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Biomedical subjects

E R Petrusa

Publications and source records attributed to E R Petrusa.

8 recordsLinked to original sources
PubMed1991

Standardized patient encounters. A method for teaching and evaluation.

The primary goal of medical education is to foster development of clinical competence in trainees at all levels. Variable clinical experience, inconsistent methods of instruction, and ambiguous evaluation criteria undermine this goal. Standardized patients, trained to consistently portray a wide variety of clinical cases, can help overcome many of these educational problems. This article describes the development and application of standardized patients throughout medical training at The University of Texas Medical Branch, Galveston, in the freshman interviewing course, the second-year physical diagnosis course, third-year clerkships, a fourth-year final exercise, and residency training. Development of this program is discussed in the context of a broader literature in medical education, and investigation of variables affecting standardized patient and student performance is reported. Future directions for use of standardized patients in monitoring and promoting the development of clinical competence are discussed.

Clinical Competence↗
PubMed1990

Reliability and validity of an objective structured clinical examination for assessing the clinical performance of residents.

Clinical performance of residents should be assessed as reliably and validly as possible. This study investigated the reliability and validity of an objective structured clinical examination (OSCE) for assessing clinical performance of internal medicine residents. Residents were required to take a 17-patient OSCE in their first and second year. Reliability of the OSCE was 0.40. Validity studies indicated second-year students were significantly better than third-year students for five of six OSCE skill scores; first-year students were significantly better for three scores. Resident's scores for diagnosis, plan, and total significantly increased on their second OSCE. Generally faculty overall ratings of residents' clinical performance did not correlate with OSCE scores. American Board of Internal Medicine certifying examination scores were consistently positively correlated only with diagnosis. This 17-case OSCE is a feasible method for obtaining moderately reliable, valid data not available from other sources about the clinical performance of residents. More cases should be added to increase its reliability.

Clinical Competence↗
PubMed1988

Improving compliance with preventive medicine procedures in a house staff training program.

Performance of health maintenance procedures by internal medicine house staff is inadequate, yet little has been published outlining means to improve performance rates. We prospectively studied the effectiveness of a reminder system to improve screening by Pap smear, rectal examination with stool guaiac test, breast examination, and pneumococcal vaccine administration in two resident outpatient clinics. Performance of these preventive health measures was determined during a six-week baseline period and again after five months of chart reminders to residents in one clinic, and after six months without reminders. For the intervention, a physician's assistant screened each chart and attached a reminder to the front indicating which procedures were overdue based on published recommendations. Health screening behavior was not significantly different between the two resident clinics during baseline. After the five-month reminder intervention, residents in both groups moderately increased their preventive health activities over baseline; however, only the reminded group showed significant improvement (chi 2 = 11.60, P less than .001). Six months after remainders were discontinued there was no difference in overall performance between the two clinics (chi 2 = 2.79, NS). The reminded group did preserve its significant improvement over the baseline phase (chi 2 = 6.12, P less than .01). This simple reminder system had a modest but statistically significant positive impact on health screening behavior. Despite this improvement, absolute rates of screening remained below 50% in both clinics.

Attitude of Health Personnel↗
PubMed1987

An objective measure of clinical performance.

Studies repeatedly have shown the clinical performance of students and residents to be less than expected by faculty. Because evaluation methods substantially influence education, poor performance can be improved with better clinical evaluation methods. This study evaluated a standardized method to measure clinical performance in which trained actual and simulated patients were organized in a multiple-station format for efficient testing of examinees on 17 cases in less than four hours. Specific checklists completed by patients and predetermined scoring protocols yielded reliable data and reduced faculty time. Data from 204 students in three clerkships were consistent with previous research showing case specificity and substantial case-to-case variability. As a group however, the students' overall total scores were very similar. This suggests that clinical education is inconsistent and that a profile of an examinee's performance is more accurate than a single overall score. Validity of this standardized clinical examination was supported by significant but moderate correlations with faculty ratings of ward performance and the medicine subtest of the National Board of Medical Examiners test, part II. Direct per-student costs were $21.00. This standardized objective examination of clinical skills is feasible for use in training programs and will provide reliable and valid data on clinical performance not available through typical methods.

Clinical Competence↗
PubMed1985

A comparative evaluation of text formats in a medical school course.

Information mapping, a system of instruction design for categorizing, sequencing and graphically presenting printed information for highly technical communication in business, seemed ideally suited for presenting the technical procedures of the general screening physical examination to medical students. To evaluate the impact of this new text format one half of the class received a conventional text for those procedures and the other half used an information mapped text. Cognitive test scores were not significantly different. However, the information mapped text was rated significantly more favorably on six dimensions. Students using the mapped text also spent significantly more time studying it than those using the conventional text.

Books↗