standardized in 2005 were also used for an additional analysis.Methods: Correlations, simple linear regressions, and principal components analysis.Main Outcome Measurements: Correlation coefficients, variance analysis, and unexplained variance in the principal components analysis.Results: There is a weak to moderate correlation between performance on the Part I and Part II examinations: r = 0.33, P < .001. There is an additional dimension of assessment that is demonstrated on the Part II examination, with this being primarily in the domains of systems-based practice and interpersonal communication skills.Conclusion: The Part I and Part II examinations, although with some overlap, contribute different and meaningful components to the overall evaluation of candidates for board certification in PM&R.Level Of Evidence: III. [ABSTRACT FROM AUTHOR]- Published
- 2019
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19. Comparison of Emergency Medicine Malpractice Cases Involving Residents to Nonresident Cases.
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Gurley, Kiersten L., Grossman, Shamai A., Janes, Margaret, Yu‐Moe, C. Winnie, Song, Ellen, Tibbles, Carrie D., Shapiro, Nathan I., and Rosen, Carlo L.
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BENCHMARKING (Management) ,ENDOVASCULAR surgery ,CLINICAL competence ,COMMUNICATION ,DIAGNOSIS ,DIAGNOSTIC errors ,DOCUMENTATION ,EMERGENCY medicine ,FISHER exact test ,HEALTH facility administration ,HOSPITAL medical staff ,LEGAL liability ,MALPRACTICE ,MEDICAL errors ,MEDICAL ethics ,ORTHOPEDICS ,PATIENT monitoring ,PATIENT safety ,PHYSICIANS ,PRIVACY ,RISK management in business ,T-test (Statistics) ,DECISION making in clinical medicine ,DISEASE prevalence ,CLINICAL supervision - Abstract
Abstract: Background: Data are lacking on how emergency medicine (EM) malpractice cases with resident involvement differs from cases that do not name a resident. Objectives: The objective was to compare malpractice case characteristics in cases where a resident is involved (resident case) to cases that do not involve a resident (nonresident case) and to determine factors that contribute to malpractice cases utilizing EM as a model for malpractice claims across other medical specialties. Methods: We used data from the Controlled Risk Insurance Company (CRICO) Strategies’ division Comparative Benchmarking System (CBS) to analyze open and closed EM cases asserted from 2009 to 2013. The CBS database is a national repository that contains professional liability data on > 400 hospitals and > 165,000 physicians, representing over 30% of all malpractice cases in the United States (>350,000 claims). We compared cases naming residents (either alone or in combination with an attending) to those that did not involve a resident (nonresident cohort). We reported the case statistics, allegation categories, severity scores, procedural data, final diagnoses, and contributing factors. Fisher's exact test or t‐test was used for comparisons (alpha set at 0.05). Results: A total of 845 EM cases were identified of which 732 (87%) did not name a resident (nonresident cases), while 113 (13%) included a resident (resident cases). There were higher total incurred losses for nonresident cases. The most frequent allegation categories in both cohorts were “failure or delay in diagnosis/misdiagnosis” and “medical treatment” (nonsurgical procedures or treatment regimens, i.e., central line placement). Allegation categories of safety and security, patient monitoring, hospital policy and procedure, and breach of confidentiality were found in the nonresident cases. Resident cases incurred lower payments on average ($51,163 vs. $156,212 per case). Sixty‐six percent (75) of resident versus 57% (415) of nonresident cases were high‐severity claims (permanent, grave disability or death; p = 0.05). Procedures involved were identified in 32% (36) of resident and 26% (188) of nonresident cases (p = 0.17). The final diagnoses in resident cases were more often cardiac related (19% [21] vs. 10% [71], p < 0.005) whereas nonresident cases had more orthopedic‐related final diagnoses (10% [72] vs. 3% [3], p < 0.01). The most common contributing factors in resident and nonresident cases were clinical judgment (71% vs. 76% [p = 0.24]), communication (27% vs. 30% [p = 0.46]), and documentation (20% vs. 21% [p = 0.95]). Technical skills contributed to 20% (22) of resident cases versus 13% (96) of nonresident cases (p = 0.07) but those procedures involving vascular access (2.7% [3] vs 0.1% [1]) and spinal procedures (3.5% [4] vs. 1.1% [8]) were more prevalent in resident cases (p < 0.05 for each). Conclusions: There are higher total incurred losses in nonresident cases. There are higher severity scores in resident cases. The overall case profiles, including allegation categories, final diagnoses, and contributing factors between resident and nonresident cases are similar. Cases involving residents are more likely to involve certain technical skills, specifically vascular access and spinal procedures, which may have important implications regarding supervision. Clinical judgment, communication, and documentation are the most prevalent contributing factors in all cases and should be targets for risk reduction strategies. [ABSTRACT FROM AUTHOR]
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- 2018
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20. Do State Continuing Medical Education Requirements for Physicians Improve Clinical Knowledge?
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Vandergrift, Jonathan L., Gray, Bradley M., and Weng, Weifeng
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PUBLIC health ,MEDICAL personnel ,ELECTRONIC health records ,PRIMARY care ,HEALTH education ,CLINICAL competence ,INTELLECT ,INTERNAL medicine ,CONTINUING medical education ,PROFESSIONAL licenses - Abstract
Objective: To evaluate the effect of state continuing medical education (CME) requirements on physician clinical knowledge.Data Sources: Secondary data for 19,563 general internists who took the Internal Medicine Maintenance of Certification (MOC) examination between 2006 and 2013.Study Design: We took advantage of a natural experiment resulting from variations in CME requirements across states over time and applied a difference-in-differences methodology to measure associations between changes in CME requirements and physician clinical knowledge. We measured changes in clinical knowledge by comparing initial and MOC examination performance 10 years apart. We constructed difference-in-differences estimates by regressing examination performance changes against physician demographics, county and year fixed effects, trend-state indicators, and state CME change indicators.Data Collection: Physician data were compiled by the American Board of Internal Medicine. State CME policies were compiled from American Medical Association reports.Principal Findings: More rigorous CME credit-hour requirements (mostly implementing a new requirement) were associated with an increase in examination performance equivalent to a shift in examination score from the 50th to 54th percentile.Conclusions: Among physicians required to engage in a summative assessment of their clinical knowledge, CME requirements were associated with an improvement in physician clinical knowledge. [ABSTRACT FROM AUTHOR]- Published
- 2018
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21. Home hemodialysis education during postdoctoral training: Challenges and innovations.
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Glickman, Joel D. and Seshasai, Rebecca Kurnik
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HOME hemodialysis ,HEMODIALYSIS ,MEDICAL education ,POSTDOCTORAL programs ,NEPHROLOGISTS ,EDUCATION ,TRAINING ,TREATMENT of chronic kidney failure ,CHRONIC kidney failure ,CLINICAL competence ,CURRICULUM ,NEPHROLOGY ,QUALITY assurance ,SCHOLARSHIPS ,DIAGNOSIS - Abstract
Inadequate education in home hemodialysis (HHD) fellowship training might contribute to underutilization of this modality in the United States. Most graduates of nephrology fellowships do not grade themselves as competent in HHD suggesting that fellowship training in HHD is inadequate. An essential component for fellow education is at least one faculty member with expertise in HHD who is passionate about promoting the use of this modality. At a minimum, fellow training should utilize a curriculum that includes both lectures about HHD and outpatient clinical exposure to this modality over a period of at least 6-12 months. Fellows benefit from the opportunity to transition at least three patients to a home modality to gain experience with modality education, access placement, initial prescriptions, and home dialysis training. They should spend time with HHD training nurses to learn more about modality education, observe nurse intake interviews with patients in order to learn the criteria for entrance into the home dialysis program as well as recognize how to identify potential barriers to successful home dialysis therapy. To expose fellows to problems that do not occur during clinic visits fellows are encouraged to take first call during the day for HHD patients. There are many opportunities to do research and quality improvement projects which might also propel some fellows into an academic career as a home dialysis nephrologist. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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22. In-center hemodialysis education: Challenges and innovations in training of fellows in nephrology.
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Moist, Louise M. and Lindsay, Robert M.
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HEMODIALYSIS ,MEDICAL education ,NEPHROLOGY ,MEDICAL specialties & specialists ,MEDICAL technology ,TECHNOLOGICAL innovations ,EDUCATION ,CLINICAL competence ,CURRICULUM ,HOSPITAL wards ,INTERNSHIP programs ,QUALITY assurance ,SCHOLARSHIPS - Abstract
The in-center dialysis unit and practice of dialysis, in the current multi-team approach, requires knowledge and skills in all the domains including medical expert, communicator, collaborator, scholar, health advocate, and leader. We are tasked as a community, to embrace and incentivize new innovations and technology to address these needs for our post graduate trainees. These innovations must address the basic principles of dialysis, quality improvement, technical and procedural skills as well as leadership and administration skills. The teaching methods and innovations must also be challenged to demonstrate the translation into adoption and improvements in practice to demonstrate success. This article will review the current state of the training curriculum in Nephrology for in-center hemodialysis and address some of the recent innovations. [ABSTRACT FROM AUTHOR]
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- 2018
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23. Peritoneal dialysis education: Challenges and innovation.
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Mehrotra, Rajnish
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PERITONEAL dialysis ,MEDICAL education ,NEPHROLOGISTS ,CLINICAL competence ,NEPHROLOGY ,EDUCATION ,TRAINING ,TREATMENT of chronic kidney failure ,CHRONIC kidney failure ,CURRICULUM ,HOME hemodialysis ,QUALITY assurance ,SCHOLARSHIPS - Abstract
Peritoneal dialysis is the most common modality for home dialysis and to ensure patients have access to dialysis at home, training programs have to ensure that the fellows attain clinical competency in the care of such patients. The limited data available however are sobering; about 10 years ago, 44% of nephrologists reported that they did not feel competent in the care of patients undergoing peritoneal dialysis. There are recognizable challenges in ensuring clinical competency of trainees that may need creative solutions. It is important for training program directors to evaluate the state of training at their institution, identify their unique barriers, and work to overcome them in the interest of ensuring that fellows are trained in all aspects of nephrology. [ABSTRACT FROM AUTHOR]
- Published
- 2018
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24. Stakeholders’ qualitative perspectives of effective telepractice pedagogy in speech–language pathology.
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Overby, Megan S.
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TELEMEDICINE ,SPEECH-language pathology ,ACADEMIC programs ,EFFECTIVE teaching ,OPEN-ended questions ,TEACHING demonstrations ,THEORY of knowledge ,CLINICAL competence ,ADULTS ,PROFESSIONAL education ,QUALITATIVE research ,UNIVERSITIES & colleges ,HEALTH occupations students ,HEALTH services accessibility ,INTERVIEWING ,RESEARCH methodology ,MULTIVARIATE analysis ,REHABILITATION ,SPEECH therapists ,STATISTICS ,STUDENT attitudes ,TELEPHONES ,DATA analysis ,COLLEGE teacher attitudes ,DESCRIPTIVE statistics ,ATTITUDE (Psychology) - Abstract
Abstract: Background: Academic programmes in speech–language pathology are increasingly providing telehealth/telepractice clinical education to students. Despite this growth, there is little information describing effective ways to teach it. Aims: The current exploratory study analyzed the perceptions of speech–language pathology/therapy (SLP/SLT) faculty, student and SLP/SLT clinicians to ascertain effective pedagogical approaches for telepractice service delivery, rank the relative importance of telepractice skills and knowledge competencies, and define any pedagogical challenges to teaching them. Methods & Procedures: Qualitative data were collected from two sources: three open‐ended questions within an online survey (SLP/SLT faculty
n = 31, graduate studentsn = 16, telehealth (‘telepractice’) cliniciansn = 16); and follow‐up telephone interviews (n = 22). Data were analyzed with a grounded theory approach followed by a summative rank‐order analysis of themes. Outcomes & Results: All three groups agreed the most effective telepractice instructional approach was telepractice demonstrations (such as students role playing or watching a supervisor). Professional development approaches such as workshops or training manuals were less effective and didactic approaches such as lecture‐only were ineffective. Skills and knowledge competencies students needed before entering the workforce were, in order of implied importance: telepractice clinical skills, telepractice technology skills, legal knowledge pertinent to telepractice and knowledge of telepractice literature. The most important telepractice clinical skills students needed to acquire were appropriate selection of telepractice materials and engaging the client over the internet. Many participants said teaching and learning telepractice was more challenging than in‐person service delivery because of the difficulties in selecting appropriate telepractice clinical materials, managing technology problems and engaging with clients over the internet. Conclusions & Implications: Despite substantial limitations to this investigation, findings imply that telepractice instruction, like other methods of SLP/SLT clinical education, may be most effective when students engage in critical thinking and problem‐solving issues through intense practice. Because the skills and competencies associated with telepractice appear to vary in their perceived value, academic programmes may wish to consider prioritizing how they are taught, giving students additional instruction in the selection of telepractice clinical materials and development of online interpersonal communication skills. For some clinical educators, the challenges associated with telepractice may necessitate additional educator training. [ABSTRACT FROM AUTHOR]- Published
- 2018
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25. For nature cannot be fooled. Why we need to talk about fatigue.
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Farquhar, M.
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DISEASE prevalence ,FATIGUE (Physiology) ,PHYSICIANS ,REST periods ,SLEEP deprivation ,NIGHT work ,WORK & psychology ,GOVERNMENT agencies ,CLINICAL competence ,CORPORATE culture ,NATIONAL health services - Abstract
The author comments on a study published within the issue which investigated the prevalence of fatigue among anaesthetic junior doctors working in the National Health Service in Great Britain. Topics covered include the significance of having doctors take regular breaks to the delivery of safe, effective patient care, the cumulative effects of sleep deprivation especially among those who work night shifts, and the likely errors in care and judgment caused by fatigue.
- Published
- 2017
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26. Preparing Student Nurses as Parent-based Adolescent Sexual Health Educators: Results of a Pilot Study.
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Santa Maria, Diane, Markham, Christine, Crandall, Stacy, and Guilamo‐Ramos, Vincent
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EDUCATION of parents ,COLLEGE students ,MEDICAL communication ,COMMUNICATIVE competence ,COMMUNITY health nursing ,CONFIDENCE ,CONTENT analysis ,FAMILY medicine ,INTERVIEWING ,NURSING students ,PARENT-child relationships ,QUESTIONNAIRES ,RESEARCH funding ,SCALE analysis (Psychology) ,SELF-efficacy ,SEX counseling ,SEX education ,SOCIAL role ,STATISTICS ,STUDENTS ,STUDENT attitudes ,T-test (Statistics) ,TEENAGERS' conduct of life ,CLINICAL competence ,REPRODUCTIVE health ,QUALITATIVE research ,PILOT projects ,DATA analysis ,QUANTITATIVE research ,HEALTH education teachers ,THEMATIC analysis ,PRE-tests & post-tests ,PARENT attitudes ,BACCALAUREATE nursing education ,EDUCATION - Abstract
Objectives: While health promotion and patient education are central to the scope of practice of professional nurses, they often feel ill‐equipped to assume the role of sexual health educator and lack adequate knowledge and skills to effectively engage parents in adolescent sexual and reproductive health efforts. Design and Sample: Employing a mixed‐methods study consisting of both pre‐ and post‐test survey and exit interviews, a pilot study was conducted to assess the impact of implementing a parent‐based adolescent sexual health intervention on baccalaureate nursing student outcomes (N = 31). Results: We found statistically significant improvements in student outcome expectancies of parenting strategies, barriers to sexual health communication, self‐efficacy, and sexual health counseling experience. Using thematic content analysis of exit interview content, emerging themes were (1) need for increased sexual and reproductive health (SRH) preparation, (2) wanting greater experience and opportunity for involvement in nursing research, and (3) educational gaps in family‐focused community public health. Conclusions: Incorporating adolescent sexual health education into public health nursing clinical training can prepare nurses as parent‐based adolescent sexual health educators, a core competency for nurses working with families in communities and across all health care delivery settings. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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27. Emergency Medicine Resident Assessment of the Emergency Ultrasound Milestones and Current Training Recommendations.
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Stolz, Lori A., Stolz, Uwe, Fields, J. Matthew, Saul, Turandot, Secko, Michael, Flannigan, Matthew J., Sheele, Johnathan M., Rifenburg, Robert P., Weekes, Anthony J., Josephson, Elaine B., Bedolla, John, Resop, Dana M., dela Cruz, Jonathan, Boysen ‐ Osborn, Megan, Caffery, Terrell, Derr, Charlotte, Bengiamin, Rimon, Chiricolo, Gerardo, Backlund, Brandon, and Heer, Jagdipak
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EMERGENCY physicians ,CLINICAL competence ,CONFIDENCE intervals ,CONSENSUS (Social sciences) ,EMERGENCY medicine ,HOSPITAL patients ,HOSPITAL medical staff ,INTERNSHIP programs ,LONGITUDINAL method ,MEDICAL protocols ,MEDICAL societies ,STUDY & teaching of medicine ,PHYSICAL diagnosis ,RESUSCITATION ,ROOMS ,SCHOLARSHIPS ,SURVEYS ,ULTRASONIC imaging ,CROSS-sectional method ,DISEASE progression ,DATA analysis software ,PERITONSILLAR abscess ,EDUCATION - Abstract
Objectives Emergency ultrasound ( EUS) has been recognized as integral to the training and practice of emergency medicine ( EM). The Council of Emergency Medicine Residency-Academy of Emergency Ultrasound ( CORD- AEUS) consensus document provides guidelines for resident assessment and progression. The Accredited Council for Graduate Medical Education ( ACGME) has adopted the EM Milestones for assessment of residents' progress during their residency training, which includes demonstration of procedural competency in bedside ultrasound. The objective of this study was to assess EM residents' use of ultrasound and perceptions of the proposed ultrasound milestones and guidelines for assessment. Methods This study is a prospective stratified cluster sample survey of all U.S. EM residency programs. Programs were stratified based on their geographic location (Northeast, South, Midwest, West), presence/absence of ultrasound fellowship program, and size of residency with programs sampled randomly from each stratum. The survey was reviewed by experts in the field and pilot tested on EM residents. Summary statistics and 95% confidence intervals account for the survey design, with sampling weights equal to the inverse of the probability of selection, and represent national estimates of all EM residents. Results There were 539 participants from 18 residency programs with an overall survey response rate of 85.1%. EM residents considered several applications to be core applications that were not considered core applications by CORD- AEUS (quantitative bladder volume, diagnosis of joint effusion, interstitial lung fluid, peritonsillar abscess, fetal presentation, and gestational age estimation). Of several core and advanced applications, the Focused Assessment with Sonography in Trauma examination, vascular access, diagnosis of pericardial effusion, and cardiac standstill were considered the most likely to be used in future clinical practice. Residents responded that procedural guidance would be more crucial to their future clinical practice than resuscitative or diagnostic ultrasound. They felt that an average of 325 (301-350) ultrasound examinations would be required to be proficient, but felt that number of examinations poorly represented their competency. They reported high levels of concern about medicolegal liability while using EUS. Eighty-nine percent of residents agreed that EUS is necessary for the practice of EM. Conclusions EM resident physicians' opinion of what basic and advanced skills they are likely to utilize in their future clinical practice differs from what has been set forth by various groups of experts. Their opinion of how many ultrasound examinations should be required for competency is higher than what is currently expected during training. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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28. Maintenance of certification: How performance in practice changes improve tobacco cessation in addiction psychiatrists' practice.
- Author
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Ford, James H., Oliver, Karen A., Giles, Miriam, Cates‐Wessel, Kathryn, Krahn, Dean, and Levin, Frances R.
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PSYCHIATRISTS ,NICOTINE addiction ,CERTIFICATION ,MEDICAL care ,PREVENTION ,CLINICAL competence ,PSYCHIATRY ,QUALITY assurance ,RESEARCH funding ,SMOKING cessation ,CONTINUING medical education - Abstract
Background and Objectives: In 2000, the American Board of Medical Specialties implemented the Maintenance of Certification (MOC), a structured process to help physicians identify and implement a quality improvement project to improve patient care. This study reports on findings from an MOC Performance in Practice (PIP) module designed and evaluated by addiction psychiatrists who are members of the American Academy of Addiction Psychiatry (AAAP).Method: A 3-phase process was utilized to recruit AAAP members to participate in the study. The current study utilized data from 154 self-selected AAAP members who evaluated the effectiveness of the MOC Tobacco Cessation PIP.Results: Of the physicians participating, 76% (n = 120) completed the Tobacco PIP. A paired t-test analysis revealed that reported changes in clinical measure documentation were significant across all six measures. Targeted improvement efforts focused on a single clinical measure. Results found that simple change projects designed to improve clinical practice led to substantial changes in self-reported chart documentation for the selected measure.Conclusions: The current findings suggest that addiction psychiatrists can leverage the MOC process to improve clinical care.Scientific Significance: The study demonstrates that a quality improvement collaborative can support an MOC process to help addiction psychiatrists eliminate barriers to access to tobacco cessation treatment. (Am J Addict 2017;26:34-41). [ABSTRACT FROM AUTHOR]- Published
- 2017
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29. A survey of dental public health specialists on current dental public health competencies.
- Author
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Mascarenhas, Ana Karina and Altman, Donald
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PUBLIC health ,DENTAL specialties ,DENTAL associations ,DENTAL public health ,SPECIALISTS ,CLINICAL competence ,HEALTH attitudes ,INFORMATION literacy ,CULTURAL competence - Abstract
In preparation to update the Dental Public Health specialty competencies, the Expert Panel determined that a needs assessment be conducted. A nine item open and close ended survey developed by the Expert Panel was used to collect data on the Diplomates current work environment, the utility of the current set of Dental Public Health competencies, and to identify any gaps in the current competencies. In 2015, the survey was administered to all active Diplomates of the American Board of Dental Public Health. One hundred and nine Diplomates responded. Diplomates overwhelmingly reported that each of the ten current competencies were still relevant for Dental Public Health specialists in the 21st Century, but needed to be updated to be more contemporary. Domains suggested to achieve this were interprofessional care, cultural competency, health literacy, and evidence-based dentistry. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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30. A typology of longitudinal integrated clerkships.
- Author
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Worley, Paul, Couper, Ian, Strasser, Roger, Graves, Lisa, Cummings, Beth‐Ann, Woodman, Richard, Stagg, Pamela, Hirsh, David, Banh, Kenny V, Barnard, Amanda, Bartlett, Maggie, Brooks, Kathleen, Brousseau, Gilles, Campbell, David, Campbell, Narelle, Conradie, Hoffie, Crouse, Byron, DeWitt, Dawn, Douglas, Michael, and Duplain, Rejean
- Subjects
ANALYSIS of variance ,CLINICAL medicine ,CLUSTER analysis (Statistics) ,DIFFUSION of innovations ,CURRICULUM ,EDUCATION research ,TEST validity ,FISHER exact test ,MEDICAL schools ,MEDICAL students ,MEDICAL specialties & specialists ,STUDY & teaching of medicine ,METROPOLITAN areas ,PROBABILITY theory ,RURAL conditions ,SCHOOL environment ,STATISTICAL hypothesis testing ,STUDENTS ,SUPERVISION of employees ,SURVEYS ,CLINICAL competence ,QUALITATIVE research ,EDUCATIONAL attainment ,DATA analysis software ,DESCRIPTIVE statistics ,EDUCATION - Abstract
Context Longitudinal integrated clerkships ( LICs) represent a model of the structural redesign of clinical education that is growing in the USA, Canada, Australia and South Africa. By contrast with time-limited traditional block rotations, medical students in LICs provide comprehensive care of patients and populations in continuing learning relationships over time and across disciplines and venues. The evidence base for LICs reveals transformational professional and workforce outcomes derived from a number of small institution-specific studies. Objectives This study is the first from an international collaborative formed to study the processes and outcomes of LICs across multiple institutions in different countries. It aims to establish a baseline reference typology to inform further research in this field. Methods Data on all LIC and LIC-like programmes known to the members of the international Consortium of Longitudinal Integrated Clerkships were collected using a survey tool developed through a Delphi process and subsequently analysed. Data were collected from 54 programmes, 44 medical schools, seven countries and over 15 000 student-years of LIC-like curricula. Results Wide variation in programme length, student numbers, health care settings and principal supervision was found. Three distinct typological programme clusters were identified and named according to programme length and discipline coverage: Comprehensive LICs; Blended LICs, and LIC-like Amalgamative Clerkships. Two major approaches emerged in terms of the sizes of communities and types of clinical supervision. These referred to programmes based in smaller communities with mainly family physicians or general practitioners as clinical supervisors, and those in more urban settings in which subspecialists were more prevalent. Conclusions Three distinct LIC clusters are classified. These provide a foundational reference point for future studies on the processes and outcomes of LICs. The study also exemplifies a collaborative approach to medical education research that focuses on typology rather than on individual programme or context. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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31. Evidence-based medicine teaching requirements in the USA: taxonomy and themes.
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Shaughnessy, Allen F., Torro, John R., Frame, Kara A., and Bakshi, Munish
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EVIDENCE-based medicine ,CLINICAL epidemiology ,ATTITUDE (Psychology) ,INFORMATION resources ,MEDICAL education ,EDUCATION - Abstract
Background In the USA, recent changes to oversight of residency training codify the requirements for teaching evidence-based medicine and information mastery (lifelong learning) knowledge, skills, and attitudes. Objective The goal of this project is to determine current requirements for teaching of evidence-based medicine (EBM) and information mastery (IM) in specialty residency education in the USA. Methods The project was a qualitative thematic analysis using content analysis. The source of the requirements for EBM and IM were the 'milestone' statements for all 28 major specialties and transition year programs. Milestone descriptors related to EBM/IM were extracted and codes were developed and applied to each descriptor by four researchers. The resulting codes were coalesced into themes and tested against the milestone descriptors. Results The coding process identified 15 content areas comprising five themes. Two themes related to the knowledge and skills of EBM and three themes related to the knowledge, skills, and attitudes of IM. EBM themes encompassed basic critical appraisal skills and knowledge of clinical epidemiology principles and statistics. IM themes centered on identifying one's information needs for patient-specific information, using information sources, and using current awareness services to remain abreast of changes in medicine. In general, they align well with the Sicily Statement on Evidence-Based Practice. No specialty required competence in all areas. Conclusion New training requirements for specialties in the USA require the development of both classic EBM skills as well as skills for managing information. However, there is marked variation in the requirements among specific specialties. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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32. Evidence-Based Practice Knowledge, Perceptions, and Behavior: A Multi-Institutional, Cross-Sectional Study of a Population of U.S. Dental Students.
- Author
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Straub-Morarend, Cheryl L., Wankiiri-Hale, Christine R., Blanchette, Derek R., Lanning, Sharon K., Bekhuis, Tanja, Smith, Becky M., Brodie, Abby J., Oliveira, Deise Cruz, Handysides, Robert A., Dawson, Deborah V., and Spallek, Heiko
- Subjects
DENTAL education ,DENTAL schools ,DENTAL students ,EVIDENCE-based dentistry ,CURRICULUM ,ATTITUDE (Psychology) ,BEHAVIOR ,CLINICAL competence ,DATABASES ,EXPERIMENTAL design ,INTERNET ,INTERPROFESSIONAL relations ,MEDICAL personnel ,META-analysis ,READABILITY (Literary style) ,RESEARCH funding ,SELF-perception ,STATISTICS ,THOUGHT & thinking ,ACCESS to information ,CROSS-sectional method ,PSYCHOLOGY - Abstract
The aim of this study was to help inform faculty and curriculum leaders in academic dental institutions about the knowledge, skills, perceptions, and behavior of an institutionally diverse population of dental students with respect to evidence-based practice (EBP). A survey utilizing the validated Knowledge, Attitudes, Access, and Confidence Evaluation instrument developed by Hendricson et al. was conducted in 2012 with fourth-year dental students at seven geographically dispersed U.S. dental schools. The survey addressed elements of EBP knowledge, attitudes toward EBP, behavior in accessing evidence, and perceptions of competence in statistical analysis. A total of 138 students from the seven schools participated. A slight majority of these students correctly responded to the knowledge of critical appraisal questions. While the students demonstrated positive attitudes about EBP, they did not report high levels of confidence in their critical appraisal skills. The findings also showed that the students accessed various sources of evidence with differing frequencies. The most frequently accessed resources were colleagues, the Internet (excluding Cochrane Database of Systematic Reviews), and textbooks. The results of this study help to identify areas for improvement in EBP education in order to advance dental students' preparation to become evidence-based practitioners. [ABSTRACT FROM AUTHOR]
- Published
- 2016
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33. How clinical supervisors develop trust in their trainees: a qualitative study.
- Author
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Hauer, Karen E, Oza, Sandra K, Kogan, Jennifer R, Stankiewicz, Corrie A, Stenfors‐Hayes, Terese, Cate, Olle ten, Batt, Joanne, and O'Sullivan, Patricia S
- Subjects
ADULTS ,HIGHER education ,PROFESSIONAL education ,CLINICAL competence ,HOSPITAL medical staff ,INTERVIEWING ,MATHEMATICAL models ,PHENOMENOLOGY ,RESEARCH methodology ,STUDY & teaching of medicine ,RESEARCH funding ,TEACHER-student relationships ,TRUST ,QUALITATIVE research ,THEORY ,CLINICAL supervision ,MEDICAL coding - Abstract
Context Clinical supervisors oversee trainees' performance while granting them increasing opportunities to work independently. Although the factors contributing to supervisors' trust in their trainees to conduct clinical work have been identified, how the development of trust is shaped by these factors remains less clear. Objectives This study was designed to determine how supervisors develop and experience trust in resident (postgraduate years 2 and 3) trainees in the clinical workplace. Methods Internal medicine in-patient supervisors at two institutions were interviewed about the meaning and experience of developing trust in resident trainees. Transcribed data were coded and analysed using a phenomenographic approach. Results Forty-three supervisors participated. Supervisors characterised the meaning of trust from the perspectives of trainee competence and leadership or from their own perspective of needing to provide more or less supervision. Supervisors initially considered trust to be usually independent of prior knowledge of the resident, and then used sources of information about trust to develop their judgements of trust. Sources, which incorporated inference, included supervisors' comparisons with a standard, direct observation of the trainee as a team leader or care provider, and stakeholder input from team members, patients and families. Barriers against and accelerators to trust formation related to the resident, supervisor, resident-supervisor relationship, context and task. Trust formation had implications for supervisors' roles, residents' increasingly independent provision of care, and team functioning. Conclusions From a general starting point, supervisors develop trust in residents informed by observation, inference and information gathered from the team and patients. Judgements of trust yield outcomes defined by supervisors' changing roles, the increasingly independent provision of care by residents, and team functioning. The implications of these findings for graded resident autonomy aligned with learning needs can inform the design of training environments to enable readiness for unsupervised practice. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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34. Developing a Fidelity Assessment Instrument for Nurse Home Visitors.
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Black, Kirsten J., Wenger, Mary Beth, and O' Fallon, Molly
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CAREER development ,CLINICAL competence ,CONCEPTUAL structures ,TEST validity ,EXPERIMENTAL design ,GROUNDED theory ,HOME care services ,INFANT health services ,RESEARCH methodology ,MEDICAL personnel ,NURSE administrators ,NURSES ,NURSING ,NURSING practice ,NURSING career counseling ,NURSING consultants ,NURSING specialties ,PROFESSIONAL employee training ,QUALITY assurance ,SCALE analysis (Psychology) ,SURVEYS ,EVIDENCE-based nursing ,CONCEPT mapping ,RESEARCH methodology evaluation ,PATIENTS' families ,DATA analysis software ,WORK experience (Employment) ,DESCRIPTIVE statistics - Abstract
Fidelity monitoring is a core component for successful translation of evidence-based interventions, yet little guidance is available on developing tools to assess intervention fidelity that are valid and feasible for use in community settings. We partnered with nurses in the field to develop a fidelity monitoring instrument that would capture the essential elements of the nursing intervention that is the core of Nurse-Family Partnership, a prenatal and early childhood home visitation program. Using a grounded approach, we employed concept mapping to identify the salient behavioral characteristics associated with the program, and then, adapting Dreyfus' model of skill development, created a tool to assess nurse home visitors (NHVs) according to their stage of growth. In a pilot, the Nursing Practice Assessment (NPA) form was used to assess 188 NHVs. The average time to complete the tool was 1 hour, and skill development stage was concordant with years of NHV experience. According to surveys of supervisors and NHVs, the tool captured the essential elements of the program model. Articulating the essential elements of each skill development stage can provide a foundation for professional development for NHVs. In response to feedback, online training modules were developed prior to large-scale implementation in the field. The grounded methods used to develop the NPA enhanced its internal consistency and implementation feasibility and could be utilized by other public health nursing programs. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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35. Context matters: emergent variability in an effectiveness trial of online teaching modules.
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Ellaway, Rachel H, Pusic, Martin, Yavner, Steve, and Kalet, Adina L
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HIGHER education ,ADULTS ,TEACHING methods ,EVALUATION of teaching ,ALTERNATIVE education evaluation ,FOCUS groups ,GROUNDED theory ,INTERVIEWING ,RESEARCH methodology ,MEDICAL schools ,MEDICAL school faculty ,MEDICAL students ,STUDY & teaching of medicine ,MULTIMEDIA systems ,RESEARCH funding ,STUDENT attitudes ,OPERATIVE surgery ,CLINICAL competence ,JUDGMENT sampling ,INTER-observer reliability ,COLLEGE teacher attitudes ,DATA analysis software ,EDUCATION - Abstract
Context Conducting research in real life settings (effectiveness studies) can introduce many confounding factors. Efficacy studies seek to control for researcher bias and data quality rather than considering how the efficacy of an intervention is changed by the contexts in which it is used. Relatively little is known about the impact of context on educational interventions, in particular on multimedia learning. Methods An effectiveness study to understand implementation variance of online educational modules in surgery clerkships was conducted in six US medical schools participating in an efficacy trial of different multimedia designs. Student and teacher experiences were captured through focus groups and one-to-one interviews with trial participants and their teachers. Audio-recordings of these sessions were transcribed and analysed using grounded theory techniques. Results Differences were identified in student and teacher perceptions of how the educational intervention had been implemented and how its uptake had been influenced by context-dependent factors: (i) the intervention was implemented in different ways to suit different educational contexts and this influenced how students and teachers responded to it; (ii) the ways students and teachers interacted with, and behaved around, the intervention influenced its uptake; (iii) the way the intervention was perceived by students and teachers influenced its uptake; and (iv) the medium and design of the intervention had a directing influence on its uptake. Conclusions It was observed that each institutional context formed a complex educational ecology. The intervention became interwoven with different educational ecologies so that it could no longer be considered a stable variable across the study. We suggest that researchers should conduct implementation-profiling studies in advance of any intervention-based research to account for the constructing nature of educational ecologies on their interventions and in doing so to more clearly differentiate between efficacy and effectiveness studies. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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36. Toward a Global Understanding of Students Who Participate in Rural Primary Care Longitudinal Integrated Clerkships: Considering Personality Across 2 Continents.
- Author
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Eley, Diann S., Brooks, Kathleen D., Zink, Therese, and Cloninger, C. Robert
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ANALYSIS of variance ,CHI-squared test ,CONFIDENCE intervals ,CURRICULUM ,LONGITUDINAL method ,MEDICAL students ,STUDY & teaching of medicine ,MULTIVARIATE analysis ,PERSONALITY ,PERSONALITY tests ,PRIMARY health care ,QUESTIONNAIRES ,RURAL conditions ,SELF-evaluation ,STATISTICS ,T-test (Statistics) ,MATHEMATICAL variables ,CLINICAL competence ,DATA analysis ,EFFECT sizes (Statistics) ,CROSS-sectional method ,DATA analysis software ,EDUCATION - Abstract
Purpose Medical schools worldwide have developed rural primary care immersive experiences to nurture students' interest in future rural careers and address workforce shortages. Few studies have looked at the students who participate in these programs. This study explores personality traits in US and Australian students who undertake rural-focused medical training. Methods A cross-sectional cohort design used the Temperament and Character Inventory to identify levels of the 7 basic dimensions of personality. Data were collected in successive cohorts over 2007-2011. Multivariate analysis compared trait levels between groups and by demographic variables. Findings The majority of the 302 students (US-167; Australia-135) were female, aged 20-29 years and single. A greater proportion of US students reported being partnered, living longest in a small rural/remote community and having a rural background. Significant differences between groups were detected in several traits but effect sizes were small. The personality pattern of the combined sample indicates students with a mature and stable personality high in Self-Directedness, Persistence, and Cooperativeness. Rural background and marital status enhanced this pattern. Conclusions Despite coming from different educational and societal backgrounds, similar personality patterns are evident in US and Australian students who pursue rural medical education. Data provide support for a pattern of traits associated with a rural background and its predictive influence on interest in rural practice. Considering the international expansion of rural longitudinal integrated clerkships, understanding student attributes may assist in identifying strategies to enhance the rural workforce that are relevant across cultures and continents. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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37. Palliative care education in US medical schools.
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Horowitz, Robert, Gramling, Robert, and Quill, Timothy
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ADULTS ,HIGHER education ,EDUCATIONAL standards ,CLINICAL competence ,MEDICAL ethics ,STUDY & teaching of medicine ,PALLIATIVE treatment - Abstract
Context Medical educators in the USA perceive the teaching of palliative care competencies as important, medical students experience it as valuable and effective, and demographic and societal forces fuel its necessity. Although it is encouraged by the Association of American Medical Colleges, the only palliative care-related mandate in US medical schools is the Liaison Committee on Medical Education directive that end-of-life ( Eo L) care be included in medical school curricula, reinforcing the problematic conflation of Eo L and palliative care. Findings A review of US medical school surveys about the teaching of palliative and Eo L care reveals varied and uneven approaches, ranging from 2 hours in the classroom on Eo L to weeks of palliative care training or hospice-based clinical rotations. Implications Palliative care competencies are too complex and universally important to be relegated to a minimum of classroom time, random clinical exposures, and the hidden curriculum. Recommendations Given the reality of overstrained medical school curricula, developmentally appropriate, basic palliative care competencies should be defined and integrated into each year of the medical school curriculum, taking care to circumvent the twin threats of curricular overload and educational abandonment. [ABSTRACT FROM AUTHOR]
- Published
- 2014
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38. Benefits and Challenges of International Clinical Education from a US-based Physiotherapist Faculty Perspective.
- Author
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Pechak, Celia and Black, Jill D.
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AUDIT trails ,CLINICAL competence ,CONTENT analysis ,INTERPROFESSIONAL relations ,INTERVIEWING ,LABOR mobility ,RESEARCH methodology ,PHYSICAL therapy education ,RESEARCH evaluation ,WORLD health ,QUALITATIVE research ,JUDGMENT sampling ,HEALTH occupations school faculty ,EDUCATIONAL outcomes ,COLLEGE teacher attitudes ,DATA analysis software ,PHYSICAL therapy students ,DESCRIPTIVE statistics ,EDUCATION - Abstract
Introduction The influence of internationalization on physiotherapist education in at least North American-based programmes has become more apparent. Faculty and students have been involved in various international activities. One category of activities includes international clinical education (ICE), where students earn clinical education credit for their learning activities at international sites. Although this educational strategy appears to be increasingly used in at least the United States and Canada, the related literature is limited in scope. The purpose of this portion of the present study was to investigate the benefits and challenges of ICE for US-based students, US-based physiotherapy programmes and international partners from the perspective of US-based faculty sending students for clinical education internationally. Methods Content analysis was used for this qualitative study. Fifteen US-based faculty members who had experience in sending physiotherapist students for ICE were recruited. The primary researcher conducted semi-structured phone interviews, averaging approximately 60 minutes in length. The primary and secondary researchers completed data analysis using NVivo 8 software (QSR International Inc., Cambridge, MA). Results Benefits of ICE to the students included exposure to alternate health systems, broadening of student perspectives and clinical competence. Challenges consisted of funding and possible language barrier. Increased visibility, expanded global perspective and faculty collaborations were benefits to the programme. Ensuring a quality learning experience was the greatest programme challenge. Benefits to the international site included education and faculty collaborations/exchanges; challenges were language, student clinical preparation and unfamiliarity with the student evaluation tool. Because the sample was limited to 15 US-based faculty members, the results may not be relevant to all programmes inside or outside of the United States. Additionally, the study lacked perspectives from the students or international sites. Implication for Physiotherapy Practice The present study is an early step in the important examination of the impact of this emerging educational trend on physiotherapy education and practice. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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39. Students entering internship show readiness in the nutrition care process.
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Baker, S. D. and Cotugna, N.
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ALTERNATIVE education ,CLINICAL competence ,CONFIDENCE ,CRITICAL thinking ,DIAGNOSIS ,DIETETICS ,DIETITIANS ,CURRICULUM ,EMPLOYEES ,EXPERIENCE ,HEALTH occupations students ,INTELLECT ,INTERNSHIP programs ,NUTRITIONAL assessment ,QUESTIONNAIRES ,STUDENT attitudes ,SURVEYS ,WORLD Wide Web ,DECISION making in clinical medicine ,DATA analysis software ,DESCRIPTIVE statistics ,NUTRITION services ,EDUCATION - Abstract
Background The British Dietetic Association and the International Confederation of Dietetic Associations are developing an international model for dietetics practice as an aid in providing evidence-based practice. In the USA, undergraduate programmes are mandated by the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) to incorporate the nutrition care process ( NCP) into the curriculum so that students can use the process during their dietetic internship and later practice. The present study aimed to assess interns' readiness in the NCP prior to beginning a dietetic internship. Methods Before starting the internship, the 40 interns in the 2009-2010 class of a university-based internship were sent an e-mail requesting they complete an online survey. Questions inquired about their NCP background with respect to: academic preparation, work or volunteer experiences, knowledge and confidence in ability to apply the NCP. Survey results were analysed with SPSS statistical software (SPSS Inc., Chicago, IL, USA). Results The 39 interns completing the survey indicated they had prior exposure to the NCP. All but one reported that their academic coursework covered the NCP. Approximately half of the interns worked or volunteered in settings that used the NCP. Overall, students correctly answered most of the questions assessing their basic knowledge in the NCP. Thirty-seven of the 39 interns had some confidence or felt confident in their ability to apply the NCP during internship rotations. Conclusions This distance internship attracts students from all over the USA, and so the findings of the present study shed light on current undergraduate preparation in the NCP. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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40. Gender differences in worry during medical school.
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Miller, Grant D, Kemmelmeier, Markus, and Dupey, Peggy
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ACADEMIC achievement ,CHI-squared test ,STATISTICAL correlation ,COUNSELING ,DEBT ,FACTOR analysis ,HELP-seeking behavior ,INTERPERSONAL relations ,LONGITUDINAL method ,MARITAL status ,MEDICAL students ,QUESTIONNAIRES ,SCALE analysis (Psychology) ,SEX distribution ,STUDENT attitudes ,CLINICAL competence ,DESCRIPTIVE statistics ,EDUCATION - Abstract
Objectives This research examined worry in medical students at various stages of training with reference to worries related to academic and clinical training, finances and relationships with peers. The study focused on gender differences in worries, testing the notion that being married or being in a long-term or cohabitating relationship with a partner would be linked to increased worry among women, but decreased worry among men. Additional goals included examining the relationship between worry and the seeking of counselling, and investigating the disadvantage for medical students associated with living with parents. Methods Data collected serially on class cohorts at one western US medical school yielded 868 responses from medical students, which were analysed using general linear models, generalised linear models and generalised estimation equations. Results Among four types of worry, academic and financial worries were similarly dominant (p < 0.001); financial worries were found to increase over the course of medical training (p < 0.001). Men reported more worry than women (p < 0.001). Gender differences were qualified by marital status (p = 0.007). Being married was linked to higher levels of academic and financial worry among women, whereas for men marriage was linked to lower academic, but higher financial worry (p < 0.001). Living with parents was always associated with a higher level of worry (p < 0.0001). Married male students were more likely to seek counselling than unmarried male students, whereas this pattern was reversed for female students (p = 0.002). Conclusions This study confirms that both academic and financial stress represent the greatest sources of worry in medical students. It also represents the first research to demonstrate higher levels of worry in male than female medical students, which may be evidence of women's increased representation in the medical school population. These data also support the persistence of traditional gender roles in the marriages of medical students; marriage is related to an increased psychological burden in women in comparison with men. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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41. Mastering improvement science skills in the new era of quality and safety: the Veterans Affairs National Quality Scholars Program.
- Author
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Estrada, Carlos A., Dolansky, Mary A., Singh, Mamta K., Oliver, Brant J., Callaway‐Lane, Carol, Splaine, Mark, Gilman, Stuart, and Patrician, Patricia A.
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MEDICAL education ,QUALITY assurance ,CLINICAL competence ,CURRICULUM ,INTERPROFESSIONAL relations ,LEADERSHIP ,LEARNING strategies ,MEDICAL quality control ,SCHOLARSHIPS ,TELECONFERENCING ,NARRATIVES ,SOCIAL learning theory ,HUMAN services programs ,ORGANIZATIONAL goals ,EVALUATION of human services programs - Abstract
Rationale, aims and objectives Healthcare professionals need a new skill set to ensure the success of quality improvement in healthcare. The Department of Veterans Affairs (VA) initiated the VA National Quality Scholars fellowship in 1998; its mission is to improve the quality of care, ensure safety, accelerate healthcare re-design, and advance the improvement science by educating the next generation of leaders in quality and safety. We describe the critical need for leadership in quality and safety and interprofessional education, illustrate the curriculum, provide lessons learned by fellows, summarize key lessons learned from the implementation of an interprofessional education approach, and present most recent accomplishments. Methods Narrative review. Results As of 2011, 106 program alumni are embedded in the health care delivery system across the United States. Since 2009, when nurse fellows joined the program, of the first nine graduating interdisciplinary fellows, the tailored curriculum has resulted in five advanced academic degrees, 42 projects, 29 teaching activities, 44 presentations, 36 publications, six grants funded or submitted, and two awards. Conclusions The VA National Quality Scholars program continues to nurture and develop leaders for the new millennium focusing on interprofessional education. The nations' health care systems need strong interdisciplinary leaders in advanced quality improvement science who are dedicated to improving the overall quality of health and health care. [ABSTRACT FROM AUTHOR]
- Published
- 2012
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42. Does self-reported clinical experience predict performance in medical school and internship?
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Artino, Anthony R, Gilliland, William R, Waechter, Donna M, Cruess, David, Calloway, Margaret, and Durning, Steven J
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ANALYSIS of covariance ,CONFIDENCE intervals ,STATISTICAL correlation ,EXPERIENCE ,FACTOR analysis ,INTERNSHIP programs ,MEDICAL schools ,QUESTIONNAIRES ,RESEARCH evaluation ,SELF-evaluation ,STATISTICS ,STUDENTS ,CLINICAL competence ,QUALITATIVE research ,DATA analysis ,PROFESSIONALISM ,SECONDARY analysis ,TEACHING methods ,SCHOOL admission ,PREDICTIVE validity ,MULTITRAIT multimethod techniques ,DATA analysis software ,DESCRIPTIVE statistics ,EDUCATION - Abstract
Medical Education 2012: 46 : 172-178 Context Medical school admissions committees attempt to select the most qualified applicants. In addition to traditional performance measures, committees often look favourably upon applicants who report previous clinical experience. Objectives This study aimed to determine if self-reported clinical experience is a valid indicator of future performance in medical school and internship. Methods We collected data for seven year groups (1993-1999; n = 1112) and operationalised trainee performance in terms of five outcomes: cumulative medical school grade point average (GPA); US Medical Licensing Examination (USMLE) Step 1 and 2 scores, and scores on a validated programme director's evaluation measuring intern expertise and professionalism. We then conducted a series of analyses of covariance to compare outcomes in applicants who self-reported previous clinical experience with outcomes in those who did not. In these analyses, the independent variable was self-reported clinical experience (yes/no), the covariate was undergraduate GPA, and the dependent variables were the five performance outcomes. Results In four of five analyses, we found no differences in the performance of the two groups (clinical experience versus no clinical experience). However, on the cumulative medical school GPA outcome, applicants who reported previous clinical experience had statistically significantly lower cumulative GPAs upon graduation than those who did not report such experience ( F
1,940 = 9.35, p = 0.002, partial η2 = 0.01 [small effect size]). Conclusions Our results suggest that applicants who self-report previous clinical experience may not be better candidates. In fact, on some measures of performance, these applicants may actually perform worse than those who report no clinical experience. [ABSTRACT FROM AUTHOR]- Published
- 2012
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43. Developing a Third-year Emergency Medicine Medical Student Curriculum: A Syllabus of Content.
- Author
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Tews, Matthew C., Wyte, Collette Marie Ditz, Coltman, Marion, Grekin, Peter A., Hiller, Kathy, Oyama, Leslie C., Pandit, Kiran, and Manthey, David E.
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TEACHING aids ,EDUCATIONAL evaluation ,INTERNSHIP programs ,COUNSELING ,CURRICULUM planning ,EMERGENCY medicine ,HOSPITAL emergency services ,HOSPITAL medical staff ,MEDICAL schools ,MEDICAL protocols ,MEDICAL students ,CLINICAL competence ,EDUCATION - Abstract
ACADEMIC EMERGENCY MEDICINE 2011; 18:S36-S40 © 2011 by the Society for Academic Emergency Medicine Abstract Emergency medicine (EM) educators have published several curricular guides designed for medical student rotations and experiences. These guides primarily provided brief overviews of opportunities to incorporate EM into all 4 years of the medical student curriculum, with one specific to the fourth year. However, there are no published guidelines specific to third-year medical students rotating in EM. Given the differences between third-year and fourth-year students in terms of clinical experience, knowledge, and skills, the Clerkship Directors in Emergency Medicine (CDEM) established the Third-year EM Medical Student Curriculum Work Group to create a third-year curriculum. The work group began this process by developing consensus-based recommendations for the content of a third-year medical student EM rotation, which are presented in this syllabus. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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44. Staffing Ratios and Quality: An Analysis of Minimum Direct Care Staffing Requirements for Nursing Homes.
- Author
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Bowblis, John R.
- Subjects
NURSING home employees ,NURSE-patient ratio ,CLINICAL competence ,PRACTICAL nurses ,NURSING care facility laws - Abstract
Objective. To study the impact of minimum direct care staffing (MDCS) requirements on nurse staffing levels, nurse skill mix, and quality. Data Sources. U.S. nursing home facility data from the Online Survey Certification and Reporting (OSCAR) System merged with MDCS requirements. Study Design. Facility-level outcomes of nurse staffing levels, nurse skill mix, and quality measures are regressed on the level of nurse staffing required by MDCS requirements in the prior year and other controls using fixed effect panel regression. Quality measures are care practices, resident outcomes, and regulatory deficiencies. Data Extraction Method. Analysis used all OSCAR surveys from 1999 to 2004, resulting in 17,552 unique facilities with a total of 94,371 survey observations. Principle Findings. The effect of MDCS requirements varied with reliance of the nursing home on Medicaid. Higher MDCS requirements increase nurse staffing levels, while their effect on nurse skill mix depends on the reliance of the nursing home on Medicaid. MDCS have mixed effects on care practices but are generally associated with improved resident outcomes and meeting regulatory standards. Conclusions. MDCS requirements change staffing levels and skill mix, improve certain aspects of quality, but can also lead to use of care practices associated with lower quality. [ABSTRACT FROM AUTHOR]
- Published
- 2011
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45. Rotating Resident Didactics in the Emergency Department: A Cross-sectional Survey on Current Curricular Practices.
- Author
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Branzetti, Jeremy B., Aldeen, Amer Z., and Courtney, D. Mark
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ANALYSIS of variance ,COMPUTER software ,CONFIDENCE intervals ,CURRICULUM ,EMERGENCY medicine ,HEALTH occupations students ,HOSPITAL medical staff ,INTERNSHIP programs ,MEDICAL education ,MEDICAL specialties & specialists ,STUDY & teaching of medicine ,RESEARCH funding ,SURVEYS ,CLINICAL competence ,DATA analysis ,CLASSROOM research ,EDUCATION - Abstract
Objectives: Rotating (non-emergency medicine [EM]) residents perform clinical rotations in many academic emergency departments (EDs). The primary objective of this work was to quantify characteristics of rotating residents and the didactic curricula offered to them during their EM rotations. Secondary objectives were to identify barriers to instituting such didactics and to establish ideal curricular contents. Methods: A Web-based survey was administered by e-mail to residency directors of all U.S. allopathic EM residency programs. Consent was obtained in the first part of the survey, and the study was deemed exempt from full review by the institutional review board. Questions solicited information regarding type and quantity of rotating residents in their main EDs, the 'didactic educational format' available to rotating residents, and ideal and actual didactic curricular contents. Statistics were reported as proportions and means with 95% confidence intervals (CIs) and medians with interquartile ranges (IQRs). Results: Surveys were sent to 143 programs, and the response rate was 71%. Ninety-nine percent of respondents had rotating residents in their EDs, and the median number per month was 4 (IQR = 3-6). Five percent of respondents had established didactic curricula specifically for rotating residents, and 64% sent them to either EM resident or medical student lectures. Thirty-one percent of programs reported no didactics, and 65% of these felt there was no need for such education. Resuscitation, trauma, and toxicology were cited as the most important subjects for actual and ideal curricula. Conclusions: Most academic EDs have rotating residents, but very few provide didactic education specific to their learning needs and almost a third provide no didactics. ACADEMIC EMERGENCY MEDICINE 2010; 17:S49-S53 © 2010 by the Society for Academic Emergency Medicine [ABSTRACT FROM AUTHOR]
- Published
- 2010
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46. Incorporating Evidence-based Medicine into Resident Education: A CORD Survey of Faculty and Resident Expectations.
- Author
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Carpenter, Christopher R., Kane, Bryan G., Carter, Merle, Lucas, Raymond, Wilbur, Lee G., and Graffeo, Charles S.
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ANALYSIS of variance ,COMPARATIVE studies ,CORPORATE culture ,JOURNAL writing ,CURRICULUM ,HOSPITAL medical staff ,INFORMATION storage & retrieval systems ,INTERNSHIP programs ,MEDICAL school faculty ,MEDICAL education ,MEDICAL research ,STUDY & teaching of medicine ,RESEARCH funding ,SURVEYS ,TEACHER attitudes ,CLINICAL competence ,EVIDENCE-based medicine ,TEACHING methods ,EDUCATIONAL attainment ,CLASSROOM research ,EDUCATION - Abstract
Background: The Accreditation Council for Graduate Medical Education (ACGME) invokes evidence-based medicine (EBM) principles through the practice-based learning core competency. The authors hypothesized that among a representative sample of emergency medicine (EM) residency programs, a wide variability in EBM resident training priorities, faculty expertise expectations, and curricula exists. Objectives: The primary objective was to obtain descriptive data regarding EBM practices and expectations from EM physician educators. Our secondary objective was to assess differences in EBM educational priorities among journal club directors compared with non-journal club directors. Methods: A 19-question survey was developed by a group of recognized EBM curriculum innovators and then disseminated to Council of Emergency Medicine Residency Directors (CORD) conference participants, assessing their opinions regarding essential EBM skill sets and EBM curricular expectations for residents and faculty at their home institutions. The survey instrument also identified the degree of interest respondents had in receiving a free monthly EBM journal club curriculum. Results: A total of 157 individuals registered for the conference, and 98 completed the survey. Seventy-seven (77% of respondents) were either residency program directors or assistant/associate program directors. The majority of participants were from university-based programs and in practice at least 5 years. Respondents reported the ability to identify flawed research (45%), apply research findings to patient care (43%), and comprehend research methodology (33%) as the most important resident skill sets. The majority of respondents reported no formal journal club or EBM curricula (75%) and do not utilize structured critical appraisal instruments (71%) when reviewing the literature. While journal club directors believed that resident learners' most important EBM skill is to identify secondary peer-reviewed resources, non-journal club directors identified residents' ability to distinguish significantly flawed research as the key skill to develop. Interest in receiving a free monthly EBM journal club curriculum was widely accepted (89%). Conclusions: Attaining EBM proficiency is an expected outcome of graduate medical education (GME) training, although the specific domains of anticipated expertise differ between faculty and residents. Few respondents currently use a formalized curriculum to guide the development of EBM skill sets. There appears to be a high level of interest in obtaining EBM journal club educational content in a structured format. Measuring the effects of providing journal club curriculum content in conjunction with other EBM interventions may warrant further investigation. ACADEMIC EMERGENCY MEDICINE 2010; 17:S54-S61 © 2010 by the Society for Academic Emergency Medicine [ABSTRACT FROM AUTHOR]
- Published
- 2010
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47. Assessing resident's knowledge and communication skills using four different evaluation tools.
- Author
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Nuovo, Jim, Bertakis, Klea D, and Azari, Rahman
- Subjects
MEDICAL education ,PHYSICIANS ,FAMILY medicine ,MEDICINE - Abstract
Purpose This study assesses the relationship between 4 Accreditation Council for Graduate Medical Education (ACGME) outcome project measures for interpersonal and communication skills and medical knowledge; specifically, monthly performance evaluations, objective structured clinical examinations (OSCEs), the American Board of Family Practice in-training examination (ABFP–ITE) and the Davis observation code (DOC) practice style profiles. Methods Based on previous work, we have DOC scoring for 29 residents from the University of California, Davis Department of Family and Community Medicine. For all these residents we also had the results of monthly performance evaluations, 2 required OSCE exercises, and the results of 3 American Board of Family Medicine (ABFM) ITEs. Data for each of these measures were abstracted for each resident. The Pearson correlation coefficient was used to assess the presence or lack of correlation between each of these evaluation methods. Results There is little correlation between various evaluation methods used to assess medical knowledge, and there is also little correlation between various evaluation methods used to assess communication skills. Conclusion The outcome project remains a ‘work in progress’, with the need for larger studies to assess the value of different assessment measures of resident competence. It is unlikely that DOC will become a useful evaluation tool. [ABSTRACT FROM AUTHOR]
- Published
- 2006
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48. The use of standardised patients to assess clinical competence: does practice make perfect?
- Author
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Stimmel, Barry, Cohen, Devra, Fallar, Robert, and Smith, Lawrence
- Subjects
PATIENTS ,LICENSES ,MEDICAL schools ,MEDICAL education ,MEDICAL care - Abstract
Context The use of standardised patients (SPs) is now an integral component of the United States Medical Licensing Examination (USMLE). This new requirement has caused more schools to include SP examinations (SPEs) in their curricula. This study reviews the effect of prior experience with SPs in a medical school curriculum on SPE pass rates. Methods This study reviewed the mean scores and pass rates on a 4-station SPE, comparing the performance of 121 US medical school graduates (USMGs) with that of 228 international medical graduates (IMGs). The analysis of USMGs' performance was based upon whether the resident had had previous exposure to an SPE during medical school, while the analysis of IMGs' performance was based upon whether the IMG had taken the Clinical Skills Assessment (CSA) for certification by the Education Commission for Foreign Medical Graduates. A distinction was made between those who had received prior exposure at Mount Sinai School of Medicine's Morchand Center, where the cases utilised were identical to those of the SPE, and those who had gained exposure elsewhere. Results Neither the mean scores of the IMGs and the USMGs nor the percentage who failed was significantly different relative to prior exposure to SPs. Conclusion Prior exposure to SPs does not appear to have a positive effect on subsequent performance on an SPE unless similar or identical cases are used. However, the type and site of prior exposure limited the influence of the review. In view of the increased use of SPEs in medical schools, the content of prior exposure needs to be more fully established. [ABSTRACT FROM AUTHOR]
- Published
- 2006
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49. Quality of cardiac surgeons and managed care contracting practices.
- Author
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Mukamel, Dana B, Weimer, David L, Zwanziger, Jack, and Mushlin, Alvin I
- Subjects
MANAGED care programs ,SURGEONS ,MANAGED care plan statistics ,THORACIC surgery ,CLINICAL competence ,CLINICAL medicine ,COMMUNICATION ,COMPARATIVE studies ,CONTRACTING out ,CORONARY artery bypass ,MANAGEMENT ,RESEARCH methodology ,MEDICAL care research ,MEDICAL cooperation ,PROBABILITY theory ,RESEARCH ,EVALUATION research ,KEY performance indicators (Management) - Abstract
Objective: To evaluate the association between contracting practices of managed care organizations (MCOs) with cardiac surgeons and the quality of the cardiac surgeons.Data Sources/study Setting: The study included all cardiac surgeons offering coronary artery bypass graft (CABG) surgery and 78 percent of MCOs in New York State in 1998. Primary data: The MCOs' panel composition with respect to hospitals and cardiac surgeons. Secondary data: New York State (NYS) Cardiac Surgery Reports.Study Design: Statistical analyses of the probability of a contract between cardiac surgeons and MCOs conditional on the surgeon's risk-adjusted mortality rates (RAMR), outlier and low volume status, and controlling for other confounding variables, were performed.Principal Findings: Contract probability exhibited a tendency to decrease with RAMR, low volume and low-quality outlier status and to increase with high-quality outlier status. These effects were statistically significant for RAMR and high-quality outliers in Downstate and for low volume in Downstate and Upstate.Conclusions: In some, but not all cases, MCOs are seeking higher-quality providers. Further research is required to understand regional variability and the effect of market structure on the quality profile of MCOs. [ABSTRACT FROM AUTHOR]- Published
- 2002
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50. Understanding team-based quality improvement for depression in primary care.
- Author
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Rubenstein, Lisa V., Parker, Louise E., Meredith, Lisa S., Altschuler, Andrea, DePillis, Emmeline, Hernandez, John, and Gordon, Nancy P.
- Subjects
MENTAL health services ,MENTAL depression ,PRIMARY care ,THERAPEUTICS ,CLINICAL competence ,HEALTH care teams ,MEDICAL quality control ,PRIMARY health care ,QUALITY assurance ,QUALITY circles ,RESEARCH funding - Abstract
Objective: To assess the impacts of the characteristics of quality improvement (QI) teams and their environments on team success in designing and implementing high quality, enduring depression care improvement programs in primary care (PC) practices.Study Setting/data Sources: Two nonprofit managed care organizations sponsored five QI teams tasked with improving care for depression in large PC practices. Data on characteristics of the teams and their environments is from observer process notes, national expert ratings, administrative data, and interviews.Study Design: Comparative formative evaluation of the quality and duration of implementation of the depression improvement programs developed by Central Teams (CTs) emphasizing expert design and Local Teams (LTs) emphasizing participatory local clinician design, and of the effects of additional team and environmental factors on each type of team. Both types of teams depended upon local clinicians for implementation.Principal Findings: The CT intervention program designs were more evidence-based than those of LTs. Expert team leadership, support from local practice management, and support from local mental health specialists strongly influenced the development of successful team programs. The CTs and LTs were equally successful when these conditions could be met, but CTs were more successful than LTs in less supportive environments.Conclusions: The LT approach to QI for depression requires high local support and expertise from primary care and mental health clinicians. The CT approach is more likely to succeed than the LT approach when local practice conditions are not optimal. [ABSTRACT FROM AUTHOR]- Published
- 2002
- Full Text
- View/download PDF
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