Medical teacher
-
Editorial Comment Review
Competency-based assessment: making it a reality.
-
Randomized Controlled Trial Comparative Study Clinical Trial
A feasibility study comparing checklists and global rating forms to assess resident performance in clinical skills.
This study evaluated the feasibility of two different scoring forms for assessing the clinical performance of residents in anaesthesiology. One of the forms had a checklist format including task-specific items and the other was a global rating form with general dimensions of competence including 'clinical skills', 'communication skills' and 'knowledge'. Thirty-two clinicians representing 25 (83%) of the 30 training hospitals in the country participated in the study. ⋯ The checklist format was rated significantly higher compared with the global rating form (mean 4.6, 0.5 vs. mean 3.5, 1.4, p < 0.001). The inter-rater agreement regarding pass/fail decisions was poor irrespective of the scoring form used. This was explained by clinicians' leniency as assessors rather than by lack of vigilance in the observations or disagreements on standards for good performance.
-
Many medical students wish to begin developing clinical teaching skills before residency. Faculty at the University of California, Irvine developed a 60-hour, longitudinal 'service elective' in teaching skills, which 50 third-year and fourth-year students have completed since 2001. ⋯ Participating students gave the elective a mean rating of 5.24 on a seven-point Likert-type scale, which fell between 'very good' (5) and 'excellent' (6). Narrative comments showed that students believed the elective--and in particular the OSTE training--prepared them well for teaching as residents.
-
Comparative Study
Clinical reasoning: the relative contribution of identification, interpretation and hypothesis errors to misdiagnosis.
The aim of this study was to identify and describe the types of errors in clinical reasoning that contribute to poor diagnostic performance at different levels of medical training and experience. Three cohorts of subjects, second- and fourth- (final) year medical students and a group of general practitioners, completed a set of clinical reasoning problems. The responses of those whose scores fell below the 25th centile were analysed to establish the stage of the clinical reasoning process--identification of relevant information, interpretation or hypothesis generation--at which most errors occurred and whether this was dependent on problem difficulty and level of medical experience. ⋯ Furthermore, although hypothesis errors increased in line with problem difficulty, identification and interpretation errors decreased. A possible explanation is that as problem difficulty increases, subjects at all levels of expertise are less able to differentiate between relevant and irrelevant clinical features and so give equal consideration to all information contained within a case. It is concluded that the development of clinical reasoning in medical students throughout the course of their pre-clinical and clinical education may be enhanced by both an analysis of the clinical reasoning process and a specific focus on each of the stages at which errors commonly occur.
-
As the healthcare system continues to change, healthcare professionals will need to assume an increasing number of administrative and management responsibilities. The goal of this article is to describe a two-day workshop on Executive Skills for Medical Faculty and the results of an evaluation conducted one year later. This workshop consisted of specific modules on analyzing time-management skills, determining goals and priorities, improving time-management strategies, assessing leadership styles and skills, and conducting effective meetings. ⋯ Both the immediate and delayed workshop evaluations indicated that the most useful sessions were those devoted to determining goals and priorities, time management and effective meetings. These results suggest that a two-day workshop can improve health care professionals' administrative and management skills in certain areas. A longer workshop and built-in 'follow-up' activities would enhance the potential for change.