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Biomedical subjects

G Bordage

Publications and source records attributed to G Bordage.

At least 37 records · Page 2Linked to original sources
PubMed1995

Physician-assessment and physician-enhancement programs in Canada.

Since the mid-1980s, the licensing authorities in Quebec, Ontario and Manitoba have introduced programs to conduct in-depth assessments of the clinical skills and abilities of physicians with suspected deficiencies. These assessments are intended to supplement the provincial licensing authorities' existing peer review or patient-complaint mechanisms by confirming the physicians' overall level of competence and identifying specific clinical strengths and weaknesses. An "educational prescription," based on the results of the assessment, focuses on aspects of clinical practice in which the physicians need or wish to enhance their skills. In some situations, licensure decisions are based on the assessment information. This article describes the programs in Quebec, Ontario and Manitoba. Each program comprises a different process of personal assessment and individualized continuing medical education to help physicians improve their clinical competence, and each is built on sound principles of clinical-competence assessment and educational planning.

Clinical Competence↗
PubMed1995

Where are the history and the physical?

In clinical practice, the history and physical examination are being superseded by laboratory tests and biomedical technology. The author discusses the importance of the clinical examination as the basis for clinical reasoning and of direct observation of students at the patients' bedside in order to assess their diagnostic reasoning. Greater attention to the clinical examination would lead not only to improved clinical skills but also to more cost-effective use of ancillary investigations and, moreover, to a better understanding of the patient by the physician.

Humans↗
PubMed1995

The Medical Council of Canada's key features project: a more valid written examination of clinical decision-making skills.

In 1986 the Medical Council of Canada (MCC) commissioned a six-year research and development project to create a new, more valid written examination of clinical decision-making skills for the Canadian Qualifying Examination in Medicine. At that time, the qualifying examination consisted of three booklets of multiple-choice questions and one booklet of patient management problems administered over a two-day period. All graduates of Canadian and foreign medical schools must pass this examination before practicing medicine anywhere in Canada except Québec. The project was undertaken because (1) numerous studies do not support the use of patient management problems (PMPs) to assess clinical decision-making skills, and (2) research results on the characteristics of clinical decision-making skills offered guidance to develop new approaches to their assessment. In particular, research suggested that these skills are specific to the case or problem encountered and are contingent on the effective manipulation of a few elements of the problem that are crucial to its successful resolution--the problem's key features. The problems developed by this project focused only on the assessment of these key features. The project was implemented in three overlapping phases over a six-year period, 1986-1992, each containing a development component followed by a pilot test through which the research studies were carried out. The pilot tests were conducted by presenting sets of new key feature problems to classes of graduating students in medical schools across Canada.(ABSTRACT TRUNCATED AT 250 WORDS)

Canada↗
PubMed1995

Developing key-feature problems and examinations to assess clinical decision-making skills.

This article introduces the concept of a key feature and describes its function as the cornerstone of key-feature problems, a new problem format for the written assessment of clinical decision-making skills of medical trainees and practitioners. The rationale for using this problem format and the steps in problem and examination development--including issues of scoring and standard setting--are described. A key feature is defined as a critical step in the resolution of a clinical problem, and a key-feature problem consists of a clinical case scenario followed by questions that focus on only those critical steps. The questions can be presented to require examinees either to write in their responses or to select them from a list of options. For each question, examines can be instructed to supply or select whatever number of responses is appropriate to the clinical task being tested, and answer keys can comprise one or several responses. This problem format, with its focus on only the critical steps in problem resolution, and with its flexibility in question format and scoring keys, effectively addresses the psychometric considerations of content validity and test score reliability, and accommodates the complexity and configurations of actions often required in the resolution of clinical problems.

Clinical Competence↗
PubMed1995

Content validation of key features on a national examination of clinical decision-making skills.

Key features (KFs) represent the critical, or essential, steps in the identification and management of a clinical problem. KFs for 59 clinical problems were defined by members of a test committee for the Medical Council of Canada as part of their efforts to create a more valid written examination of clinical decision-making skills for the Canadian Qualifying Examination in Medicine. In order to evaluate the content validity of KFs that the test committee had defined for the examination, 99 physicians from outside the committee, who came from clerkship programs at all 16 of Canada's medical schools, participated in three studies conducted in 1991. The first study was retrospective and was designed to find the degree of agreement or disagreement that the outside physicians had with the KFs already defined for each problem by the committee members. The second study was prospective and was to compare the KFs generated de novo by the participants with those already defined by the committee members. The third study was to gather the outside physicians' opinions of the frequencies with which graduating students in Canada are exposed to the 59 problems used in the retrospective and prospective studies. Almost all the KFs defined by the test committee were corroborated by the outside physicians, 92% in the retrospective study and 94% in the prospective one.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Comparing times and performances of French- and English-speaking candidates taking a national examination of clinical decision-making skills.

French-speaking candidates taking the translated version of the Medical Council of Canada's (MCC's) Qualifying Examination in Medicine often complain that poor performance could be due to translation defects. The purposes of this 1991 study were to determine (1) whether French-speaking candidates spend the same time as do English-speaking candidates in answering the questions in the fourth and last booklet of Part 1 of the MCC's Qualifying Exam, and (2) for items where the French-speaking candidates have more difficulty, whether these differences are within normal limits, and if not, could they be attributed to faults in the translation? Two versions of the fourth booklet, one in English and the other a translation into French, were administered to 229 randomly selected candidates (98 French speakers and 131 English speakers). The booklets contained 19 clinical problems and a total of 44 key features; performance was measured by the number of key features the examinees correctly responded to. (Key features are the critical or essential steps needed to resolve a clinical problem.) The French text was 16% longer, and the French candidates took longer to complete the two-hour examination (a mean of 116.31 minutes versus 107.84 minutes for the English speakers, p = .000). However, there was no direct relationship between the time spent on a section of the examination and the number of words it contained. The French candidates' overall scores did not differ from those of the English candidates (59.76% versus 61.33%, p = .11).(ABSTRACT TRUNCATED AT 250 WORDS)

Canada↗
PubMed1995

Structured oral interview. One way to identify family physicians' educational needs.

OBJECTIVE: To design and test a structured oral interview that would elicit information on the educational needs of physicians in order to help them plan individualized continuing education. DESIGN: Seven different sets of problems were prepared, each including 40 cases, of which 26 are common. Each pilot test candidate was interviewed by two physician-interviewers during a 1-day session. After each answer, candidates were told the predetermined correct answer. PARTICIPANTS: Six candidates were selected at random from among Montreal physicians aged 50 and older with no hospital privileges. All had to have no history of professional complaints or prosecution and to be unknown to the interviewers. MAIN OUTCOME MEASURES: Inter-rater reliability and perceived difficulty of the cases. RESULTS: Candidates rated the interview process and cases used pertinent, credible, and not too difficult. Candidates' performance level was about 50%. Agreement between interviewers averaged 91.2%. CONCLUSIONS: A structured oral interview appears to be a credible instrument for helping determine practising physicians' deficiencies in clinical knowledge and reasoning.

Curriculum↗
PubMed1994

Hypopituitarism with invisible pituitary stalk: two case reports of males with micropenis suggesting fetal onset of hypopituitarism.

The presence of hypopituitarism and invisible pituitary stalk on a magnetic resonance image (MRI) is commonly attributed to birth trauma. Two patients with severe hypopituitarism and invisible pituitary stalk are presented. One was born by breech delivery, the other by Cesarean section. The presence of a micropenis since early infancy in these two patients suggested that their hypopituitarism might have begun during early fetal life thus effecting penile growth during the second and third triministers of gestation. These findings raise the possibility that the association of hypopituitarism and invisible pituitary stalk may have multiple etiologies including hormonal abnormalities during early fetal life.

Adolescent↗
PubMed1993

Taxonomy of difficulties in general practice.

A questionnaire combining qualitative and quantitative methods was used to compile a taxonomy of the difficulties experienced by general practitioners in their practices. Difficulties are grouped in 11 categories, ranging from clinical diagnosis to physicians' personal feelings. The taxonomy can be used as a guide for planning medical education or as a starting point for further research in general practice.

Attitude of Health Personnel↗
PubMed1992

Nature of the clinical difficulties of first-year family medicine residents under direct observation.

OBJECTIVE: To determine and classify the difficulties of first-year family medicine residents observed during clinical interviews. DESIGN: Retrospective, descriptive study. SETTING: Family practice unit at a teaching hospital. PARTICIPANTS: Forty-seven of the 56 first-year family medicine residents during their 2-month compulsory rotation in ambulatory family medicine, between July 1983 and December 1988, and 4 physicians who supervised the residents. MAIN OUTCOME MEASURE: The residents' difficulties noted on the observation forms. MAIN RESULTS: A total of 1500 difficulties were observed during 194 interviews, an average of 7.7 (standard deviation 5.2) per interview. There were 167 different difficulties, which were classified into seven categories (introduction, initial contract, body of the interview, techniques and organization, interpersonal aspects, final contract and miscellaneous) and 20 subcategories. The 17 most frequently noted difficulties accounted for 40% of the total. CONCLUSIONS: The results constitute a useful starting point for developing a classification of residents' difficulties during clinical interviews. We believe that the list of difficulties is applicable to residents at all levels and in other specialties, especially in ambulatory settings. The list can be used to develop learning materials for supervisors and residents.

Clinical Competence↗
PubMed1990

Why are clinical problems difficult? General practitioners' opinions concerning 24 clinical problems.

This study was conducted to describe the difficulties perceived by general practitioners concerning 24 common clinical problems and to compare their perceptions with those of faculty members in family medicine. A random sample of 467 general practitioners and all 182 faculty members in family medicine in Quebec were sent one of four open-ended questionnaires, each of which dealt with six clinical problems; 214 general practitioners and 114 faculty members participated. A total of 5111 difficulties were reported; the number reported by each subject varied from 0 to 13 (mean 2.6 [standard deviation 2.09]) per problem. The problems that generated the most difficulties were depression, confusion in the elderly, chronic back pain, loss of autonomy in the elderly and sexually transmitted disease. The most frequent difficulties were with the patient's noncompliance with treatment, clinical diagnosis, failure of a specific treatment, inadequate health care resources and the physician's own emotional reactions. The difficulties for each problem were the same in the two groups 70% of the time. Physician's perceptions of their difficulties can be useful in the planning of initial training and continuing medical education.

Adult↗
PubMed1990

Quantitative assessment of diagnostic ability.

This paper describes variables critical to diagnostic thinking that are based on research by Bordage and Grant & Marsden on the diagnostic thinking of medical students and experienced doctors. The purpose of the study is to use their findings to develop an inventory of diagnostic thinking. A 56-item diagnostic thinking inventory was initially developed; each item contains a stem followed by a 6-point, semantic differential scale. The inventory is designed to measure two aspects of diagnostic thinking: the degree of flexibility in thinking and the degree of knowledge structure in memory. The specific goal of the study is to determine which items discriminate best between weaker and stronger diagnosticians and to reduce the inventory to only those items which significantly contribute to the overall score. Thirty subjects from nine groups, each representing a distinct phase of medical education and clinical practice, participated, namely first- and third-year clinical medical students, house officers, senior house officers, registrars, senior registrars, consultants, trainees in general practice, and general practitioners, all from the UK (n = 270). Discrimination indices were calculated for each item. The revised version of the inventory contains 41 items. All the subjects found the exercise meaningful and the resulting scores showed variance and discrimination. The inventory will eventually be used to assess individual student's and clinician's diagnostic thinking and to plan ways of improving their diagnostic thinking.

Clinical Competence↗
PubMed1987

The curriculum: overloaded and too general?

Two educational implications of the prototype view of categorization of medical disorders in the long-term memory of medical students are tested: first, that categories are better learned when the initial exposure is through representative exemplars, the prototypes as opposed to the whole range of instances; second, that concepts are initially learned at an intermediate level of abstraction (e.g. angina pectoris), corresponding to the prototypes, as opposed to more general levels (e.g. coronary disorders). In a group of third-year medical students (n = 42) taken from a previous study, the recall frequencies of undergraduate course materials in eight system courses are inversely related to the number of disorders presented, r(6) = -0.58, P = 0.06. The recall frequencies are highest for courses with the highest proportion of intermediate-level materials, r(6) = 0.73, P = 0.02. The implications of these results for curriculum design are discussed.

Curriculum↗