Biomedical subjects

L J M Caldon

Publications and source records attributed to L J M Caldon.

3 recordsLinked to original sources

PubMed2005

Case-mix fails to explain variation in mastectomy rates: management of screen-detected breast cancer in a UK region 1997-2003.

Wide variation in the surgical management of breast cancer exists at hospital, regional, national and international level. To demonstrate whether variation in surgical practice observed at aggregate level between breast units persists following adjustment for case-mix, individual patient-level data from the Trent Breast Screening Programme Quality Assurance database (1997-2003) was analysed. Expected case-mix adjusted mastectomy rates were derived by logistic regression using the variables tumour size, site and grade, patient age and year of presentation, employing the region's overall case-mix adjusted practice as the reference population. The region's 11 breast screening units detected 5109 (3989 invasive) surgically managed primary breast cancers over the 6-year period. A total of 1828 mastectomies (Mx) were performed (Mx rate 35.8%, 95% confidence interval: 34.5-37.1%). Significant variation in mastectomy rates were observed between units (range 25-45%, P<0.0001), and persists following case-mix adjustment (P<0.0001). Two-fold variation in observed to expected unit mastectomy rate coefficient is demonstrated overall (range 0.66-1.36), increasing to almost four-fold variation in cancers less than 15 mm diameter (range 0.55-1.95). Significant variation in surgery for screen-detected primary breast cancer is not explained by case-mix. Further research is required to investigate potential patient and professional causative factors.

Aged↗

PubMed2002

Selecting performance assessment methods for experienced physicians.

BACKGROUND: While much is now known about how to assess the competence of medical practitioners in a controlled environment, less is known about how to measure the performance in practice of experienced doctors working in their own environments. The performance of doctors depends increasingly on how well they function in teams and how well the health care system around them functions. METHODS: This paper reflects the combined experiences of a group of experienced education researchers and the results of literature searches on performance assessment methods. CONCLUSION: Measurement of competence is different to measurement of performance. Components of performance could be re-conceptualised within a different domain structure. Assessment methods may be of a different utility to that in competence assessment and, indeed, of different utility according to the purpose of the assessment. An exploration of the utility of potential performance assessment methods suggests significant gaps that indicate priority areas for research and development.

Clinical Competence↗

PubMed2002

Is insight important? measuring capacity to change performance.

BACKGROUND: Some doctors who perform poorly appear not to be aware of how their performance compares with accepted practice. The way that professionals maintain their existing expertise and acquire new knowledge and skills - that is, maintain their 'currency' of practice - requires a capacity to change. This capacity to change probably requires the individual doctor to possess insight into his or her performance as well as motivation to change. There may be a range of levels of insight in different individuals. At some point this reaches a level which is inadequate for effective self-regulation. Insight and performance may be critically related and there are instances where increasing insight in the presence of decreasing performance can also cause difficulties. OBJECTIVE: This paper presents an exploration into the nature of insight, its relationship to professional performance and its measurement as part of performance, reflecting the combined experiences of a group of experienced education researchers and the results of literature searches on insight and performance. CONCLUSION: There may be individuals in whom insight is so lacking that they are beyond remediation. If there is a dichotomy between adequate and inadequate levels of insight, testing this could be a cost-effective way of determining where efforts for remediation should be focussed.

Clinical Competence↗