Advances in health sciences education : theory and practice
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Adv Health Sci Educ Theory Pract · May 2010
ReviewOral assessment and postgraduate medical examinations: establishing conditions for validity, reliability and fairness.
The purpose of this review was to examine the practice of oral assessment in postgraduate medical education in the context of the core assessment constructs of validity, reliability and fairness. Although oral assessment has a long history in the certification process of medical specialists and is a well-established part of such proceedings for a wide range of specialties in most countries, there remains concern regarding its use. ⋯ Supporting high quality published research into examination practices and outcomes and acting on the findings of such research is needed urgently to allay concerns about the transparency and fairness of these examinations, especially when assessing international medical graduates. The article concludes by proposing 15 conditions under which oral assessment is valid, reliable and fair.
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Adv Health Sci Educ Theory Pract · May 2010
Cognitive elements in clinical decision-making: toward a cognitive model for medical education and understanding clinical reasoning.
Physician cognition, metacognition and affect may have an impact upon the quality of clinical reasoning. The purpose of this study was to examine the relationship between measures of physician metacognition and affect and patient outcomes in obstetric practice. Reflective coping (RC), proactive coping, need for cognition (NFC), tolerance for ambiguity, state-trait anxiety and metacognitive awareness were assessed for obstetricians (n = 12) who provided intra-partum care to 4,149 women. ⋯ Obstetricians high in trait anxiety were more likely to perform a mid forceps delivery (OR 2.49, p = 0.01) or a vacuum delivery (OR 5.08, p = 0.003), and less likely to supervise a spontaneous vaginal delivery (OR 0.38, p < 0.0001). NFC was negatively associated (OR 0.10, p < 0.001) and trait anxiety was positively associated with intrapartum asphyxia (p < 0.05, rho = 0.582). In summary, physician cognitive processes and affect have a significant impact on patient outcomes, particularly in situations where there is a higher level of clinical unpredictability.