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Biomedical subjects

B Templeton

Publications and source records attributed to B Templeton.

At least 19 recordsLinked to original sources
PubMed1996

USMLE (United States medical licensing examination) step 1 examination. Legal vulnerability.

Since the passage of the Civil Rights Act of 1964, the courts have ruled that sponsors of job entry assessment procedures must demonstrate the absence of discrimination against minorities. If an assessment discriminates, the courts may prohibit the use of the assessment unless the assessment is linked to a job analysis and exhibits validity. In 1994, the Federation of State Medical Boards (FSMB) and the National Board of Medical Examiners (NBME) instituted a three-step USMLE examination program as a single pathway for medical licensure. The Step 1 examination is not linked to a physician job analysis, exhibits lower scores for minority groups, and lacks construct validity. To avoid the chaos and expense of a protracted legal challenge, the FSMB and the NBME may need to revise the Step 1 examination, or discontinue it as a requirement of medical licensure.

Civil Rights↗
PubMed1995

Stability of standardized patients' performance in a study of clinical decision making.

BACKGROUND: Standardized patients (SPs) have been used extensively in teaching, but their reliability for use in research has been infrequently addressed. This study analyzes the reliability of performance of 13 SPs during 228 doctor-patient encounters in a year-long study related to the diagnosis of depression. METHODS: Patient scenarios were based on real patient cases. Four of the five cases had major depressive disorder. Two to three SPs were coached to enact each of the five case scenarios. Medical encounters were videotaped. Interview content was extracted onto a standardized checklist. Interaction between physician and patient was measured by the Interactional System for Interview Evaluation. Tests of SP performance reliability included the: 1) consistency of symptoms volunteered, 2) stability of affect and behavior, and 3) association of SP performance to detection of depression. RESULTS: The mean number of SP performances was 20.8 (SD = 5.8), with a range of 6 to 28. Problems with reliability emerged in one of the five patient cases. Results otherwise revealed high intra-performance and inter-performance reliabilities. Detection of depression was consistent across SPs and with the rates reported in the literature. CONCLUSIONS: This study provides evidence that performances, within and among SPs, remained consistent, even when intervals between performances were as long as 3 months.

Adult↗
PubMed1994

Psychosocial interest, medical interviews, and the recognition of depression.

OBJECTIVES: To measure primary care physicians' attitudes toward psychosocial issues, determine their relationship to the style of the medical interview, and assess whether attitudes and interview behaviors lead to correct diagnosis in patients with depression. DESIGN: Physicians were videotaped while interviewing four patients standardized with criteria symptoms of major depression. Physicians were unaware of the mental health focus of the study. SETTING: Patient examining rooms. PARTICIPANTS: Physicians were eligible for recruitment if they were board certified or eligible in family practice or internal medicine, practiced primary care medicine, and were listed in regional directories. Standardized patients were recruited from the community. MAIN OUTCOME MEASURES: Attitudes toward psychosocial issues (measured by the Physician Belief Scale), interview content (measured by review of the videotaped encounters), interview behaviors (measured by the Interaction Analysis System for Interview Evaluation), and a listing of depression in the differential diagnosis (determined by physician debriefing interviews). RESULTS: Forty-seven community-based practitioners participated. Forty-eight percent of interviews resulted in a diagnosis of depression. Physician Belief Scale scores were not significantly correlated with patient-centered interviewing, psychosocial questions, inquiry about depression symptoms, or a depression diagnosis. Longer interviews were more likely to result in a depression diagnosis. CONCLUSIONS: High interest in psychosocial issues was not associated with patient-centered interviewing behaviors, questions about psychosocial or depression symptoms, or depression diagnoses. However, certain patient-centered interviewing behaviors, particularly those defined as "affective," did lead to the recognition of depression.

Adult↗
PubMed1994

Evaluating consultation psychiatry residents.

The overall goal of this report is to provide a list of recommendations to consultation-liaison (C-L) unit chiefs for the evaluation of psychiatric residents in conjunction with the latters' assignments to the C-L service. Following a fairly extensive review of references on evaluation, the authors developed 13 recommendations: written examination materials; development of problem-solving assessment techniques; Case Presentation Inventory; and peer assessment and other nontraditional sources of performance ratings. The authors emphasize the need for direct observation of resident performance, and the problem of achieving good interrater reliability when using subjective ratings of resident performance.

Clinical Competence↗
PubMed1990

Evidence of the role of psychosocial factors in diabetes mellitus: a review.

Diabetes mellitus is a very prevalent illness that produces a variety of stresses for the individual patient, but the role of psychosocial factors in this illness is frequently minimized in the teaching of physicians and the care of patients. The authors review a framework for evaluating the role of psychosocial issues in illness in general and examine the evidence that demonstrates the importance of these issues in diabetes.

Adaptation, Psychological↗
PubMed1990

Facial augmentation with Proplast and nonporous hydroxylapatite in rhesus monkeys.

Using an extra-oral approach, subperiosteal pockets were created bilaterally over zygomatic and mandibular areas in six Rhesus monkeys. One side of each anatomic site received a Proplast I implant and the contralateral a nonporous hydroxylapatite (NPHA) block. Two animals were killed postoperatively at 3, 6, and 12 months, and the implants retrieved en bloc for histologic evaluation. Clinical evaluation showed the Proplast implants more stable than NPHA implants. Histologic evaluation for Proplast implants demonstrated complete encapsulation, fibrous tissue infiltration, fragmentation of implants, and some giant cell reaction. The NPHA implants were completely encapsulated with fibrous tissues, and no giant cell response, fragmentation, biodegradation, or bone formation was observed. We concluded that the Proplast was more stable than NPHA implants, but the NPHA produced less inflammatory cell and giant cell reaction.

Animals↗
PubMed1987

Exercise training reduces depression and increases the performance of pleasant activities in hemodialysis patients.

This study compares the effects of a structured exercise training program to the therapeutic benefits of a 'support' group on the depressed mood and reduced performance of pleasant activities by hemodialysis patients. After 6 months of an aerobic exercise training program, the 10 exercisers showed a significant increase in maximal aerobic capacity (VO2max) and a significant decrease in dysphoric mood when compared to 7 patients attending the support group. Support group participants reported a significant decrease in pleasant activities while there was no change in the exercisers. Eighteen months after the exercise training program, the exercisers reported continued low levels of depressed mood, and were performing significantly more pleasant activities than they reported prior to the exercise program. The results of this study suggest an exercise training program may be useful in the psychosocial rehabilitation of some hemodialysis patients.

Activities of Daily Living↗
PubMed1986

Item modelling procedure for constructing content-equivalent multiple choice questions.

Recent research on multiple choice questions has identified deficiencies of inadequate content-equivalence and item-writer bias. Systematic methods of writing multiple choice questions are being advocated as effective responses. This article describes preliminary development of a new item-writing method. Details of the procedure, called item modelling, are provided.

Education, Medical↗
PubMed1980

The relationship of pediatric resident recording behavior across medical conditions.

During the July 1975-June 1976 academic year, nonphysician abstractors collected data on 15,101 ambulatory patient visits managed by 175 residents in five pediatric training programs. The visits included in this study were those on which a general data base should be collected and visits for health maintenance, head trauma, impetigo, otitis media, tonsillopharyngitis and urinary tract infection. These data provided an opportunity to investigate the number of medical record audits required to obtain a stable estimate of resident performance for a given medical condition and the relationship of performance across a number of medical conditions. The standard errors of the mean for 844 distributions of per cent compliance scores for individual residents were calculated. The standard error was less than five in 97 per cent of the instances where ten or more records had been abstracted for a given resident. Although there was some variability of resident performance from case to case, these data indicate that ten records may be a lower bound on the number of abstracts required to provide a stable estimate of performance. The correlations across conditions showed a moderate amount of homogeneity of performance and a clustering of performance for the acute care conditions included in the study. The correlations across acute care conditions were all statistically significant and ranged in magnitude from .52 to .77. Although the relationships between general data base and health maintenance and the acute conditions were statistically significant in some instances, they were all of lower magnitude and ranged from -.20 to .36. Thus, a modest number of abstracts for only a few conditions may provide a reliable estimate of resident day-to-day performance in ambulatory care clinics.

Ambulatory Care↗
PubMed1977

Development of a medical record audit for continuing medical education.

A self-instructional audit package for the identification and management of hypertensive patients was developed. The materials were field tested in the clinics of seven institutions to assess their clarity and collect data to illustrate the usefulness of an audit as an educational tool.

Ambulatory Care↗