Biomedical subjects

M B Donnelly

Publications and source records attributed to M B Donnelly.

At least 19 recordsLinked to original sources

PubMed2000

A multidimensional approach to breast cancer education.

BACKGROUND: This study was undertaken to present a multidimensional breast cancer education package (BCEP) to medical students in an effort to improve breast cancer education. METHODS: The students were exposed to a four-part BCEP consisting of a hands-on structured clinical instruction module (SCIM), a lecture, a problem-based learning (PBL) small-group discussion, and a written manual. Each component was evaluated with a questionnaire. Students responded to the items using a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). RESULTS: The mean overall evaluations for the BCEP components were: SCIM, 4.6; lecture, 4.0; manual 3.8, and PBL discussion, 3.6. Highly rated qualities of the SCIM included organization (4.7), faculty preparedness (4.8), and opportunity to practice skills (4.5). The students agreed that the lecture (4.1), manual (3.8), and PBL discussion (4.2) had prepared them for the SCIM. CONCLUSION: This innovative BCEP effectively improved students' understanding of breast cancer.

Analysis of Variance↗

PubMed1999

The relative contributions of interpersonal and specific clinical skills to the perception of global clinical competence.

BACKGROUND: The objective structured clinical examination (OSCE), an established instrument for evaluating resident competence, was used to test the hypothesis that faculty assessment of clinical competence in residents at various levels of training may be influenced more by general skills as a physician and less by competency in the actual skills being specifically tested. In this study, advantage was taken of the anticipated observation that general surgery residents did not demonstrate improvement in their ability to perform a focused neurological assessment over time. METHODS: An OSCE, which was administered to 56 general surgery residents at all levels of training, included the assessment of a specific clinical neurosurgical problem (sciatica). Univariate and multivariate analyses were used to evaluate the relationship between the global faculty judgment of competent or noncompetent and the other performance measures that were applied. RESULTS: At different levels of training, there was no observed difference in the specific skills being tested; nevertheless, junior and senior residents were more likely than incoming interns to be judged "competent" and received better evaluations of how well they introduced themselves to the patient. The competence judgment correlated significantly with all of the other performance measures, including the skills being tested. CONCLUSIONS: The perception of competence is not solely dependent upon the particular skills under scrutiny. General competence does not guarantee competence in each specific skill set of a medical specialty.

Clinical Competence↗

PubMed1999

Interpreting the judgment of surgical faculty regarding resident competence.

BACKGROUND: It is reasonable to propose that competence is a multifaceted characteristic defined in part by some minimum level of knowledge and skill. In this study we examined the relationship between surgical faculty's judgment of clinical competence, as measured by a surgical resident objective structured clinical examination (OSCE), and the residents' objective performance on the skills being tested. METHODS: Fifty-six general surgery residents at all levels of training participated in a 30-station OSCE. At the completion of each station, the faculty proctor made several overall judgments regarding each resident's performance, including a global judgment of competent or not competent. The competence judgment was applied to the objective percentage performance score in three different ways to construct methods for determining competence based solely upon this objective percentage score. RESULTS: The average mean competent score (MCS) across the stations was 61%, and the average mean noncompetent score (MNCS) was 38%. The difference between MCS and MNCS for each station was very consistent. Upper threshold scores above which a judgment of competent was always made, and lower threshold scores below which a judgment of noncompetent was always made were observed. Overall, the average mean and threshold scores for competent and noncompetent groups were remarkably similar. For performance scores in the range between the threshold competent and noncompetent scores at each station, measures other than objective performance on the skills being evaluated determined the judgment of competent or not competent. CONCLUSIONS: Empirically determined minimum acceptable standards for objective performance in clinical skills and knowledge appeared to have been subconsciously applied to the competence judgment by the faculty evaluators in this study. Other factors appeared to have become determinate when the objective performance score fell within a range of uncertainty.

Animals↗

PubMed1998

Critical assessment of the head and neck clinical skills of general surgery residents.

Head and neck surgery is an important part of general surgery. There is, however, little information about the quality of residents' clinical skills in this important field. In an Objective Structured Clinical Examination (OSCE), residents encounter multiple patients with various clinical problems and are rated by faculty members using objective criteria. This study was undertaken to assess the head and neck surgery skills of a group of general surgical residents. Fifty-one general surgery residents examined the same nine patients with head and neck disease. Faculty members graded each clinical interaction according to preset objective criteria. Both actual (e.g., thyroid nodule, oral cancer follow-up examination) and simulated (e.g., dysphagia) patients were used in the OSCE. The reliability of the examination was assessed by coefficient alpha. The construct validity was determined by a two-way analysis of variance with one repeated measure. The reliability was 0.75 for the clinical examination. Performance varied by level of training: Residents performed at a higher level than interns (p < 0.0001), but overall scores were poor (mean score 55%). Important deficits in skills were identified at all levels of training. It is concluded that more attention should be focused on specific outcome assessments of surgical training programs and on strategies for upgrading the clinical skills of surgical residents.

Analysis of Variance↗

PubMed1998

The reliability of six faculty members in identifying important OSCE items.

PURPOSE: To measure the agreement among faculty members about the importance of items on a checklist used to grade an objective structured clinical examination (OSCE) station. METHODS: Six faculty members rated the importance of 47 items for an OSCE station in which students took the history of a patient with sore throat and hoarseness. RESULTS: Of the 47 items, the raters independently identified 15 items as very important. The reliability of each individual rater was fair (averaged value of alpha = .63.) The reliability of the mean rating of the six raters was high (alpha = .91). CONCLUSIONS: The results strongly suggest that when a group of faculty members cooperatively identifies the important items to be included in an OSCE checklist, the reliability of the checklist is superior to one created by a single author.

Algorithms↗

PubMed1998

Assessing residents' clinical performance: cumulative results of a four-year study with the Objective Structured Clinical Examination.

BACKGROUND: The Objective Structural Clinical Examination (OSCE) is an objective method for assessing clinical skills and can be used to identify deficits in clinical skill. During the past 5 years, we have administered 4 OSCEs to all general surgery residents and interns. METHODS: Two OSCEs (1993 and 1994) were used as broad-based examinations of the core areas of general surgery; subsequent OSCEs (1995 and 1997) were used as needs assessments. For each year, the reliability of the entire examination was calculated with Cronbach's alpha. A reliability-based minimal competence score (MCS) was defined as the mean performance (in percent) minus the standard error of measurement for each group in 1997 (interns, junior residents, and senior residents). RESULTS: The reliability of each OSCE was acceptable, ranging from 0.63 to 0.91. The MCS during the 4-year period ranged from 45% to 65%. In 1997, 4 interns, 2 junior residents, and 2 senior residents scored below their group's MCS. MCS for the groups increased across training levels in developmental fashion (P < .05). CONCLUSIONS: Given the relatively stable findings observed, we conclude (1) the OSCE can be used to identify group and individual differences reliably in clinical skills, and (2) we continue to use this method to develop appropriate curricular remediation for deficits in both individuals and groups.

Clinical Competence↗

PubMed1997

Measuring the ability of residents to manage oncologic problems.

BACKGROUND: An OSCE was used to measure the ability of a cohort of residents to manage oncologic problems. METHODS: Nine oncologic clinical problems were presented to 56 surgical residents. Each problem contained a 5-minute data-gathering period (DGP) and a 5-minute data-interpretation period (DIP). A performance score was determined for each resident for each problem. Reliability was estimated by coefficient alpha; validity, by the construct of experience. Wilks's lambda criterion was used to determine whether training level could be identified by OSCE performance. RESULTS: The DGP reliability was 0.80; the DIP, 0.49. Senior residents performed significantly better than junior residents (P = 0.0001), who performed significantly better than interns (P = 0.0009). Of the residents, 62% were competent on the DGP, but only 21% on the DIP. Important deficits in knowledge and clinical skills were apparent at all levels of training. CONCLUSION: The education and evaluation of residents in oncology need improvement.

Clinical Competence↗

PubMed1997

Ward evaluations: should they be abandoned?

Even in the era of the objective structured clinical examination (OSCE), the predominant method of resident evaluation is the faculty ward evaluation (WE), despite many concerns about its reliability. The aim of this study was to determine the value of the WE as a measurement of clinical competence in terms of both reliability and validity. In a one-year period, surgery faculty members evaluated 72 residents. An average of 7 faculty members evaluated each resident. The evaluation form contained 10 specific performance ratings and an overall evaluation. Inter-rater reliability of the overall performance ratings was calculated by using the intraclass correlation. Validity of the WE was evaluated in four ways. Inter-rater reliability of the overall performance rating was 0.82; the reliability of a single overall rating was 0.39. (1) A discriminant function analysis indicated that residents at advanced levels of training received more positive evaluations than residents at less advanced levels (P < 0.0001). (2) The overall rating was significantly correlated (r = 0.55, P < 0.0001) with the overall score of a concurrent OSCE. (3) A factor analysis showed high correlations among the items, indicating a lack of discrimination between the skills. (4) Overall ratings were insensitive to performance deficiencies. Only 1.3% of the ratings were unsatisfactory or marginal. The WE was sufficiently reliable to estimate the faculty's view of each resident. The fact that the ratings tended to differentiate residents by level of training and that ratings significantly correlated with the OSCE provides strong evidence of their validity. However, factor analysis indicated that the faculty members were making one global, undifferentiated judgment and that these ratings did not identify deficient performance skills. We conclude that ward evaluations have a place in the assessment of residents.

Clinical Competence↗

PubMed1997

Residents' evaluation of a problem-based learning curriculum in a general surgery residency program.

METHODS: To determine residents' satisfaction with problem-based learning and its tutors, to determine how residents prepare for sessions, and to identify the characteristics of both effective sessions and tutors, we analyzed 132 evaluations from 24 residents who completed 1 or more of the 9 cases presented during the first 9 months of our program. The 38-item evaluation questionnaire asked residents to rate tutor characteristics, various aspects of the sessions, and methods used to prepare for the sessions. RESULTS: Residents were well satisfied with the problem-based learning sessions and with the logistics of our program; they found the overall quality of the tutor more important than that of the case; they valued an active, thought-provoking tutor more than a traditional facilitator; and they most often used standard textbooks to prepare for the sessions. CONCLUSIONS: Problem-based learning is a practical, enjoyable graduate curricular vehicle when implemented with well-written cases and active tutors.

Adult↗

PubMed1997

The multidisciplinary structured clinical instruction module as a vehicle for cancer education.

BACKGROUND: The Structured Clinical Instruction Module (SCIM) modifies the Objective Structured Clinical Examination (OSCE) for teaching purposes. This study determined the effectiveness of a breast cancer SCIM in enhancing residents' clinical skills. METHODS: Twenty-five residents, 15 faculty members, and 12 breast cancer patients (simulated and actual) participated in the multistation, multidisciplinary SCIM. Afterward, faculty members, residents, and patients evaluated the SCIM. Residents completed an 18-item self-assessment of their skills before and after the SCIM. RESULTS: All residents, faculty members, and patients rated the SCIM as either outstanding or above average as an educational experience. The residents' self-assessments of their skills were significantly higher after the SCIM than before. CONCLUSIONS: This study shows that residents are aware of their deficiencies in breast cancer management. The SCIM provides an excellent format for residents to improve their clinical skills.

Attitude of Health Personnel↗

PubMed1997

Improving residents' clinical skills with the structured clinical instruction module for breast cancer: results of a multiinstitutional study. Breast Cancer Education Working Group.

BACKGROUND: The purpose of this study was to determine, in a multiinstitutional setting, the effectiveness of the structured clinical instruction module (SCIM) as an instructional format for surgical residents. METHODS: The breast cancer SCIM is an abbreviated (3-hour) clinical skills course that places residents in realistic clinical settings. The curriculum encompasses all aspects of breast cancer patient assessment. The SCIM was administered to 137 residents at five institutions. Sixty-six faculty members and 52 patients participated. All participants were surveyed with multiitem questionnaires. The residents were also asked to perform a self-assessment of their skills before and after the SCIM. RESULTS: The SCIM was delivered at all institutions without difficulty. All participants rated the SCIM highly (from "above average" to "outstanding"). Mean ratings (on a 5-point scale) for the overall effectiveness of the SCIM as an educational format follow: [table: see text] The pretest mean (on a 5-point scale) on the self-assessment was 2.46 ("less than competent"); the posttest mean was 3.54 ("more than competent") (p < 0.0001). CONCLUSIONS: Residents are acutely aware of their deficiencies in understanding breast cancer. The SCIM is a standardized, reproducible, portable, and effective educational vehicle.

Breast Neoplasms↗

PubMed1997

Cancer pain education among family physicians.

This study used performance-based testing (objective structured clinical evaluation, OSCE) to evaluate the skills of family physicians in assessing and managing the severe pain of a cancer patient, and evaluated a new method of education about the management of cancer pain. Twenty-four primary care physicians completed a detailed pain assessment of the same standardized cancer pain patient (Part A). A proctor observed the interviews and rated the physicians on a variety of pre-determined items believed to be important for pain assessment. The physicians were then allowed 5 min to answer management questions about the patient's cancer pain (Part B). After reviewing each physician's performance on Parts A and B, the proctor provided immediate feedback and instruction (Part C) on basic principles of cancer pain assessment and management. On average, the primary care physicians asked 52% (+/-4.5%) of the indicated questions of a detailed pain assessment. Performance was poorest in asking about previous pain history, temporal pattern of pain, and pain intensity. Performance on the pain assessment was best for eliciting pain location and pain-relieving factors. Primary care physicians obtained mean scores of 36% (+/-3%) on Part B of the OSCE. Although opioid therapy was frequently prescribed, only 42% of prescriptions were for regular administration. Performance on Parts A and B correlated poorly with years in practice, and older physicians tended to perform a less detailed pain assessment than their younger colleagues. Most physicians enjoyed participating in this instructional formal and believed that the proctor feedback increased the educational value of the module. The results of our study suggest that many family physicians may be inadequate in their clinical assessment and management of cancer pain. Our study supports the need for continuing education in cancer pain management, regardless of years in practice. Further study should evaluate the effects of different educational programs on clinical practice in patient care.

Education, Medical, Graduate↗

PubMed1997

Residents' management of the symptoms associated with terminal cancer.

The principal aim of palliative care is to bring symptomatic relief to patients with progressive disease. Residents graduating from a university general surgery training program should be competent to manage common symptoms associated with advanced cancer. This study used performance-based testing to evaluate the skills of resident physicians in managing common symptoms of a patient with advanced cancer. Thirty-three resident physicians (PGY 1 to 6) were presented with four clinical symptoms of a patient with advanced cancer: (1) nausea and vomiting associated with regular morphine use; (2) lack of appetite in the last weeks of life of a terminally ill patient; (3) constipation associated with codeine analgesia; and (4) dyspnea associated with diffuse lung metastases. The management plan for the symptom problems was evaluated by using a predefined checklist. A significant number of residents showed deficits in the management of common symptoms of advanced cancer. Scheduled dosing of antiemetics was infrequently prescribed for opioid-related nausea and vomiting. Most physicians inappropriately managed lack of appetite by using forced feeding. Opioids were infrequently used in the management of terminal dyspnea. The absence of difference in scores between junior and senior residents suggests that adequate management of the symptoms of terminal cancer is not being effectively taught in postgraduate training programs.

Anorexia↗

PubMed1997

Late-onset preemptive analgesia associated with preincisional large-dose alfentanil.

UNLABELLED: Few studies using systemic opioids have been adequately designed to demonstrate a preemptive effect. We investigated the preemptive effect of intraoperative large-dose intravenous (I.V.) opioids over a 72-h period after lower abdominal surgery. Thirty-eight ASA physical status I or II patients undergoing abdominal hysterectomy were studied in a prospective, randomized, double-blind design. Group PRE received alfentanil 70 microg/kg over 10 min before surgical incision; Group POST received alfentanil 70 microg/kg over 10 min after incision. Patients received no other intraoperative opioid. Pain was treated in the recovery room with 2-mg I.V. boluses of morphine and was subsequently managed via patient-controlled analgesia (PCA) using morphine sulfate. Visual analog scale pain scores at rest (VAS-R) and on movement (VAS-M) and PCA morphine consumption were recorded for 72 hours. VAS-M and VAS-R scores did not differ at any point, and morphine consumption was similar in both groups over the initial 48 h. Group PRE used significantly less morphine from 48 to 72 h postoperatively (P < 0.02). We conclude that presurgical incisional (i.e., compared with postincisional) large-dose opioid exposure results in a modest, late decrease in postoperative morphine consumption, with no clinical impact on early postoperative pain. Timing of the observed reduction coincides with maximal output of substances implicated in experimental hyperalgesia. IMPLICATIONS: When given before surgical incision, alfentanil, a short-acting narcotic, was associated with a reduction in morphine requirements 48-72 h after surgery. Brief interventions may have a delayed and sustained impact on pain perception, possibly by reducing mechanisms of sensitization.

Adult↗

PubMed1997

The structured clinical instruction module as a tool for improving students' understanding of breast cancer.

The Structured Clinical Instruction Module (SCIM) is a novel format for teaching clinical skills. A multidisciplinary SCIM was presented to 30 medical students to improve their understanding of breast cancer. The SCIM consisted of 12 10-minute stations, each covering a different aspect of the diagnosis and management of breast cancer (e.g., history, physical examination, treatment options, mammography, cytology, and pathology). The students rotated through the various stations in groups of three. Nine patients and 14 faculty members participated. At the end of the SCIM, students, faculty, and patients rated their level of agreement (on a five-point scale ranging from "Strongly Disagree" to "Strongly Agree") with statements on a multi-item evaluation questionnaire. All ratings were positive. The students agreed most that the small-group format was an effective instructional method (mean, 4.6). Both students and faculty agreed that the SCIM increased students' clinical skills (mean, 4.4 in both evaluations). Faculty expressed a willingness to participate in future such workshops (mean, 4.6). Patients agreed most strongly that they enjoyed the SCIM (mean, 5.0) and that faculty feedback to students was excellent (mean, 5.0). The SCIM was well received by all participants in this pilot project.

Breast Neoplasms↗

PubMed1996

The use of objective structured clinical examination (OSCE) for evaluation and instruction in graduate medical education.

This study had two purposes: determining the reliability and validity of the Objective Structured Clinical Examination (OSCE) in assessing performance by trainees at all levels, including medical students and chief residents; and estimating the impact of providing OSCE participants with immediate feedback about their performance. A comprehensive 210-min OSCE was administered to 53 surgical residents and 6 junior medical students. Faculty experts proctored all patient stations and provided immediate feedback to participants after the patient interaction segments (Part A). The participants then answered questions about the patients seen (Part B). The reliability of the OSCE was high (.91), identical to that of a previous resident OSCE with no feedback. The standard error of measurement for both parts was approximately 4%. At the 95% confidence interval, each participant's actual level of clinical performance (Part A) and clinical knowledge (Part B) could be estimated with an error of +/-8%. Participants showed significant differences in clinical performance (Part A, P < 0.01) and knowledge (Part B, P < 0.01) by level of training. Most participants (74%) rated the OSCE as an above average or outstanding educational method. The OSCE is a valid and reliable test of residents' clinical skills. Feedback to participants during the OSCE was positively received and did not perturb test reliability.

Clinical Competence↗

PubMed1996

Cancer pain assessment and management by housestaff.

Pain control for cancer patients is a significant problem in health care, and lack of expertise by clinicians in assessing and managing cancer pain is an important cause of inadequate pain management. This study was designed to use performance-based testing to evaluate the skills of resident physicians in assessing and managing the severe chronic pain of a cancer patient. Thirty-three resident physicians (PGY 1-6) were presented with the same standardized severe cancer pain patient and asked to complete a detailed pain assessment. The residents then completed questions related to management of the cancer pain patient. In the cancer pain assessment, residents did well in assessing pain onset (70%), temporal pattern of pain (64%), and pain location (73%). However, only 33% and 45% physicians adequately assessed the pain description and pain intensity, respectively, and assessment of pain-relieving factors, previous pain history, and psychosocial history was done poorly or not at all by 70%, 88%, and 94% of residents. Only 58% of the residents were judged to be competent in this clinical cancer pain assessment. In the cancer pain management section, opioid analgesic therapy was prescribed by 98% of residents, and 91% used the oral route. However, only 18% of prescriptions were for regular use and 88% of residents did not provide analgesics for breakthrough pain. A significant number of graduated physicians were judged to be not competent in the assessment and management of the severe pain of a standardized cancer patient. Opioids and NSAIDs were the analgesics of choice; however, most were prescribed on a PRN basis only. Co-analgesics were rarely prescribed. Few physicians managed persistent, severe cancer pain according to the WHO guideline of increasing the opioid dose. The lack of significant difference in scores between junior and senior residents suggest that adequate cancer pain management is not being effectively taught in postgraduate training programs.

Clinical Competence↗

PubMed1996

The surgical clerkship: characteristics of the effective teacher.

A good relationship between medical students and clinicians is crucial to a positive learning experience. To increase contact between surgical teaching staff and students, a teacher programme was instituted in the problem-based surgical clerkship at the University of Kentucky. This study examined the teacher traits and skills that medical students perceive as distinguishing effective from ineffective teachers. The 312 evaluations collected from students in successive surgical clerkship rotations (87% response rate) were used to determine the characteristics of the effective teacher. Results suggest that students rate increased contact with surgical teaching staff highly and that they value increased mentoring by the staff. The traits of teachers rated highly by students in the surgical clerkship include: being a positive role model, encouraging communication, and being well organized. Comparing data from the 2 years of the clerkship also revealed that providing feedback to staff on their performance as teachers enabled them to improve their instructional skills.

Adult↗