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Biomedical subjects

T S Murray

Publications and source records attributed to T S Murray.

At least 37 records · Page 2Linked to original sources
PubMed1996

The effects of the introduction of a system of mandatory formative assessment for general practice trainees.

A series of questionnaires was used to determine the amount of formative assessment going on within the est of Scotland Region of the UK and its perceived value by trainees (General Practice [GP] Registrars) both at the beginning and end of training. The first survey was carried out in 1989 and the second in 1994. Trainers and course organizers were surveyed in 1994 to determine their attitudes to the use of videotaped consultations for formative assessment. In 1991, the region had initiated a mandatory formative assessment programme which included regular use of videotaped consultations, confidence rating scales and Manchester ratings (RCGP Occasional Paper Number 40). The use of a range of assessment methods for formative assessment of GP Registrars increased considerably between 1989 and 1994. The percentage of trainees using videotaped consultation analysis increased from 76 to 94%, for Manchester ratings from 52 to 68% and for confidence rating scales from 63 to 74%. Video and confidence scales were rated highly by trainees who were assessed by them and by most trainees at the start of the year, but less highly by those who had not been assessed by them by the end of the trainee year. Manchester ratings were not thought to be as useful, and for these there was no difference between users and non-users. Despite the mandatory system, a significant number of trainees (76%) were still not receiving the minimum assessment stipulated. Trainers rated lack of time as the main limiting factor to the greater use of video. We conclude that trainees who are exposed to assessment methods, particularly video, find it useful, but that some trainees are still receiving less than is optimal. We propose increased trainer education and intensified monitoring of the assessment carried out in training Practices.

Attitude↗
PubMed1996

Summative assessment of vocational trainees: results of a 3-year study.

BACKGROUND: Summative assessment of general practice trainees will be introduced across the UK for trainees completing vocational training after 1 September 1996. AIMS: A study was set up to assess the reliability of the consulting skills assessment which will be used to develop audit and factual knowledge testing as summative assessment tools and to determine the probable impact of the system on the numbers of trainees identified as not yet competent for independent practice. METHOD: Videotaped consultations, an audit project, a trainer's report and a multiple-choice paper were evaluated for 359 trainees in the West of Scotland completing their training between 31 July 1993 and 31 July 1995. RESULTS: A total of 77 trainees (22%) were identified as being potentially of doubtful competence and 17 (5%) were adjudged to be as yet incompetent for independent practice. Videotaped consultation produced the highest pickup rate (14) followed by trainer's judgement (3). Subsequent analysis of the video tapes identified one trainee who should have been picked up by this method but was not. CONCLUSION: The videotape instrument reliably identified the non-competent trainees. Audit and factual knowledge tests have a distinct role in summative assessment. The proportion of trainees being refused certificates by this assessment is likely to increase considerably but will still represent only about 5% of all trainees.

Education, Medical, Graduate↗
PubMed1996

Assessment of competence.

While it is essential that professional competence should be maintained, it is equally important that entry to the specialist ranks should be conditional on the demonstration of an acceptable level of competence. Multiple-choice papers and videotaped consultations are two parts of a multi-format approach to assessment which also includes a trainer's report and an audit report. The number of doctors identified as unsatisfactory at the recertification stage could be reduced by these methods, and the system could also provide a template for the introduction of recertification procedures.

Certification↗
PubMed1996

Motivation of general practitioners attending postgraduate education.

BACKGROUND: The 1990 Contract encouraged general practitioners to participate in continuing medical education by providing a financial incentive. AIM: The study was designed: to determine the motivation of general practitioners attending education events; and to compare motivation and reasons for attendance pre- and post-Contract at commercial and non-commercial meetings, and at the different educational categories of Disease Management (DM), Health Promotion (HP) and Service Management (SM). METHOD: Two structured questionnaires were used. The first was sent to all general practitioners in the West of Scotland and asked about motivation pre-1990 Contract and the second, post-Contract, looked at motivation and reasons for attending a course as part of post course assessment. This latter was part of a much larger study evaluating continuing medical education. RESULTS: A total of 1161 practitioners responded to questionnaire I and 552 general practitioners attended 27 randomly selected postgraduate meetings. Finance was a motivator in 3.8% pre-Contract, and this increased to 33.3% post-Contract and was the most commonly stated reason for attendance in 81.3%. Financial incentive had the biggest influence on those attending HP sessions (91.5%), then SM (87.2%) and finally DM (78.6% (chi 2 = 8.68; P < or = 0.013). It was also important to 73% attending drug-company-sponsored meetings compared with 83.7% going to non-commercial ones. Interest was a good motivator both pre- and post-Contract, but more so for DM than other categories and drug company as opposed to non-commercial meetings (chi 2 = 9.4; P < 0.002). Lack of knowledge became a less-important motivator post-Contract, and doctors felt least knowledgeable in SM (62.2%), as opposed to DM (57.9%) and HP (23.6%) (chi 2 = 38.8; P < 0.001, with each differing significantly from both others). Doctors found the topics provided by the pharmaceutical companies more interesting (chi 2 = 9.4; P < 0.002) and the hospitality provided more alluring than scheme meetings (chi 2 = 28.6; P < 0.001). CONCLUSIONS: Finance has a major effect on attendance at postgraduate meetings but may not be a good incentive for learning. Planning for education must take into account the different motivational factors for the different categories. Reasons for attending commercial meetings differ from non-commercial ones and these events should be closely monitored.

Education, Medical, Continuing↗
PubMed1996

Career preferences of medical students: influence of a new four-week attachment in general practice.

BACKGROUND: It is not clear why medical students choose one specialty over another. Experiences at medical school are extremely strong determinants of attitudes to the medical specialties, and attitude is the most important factor in determining choice. AIM: This study sought to describe the factors influencing career choices of final year medical students, the effect of a new four-week attachment in general practice on career choices, and changes in career choices towards or away from general practice between the final year and the end of the preregistration house officer year. METHOD: Career preferences, and influences on them, were assessed by questionnaires administered to 206 medical students undergoing their final clinical attachment at the University of Glasgow immediately before and immediately after a four-week attachment in general practice. These were followed up by a postal questionnaire at the end of the preregistration house officer year. RESULTS: One hundred and thirty-one students returned all three questionnaires. Before the attachment, students born outside the UK, and those who had a previous or intercalated degree were significantly less likely to put general practice as a career preference; female students were more likely to put it as their first career choice. After the attachment, the number stating that it was 'likely' or 'very likely' that they would choose general practice as a career increased from 60 to 72--mainly through male students changing their preference--but after the preregistration house officer year it had fallen back to 56. Seventeen of the preregistration house officers were planning to complete posts which would qualify for GP training. Reasons for changing preference towards general practice were mainly to do with a dislike of and disillusionment with hospital medicine and with the perceived lifestyle advantages of general practice. Reasons for changing preference away from general practice were mainly to do with positive feelings about hospital medicine and a dislike of the management aspects of general practice. CONCLUSION: The general practice attachment influenced students, especially males, towards a career in general practice, but this effect was transient. This cohort of doctors should be followed up in order to discover their ultimate career choices.

Adult↗
PubMed1995

Audit: trainers' and trainees' attitudes and experiences.

Little is known about the audit activity taking place among general practitioners as part of their vocational training. All 155 trainers and their trainees in the West of Scotland were asked about their attitudes to and their experiences of audit. Two hundred and thirty-five replies were received from 310 questionnaires sent, giving an 85% response from trainers and 67% from trainees. Both trainers and trainees had positive attitudes to audit with regard to its use: for assessing work (87% of trainers, 97% trainees); as an appropriate use of resources (92% of trainers, 78% of trainees); as an appropriate use of time (91% trainers, 76% trainees); in improving patient care (96% of trainers, 76% of trainees). Most trainers (90%) and 52% of trainees had started collecting data with a view to starting an audit, 56% of trainers and 23% of trainees had personally set a standard and 54% of trainers but only 12% of trainees had completed a cycle of audit. Despite very positive attitudes to audit there is a problem completing a cycle of audit, particularly among trainees. They will thus be denied the benefit of negotiating and evaluating change as part of their training, skills which will be necessary to ensure a lifelong awareness of the quality of care they are providing.

Attitude of Health Personnel↗
PubMed1995

Audit and summative assessment: two years' pilot experience.

An audit project has been submitted by all trainees in the West of Scotland since 1992 as part of a pilot process for summative assessment. The impact of 2 consecutive years of audit was assessed on 117 trainees in May 1994. A response rate of 89% was achieved. For 82 trainees (79%) this was their first practical experience of audit and as a result of it 85% felt more confident in introducing change to their next practice. Protected time was still a problem for the majority (53%) and one-third wanted more help from their trainer. Thirty trainees (29%) had attended four or fewer formal practice meetings in their 10 months of training, with 10% never having attended one. The previous trainee's audit project was rarely or never discussed with 70 trainees (87%) and only 12 trainees were evaluating changes recommended. An audit project as part of summative assessment may be encouraging trainees to think about change after they leave their training practices. Few, however, are evaluating change and protected time and support are still required. The marking of the summative assessment audit project may need to address this.

Education, Graduate↗
PubMed1995

General practitioner trainees' experience of undertaking audit projects: preliminary report from the west of Scotland region.

BACKGROUND: Departments of general practice increasingly provide formal teaching in audit. However, little is known about audit projects carried out by trainees in general practice. AIM: A study was undertaken to ascertain general practitioner trainees' experience of undertaking an audit project in the trainee year, with reference to their understanding of audit theory, perceived usefulness of the project in enhancing clinical knowledge, time taken to do the audit and practice team involvement in the project. METHOD: All 104 trainees in the west of Scotland region completing their trainee year on 31 July 1993 were sent a postal questionnaire that month. The replies to the questionnaire were analysed and compared with the audit project that each trainee had submitted in June 1993 as part of a pilot project for summative assessment. RESULTS: Responses were received from 103 trainees (99%). Seventy trainees (68%) felt strongly that their audit project was relevant to patient care but only 31 (30%) felt strongly that the project was a useful way of enhancing clinical knowledge of the disease process. Data collection was the most time consuming aspect of the audit project, 23% of trainees reporting taking a day or more to complete this stage. Trainees who chose their own audit project were more likely to complete two sets of data collection than those who had not chosen their own project. Seventy nine trainees (77%) indicated that trainers had been involved in their project and 51 trainees indicated that one of the other practice partners had been involved in their project. CONCLUSION: Performing an audit as a trainee is feasible in the time limit of the one year in general practice. The educational benefit appears to be limited to the knowledge of audit process, rather than to clinical knowledge. Audit projects of relevant size and complexity, involving appropriate members of the practice team, are to be encouraged, as is the development of an instrument for assessing trainee audit.

Education, Medical, Continuing↗
PubMed1995

Use of videotaped consultations in summative assessment of trainees in general practice.

BACKGROUND: There are many different methods by which trainees may be assessed summatively. AIM: The objective of the study was to determine if videotaped consultations could be used to identify reliably those general practitioner trainees who have not yet reached acceptable levels of competence. METHOD: Videotapes of 10 trainees carrying out normal consultations were assessed by 20 assessors for acceptable competence using a rating scale specifically developed for the purpose. RESULTS: A principal components analysis showed a strong correlation among the items in the rating scale used, indicating that a single underlying factor accounted for 76% of the overall scores. Agreement between assessors on the scoring of individual consultations was limited. There was much greater consistency with regard to the decision on overall competence, examined for the first consultation. A non-competent trainee would have a 95% probability of being identified by the process as described using two assessors for each videotape. The assessors had reached firm judgements on each trainee by the time four consultations had been viewed. CONCLUSION: The workload involved in producing and analysing the tapes is discussed. Considerations of patient consent are addressed. It is concluded that the use of videotaped consultations appears to offer a feasible and reliable method of summative assessment of general practitioner trainees.

Education, Medical, Graduate↗
PubMed1995

Audit and summative assessment: a criterion-referenced marking schedule.

BACKGROUND: 1996 will see the introduction of summative assessment of general practitioner registrars (trainees). One part of this assessment is the written submission of practical work. In the west of Scotland, audit projects have been chosen as the format for practical work. A valid and reliable marking schedule for such projects is needed. AIM: A study was undertaken to develop a criterion-referenced marking schedule for assessing registrars' audit projects for summative assessment. METHOD: Medical and non-medical professionals, in a series of workshops, compiled a list of essential elements of good audit. These features were tested and refined using registrars' audit projects. All trainers in the west of Scotland were then sent a list of 14 criteria and asked to indicate whether each criterion was an essential or desirable component of a registrar's audit project for summative assessment. A final workshop was held to develop an audit marking schedule. RESULTS: Of 155 trainers in the west of Scotland, 135 replied to the list of criteria for registrar audit projects (87%). Ten criteria were deemed essential or desirable by 80% or more of the respondents. Participants in the final workshop selected five criteria which would form the audit project marking schedule for registrars undergoing summative assessment. These were: defined reason for choice of audit project, relevance of criteria chosen, appropriate preparation and planning, appropriate interpretation of relevant data and detailed proposals for change. For an audit project to pass assessment all five criteria must be present. CONCLUSION: A criterion-referenced approach to assessing registrars' audit projects, developed from their trainers' opinions of essential or desirable criteria for good audit, is described. Further evaluation of the criterion-referenced marking schedule is required.

Educational Measurement↗