Advances in health sciences education : theory and practice
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Adv Health Sci Educ Theory Pract · Aug 2010
Comparative StudyDeveloping clinical competency in crisis event management: an integrated simulation problem-based learning activity.
This study aimed to evaluate the integration of a simulation based learning activity on nursing students' clinical crisis management performance in a problem-based learning (PBL) curriculum. It was hypothesized that the clinical performance of first year nursing students who participated in a simulated learning activity during the PBL session would be superior to those who completed the conventional problem-based session. The students were allocated into either simulation with problem-based discussion (SPBD) or problem-based discussion (PBD) for scenarios on respiratory and cardiac distress. ⋯ Their clinical performances were scored using a checklist. Mean test scores for students completing the SPBD were significantly higher than those who completing the PBD for both the first post test (SPBD 20.08, PBD 18.19) and second post test (SPBD 27.56, PBD 23.07). Incorporation of simulation learning activities into problem-based discussion appeared to be an effective educational strategy for teaching nursing students to assess and manage crisis events.
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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.
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Adv Health Sci Educ Theory Pract · Mar 2010
Multicenter StudyTwo models of raters in a structured oral examination: does it make a difference?
Oral examinations have become more standardized over recent years. Traditionally a small number of raters were used for this type of examination. Past studies suggested that more raters should improve reliability. ⋯ Reliability was higher for the candidate-specific raters. Inter-rater reliability, internal consistency and a study of station inter-correlations suggested that a halo effect may be present for candidates examined by candidate-specific raters. This study suggests that although the model of candidate-specific raters was more reliable than the model of station-specific raters for the overall examination, the presence of a halo effect may influence individual examination outcomes.
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Adv Health Sci Educ Theory Pract · Mar 2010
Increased authenticity in practical assessment using emergency case OSCE stations.
In case of an emergency, a fast and structured patient management is crucial for patient's outcome. The competencies needed should be acquired and assessed during medical education. The objective structured clinical examination (OSCE) is a valid and reliable assessment format to evaluate practical skills. ⋯ They rated ECOS to be more realistic in comparison to the traditional OSCE scenarios. The reliability estimated via Crohnbach's alpha for the 6 ECOS is high (0.793). ECOS offer a feasible alternative to the traditional OSCE stations with adequate reliability to assess students' capabilities to cope with an acute emergency in a realistic encounter.