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Biomedical subjects

Thomas J Beckman

Publications and source records attributed to Thomas J Beckman.

17 recordsLinked to original sources
PubMed2006

Current concepts in validity and reliability for psychometric instruments: theory and application.

Validity and reliability relate to the interpretation of scores from psychometric instruments (eg, symptom scales, questionnaires, education tests, and observer ratings) used in clinical practice, research, education, and administration. Emerging paradigms replace prior distinctions of face, content, and criterion validity with the unitary concept "construct validity," the degree to which a score can be interpreted as representing the intended underlying construct. Evidence to support the validity argument is collected from 5 sources: CONTENT: Do instrument items completely represent the construct? RESPONSE PROCESS: The relationship between the intended construct and the thought processes of subjects or observers. INTERNAL STRUCTURE: Acceptable reliability and factor structure. RELATIONS TO OTHER VARIABLES: Correlation with scores from another instrument assessing the same construct. CONSEQUENCES: Do scores really make a difference? Evidence should be sought from a variety of sources to support a given interpretation. Reliable scores are necessary, but not sufficient, for valid interpretation. Increased attention to the systematic collection of validity evidence for scores from psychometric instruments will improve assessments in research, patient care, and education.

Humans↗
PubMed2006

Factor instability of clinical teaching assessment scores among general internists and cardiologists.

CONTEXT: We are unaware of studies examining the stability of teaching assessment scores across different medical specialties. A recent study showed that clinical teaching assessments of general internists reduced to interpersonal, clinical teaching and efficiency domains. We sought to determine the factor stability of this 3-dimensional model among cardiologists and to compare domain-specific scores between general internists and cardiologists. METHODS: A total of 2000 general internal medicine and cardiology hospital teaching assessments carried out from January 2000 to March 2004 were analysed using principal factor analysis. Internal consistency and inter-rater reliability were calculated. Mean item scores were compared between general internists and cardiologists. RESULTS: The interpersonal and clinical teaching domains previously demonstrated among general internists collapsed into 1 domain among cardiologists, whereas the efficiency domain remained stable. Internal consistency of domains (Cronbach's alpha range 0.89-0.93) and inter-rater reliability of items (range 0.65-0.87) were good to excellent for both specialties. General internists scored significantly higher (P<0.05) than cardiologists on most items except for 4 items that more accurately assessed the cardiology teaching environment. CONCLUSIONS: We observed factor instability of clinical teaching assessment scores from the same instrument administered to general internists and cardiologists. This finding was attributed to salient differences between these specialties' educational environments and highlights the importance of validating assessments for the specific contexts in which they are to be used. Future research should determine whether interpersonal domain scores identify superior teachers and study the reasons why interpersonal and clinical teaching domains are unstable across different educational settings.

Cardiology↗
PubMed2006

Evaluation and medical management of erectile dysfunction.

Most men older than 60 years experience some degree of erectile dysfunction (ED). The physiology of erections is complex, with contributions from hormonal, vascular, psychological, neurologic, and cellular components. ED is strongly associated with cardiovascular risk factors, and this fact plays a major role in the prevention and treatment of ED. In this article, we review the evaluation of ED in terms of history, physical examination, and common laboratory studies. Additionally, we review major considerations when prescribing phosphodiesterase type 5 inhibitors and other medical treatments, including intraurethral alprostadil, penile injection therapy, and testosterone replacement.

Adrenergic alpha-Antagonists↗
PubMed2005

The interpersonal, cognitive and efficiency domains of clinical teaching: construct validity of a multi-dimensional scale.

BACKGROUND: We are unaware of any hypothesis-driven studies showing that teaching assessments are comprised solely of interpersonal and cognitive domains. Moreover, previous teaching assessments have been biased by heterogeneous samples of evaluators. Consequently, we investigated the construct validity of faculty assessments comprised of interpersonal and cognitive domains, utilising evaluations obtained from resident doctors on an internal medicine hospital service. METHODS: A total of 1000 inpatient evaluations were completed on 60 general internal medicine faculty members. Education theory supported a 2-dimensional, 14-item scale. Principal factor analysis was used to explore the scale's dimensionality. Internal reliability and interobserver agreement were determined. Relationships between domains and instructor characteristics were also examined. RESULTS: Principal factor analysis revealed interpersonal, clinical teaching and efficiency domains. Internal reliabilities of all domains are high (alpha > 0.90). Interobserver agreement is good (range 0.64-0.83). In the interpersonal domain there is a trend towards higher scores for lower ranking faculty. Significant findings are higher overall scores in the interpersonal domain (P < 0.001), higher scores for assistant professors in the interpersonal domain (P = 0.008) and higher scores for male than female faculty in the interpersonal (P = 0.041) and clinical teaching (P = 0.008) domains. CONCLUSIONS: Clinical teaching evaluations are reducible to interpersonal, clinical teaching and efficiency domains. Evidence for construct validity includes predicted domains and high internal and interobserver reliabilities. Utilising a homogenous sample of evaluators minimised variance. Interestingly, lower ranking faculty scored higher in the interpersonal domain, suggesting that lower ranking faculty may focus more attention on teaching activities than full professors do.

Clinical Medicine↗
PubMed2005

What is the validity evidence for assessments of clinical teaching?

BACKGROUND: Although a variety of validity evidence should be utilized when evaluating assessment tools, a review of teaching assessments suggested that authors pursue a limited range of validity evidence. OBJECTIVES: To develop a method for rating validity evidence and to quantify the evidence supporting scores from existing clinical teaching assessment instruments. DESIGN: A comprehensive search yielded 22 articles on clinical teaching assessments. Using standards outlined by the American Psychological and Education Research Associations, we developed a method for rating the 5 categories of validity evidence reported in each article. We then quantified the validity evidence by summing the ratings for each category. We also calculated weighted kappa coefficients to determine interrater reliabilities for each category of validity evidence. MAIN RESULTS: Content and Internal Structure evidence received the highest ratings (27 and 32, respectively, of 44 possible). Relation to Other Variables, Consequences, and Response Process received the lowest ratings (9, 2, and 2, respectively). Interrater reliability was good for Content, Internal Structure, and Relation to Other Variables (kappa range 0.52 to 0.96, all P values < .01), but poor for Consequences and Response Process. CONCLUSIONS: Content and Internal Structure evidence is well represented among published assessments of clinical teaching. Evidence for Relation to Other Variables, Consequences, and Response Process receive little attention, and future research should emphasize these categories. The low interrater reliability for Response Process and Consequences likely reflects the scarcity of reported evidence. With further development, our method for rating the validity evidence should prove useful in various settings.

Education, Medical↗
PubMed2005

Evaluation and medical management of benign prostatic hyperplasia.

Benign prostatic hyperplasia (BPH) is common among aging men. Untreated BPH may lead to complications including urinary tract infection, acute urinary retention, and obstructive nephropathy. Diagnosing BPH can be challenging because lower urinary tract symptoms are found in conditions other than BPH, and prostate size correlates poorly with symptoms of obstruction. Nonetheless, a careful medical history and physical examination, along with prudent use of diagnostic tests, can yield an accurate diagnosis. We review the evaluation of men with suspected BPH and indications for referral to a urologist for invasive therapy. We also review supporting evidence and treatment considerations for saw palmetto and the 2 major classes of prescription medications, alpha1-adrenergic antagonists and 5alpha-reductase inhibitors.

Adrenergic alpha-Antagonists↗
PubMed2004

A comparison of clinical teaching evaluations by resident and peer physicians.

The purpose of this study was to compare the reliability of inpatient teaching evaluations by resident and peer physicians on Mayo internal medicine hospital services. Three resident and three peer evaluators observed 10 consecutively chosen attending physicians on the Mayo hospital services. Evaluations by resident and peer physicians were compared in terms of mean scores. Kendall's coefficient of concordance (KCC) was used to summarize inter-rater reliabilities and Cronbach's coefficient alpha was used to determine internal consistencies of evaluations by residents and peers. Results of this study revealed that mean scores of the 13 evaluation items were generally higher for resident than peer physicians. None of the items completed by residents had KCC scores >0.5, whereas 10 of the items completed by peers had KCC scores >0.5. Likewise, none of the residents' items had KCC p-values <0.05, whereas nine of the peers' items had KCC p-values <0.05. The overall internal consistency was higher for peers (alpha = 0.76) than for residents (alpha = 0.71). In conclusion, resident physicians uniformly rate faculty highly. Furthermore, peer evaluations yield higher inter-rater and internal reliabilities than resident evaluations, indicating that peer physicians are more reliable than residents for assessing bedside teaching.

Educational Measurement↗
PubMed2004

Lessons learned from a peer review of bedside teaching.

While evaluating bedside teaching by attending physicians on the Mayo Clinic's general internal medicine hospital services, the author learned that peer review enhances an understanding of teaching for both observers and subjects of peer review. In this article the author offers five insights derived from his and two colleagues' observations of bedside teaching during a six-month period in 2002. These are (1) the value of peer review to observers, (2) the apparently unlimited number of teaching strategies, (3) the prevalence of missed opportunities to provide feedback to learners, (4) the art of asking questions effectively, and (5) the possible relationship between a teacher's maturity and successful bedside teaching. Regarding the art of asking questions, he encountered four common problems (e.g., the underutilization of questions), but also found that accomplished teachers pursue a course of co-discovery by asking questions alongside their learners. Finally, he learned that experienced attending physicians often demonstrate teaching sessions focused on psychosocial aspects of care, the use of simple questions, and a willingness to expose their own inadequacies.

Clinical Competence↗
PubMed2004

How reliable are assessments of clinical teaching? A review of the published instruments.

BACKGROUND: Learner feedback is the primary method for evaluating clinical faculty, despite few existing standards for measuring learner assessments. OBJECTIVE: To review the published literature on instruments for evaluating clinical teachers and to summarize themes that will aid in developing universally appealing tools. DESIGN: Searching 5 electronic databases revealed over 330 articles. Excluded were reviews, editorials, and qualitative studies. Twenty-one articles describing instruments designed for evaluating clinical faculty by learners were found. Three investigators studied these papers and tabulated characteristics of the learning environments and validation methods. Salient themes among the evaluation studies were determined. MAIN RESULTS: Many studies combined evaluations from both outpatient and inpatient settings and some authors combined evaluations from different learner levels. Wide ranges in numbers of teachers, evaluators, evaluations, and scale items were observed. The most frequently encountered statistical methods were factor analysis and determining internal consistency reliability with Cronbach's alpha. Less common methods were the use of test-retest reliability, interrater reliability, and convergent validity between validated instruments. Fourteen domains of teaching were identified and the most frequently studied domains were interpersonal and clinical-teaching skills. CONCLUSIONS: Characteristics of teacher evaluations vary between educational settings and between different learner levels, indicating that future studies should utilize more narrowly defined study populations. A variety of validation methods including temporal stability, interrater reliability, and convergent validity should be considered. Finally, existing data support the validation of instruments comprised solely of interpersonal and clinical-teaching domains.

Academic Medical Centers↗
PubMed2004

Regular screening in type 2 diabetes. A mnemonic approach for improving compliance, detecting complications.

Healthcare providers can be overwhelmed by the complexity of issues to address during follow-up visits with patients who have type 2 diabetes. On this basis alone, it is not surprising that physicians often fail to adequately address both diabetes-related and non-diabetes-related healthcare screening in these patients. Special recommendations exist for HbA1c level, hypertension, eye screening, hyperlipidemia, urinary protein, foot examinations, and vaccinations in patients with diabetes. I have found the HELP mnemonic useful for systematically and efficiently addressing recurring issues in patients with diabetes during routine office visits. It has also been accepted by medical students and residents as a valuable aid in the management of diabetes. My hope is that this system of organization will help the reader provide more effective care to these patients as well.

Abbreviations as Topic↗
PubMed2003

Evaluating an instrument for the peer review of inpatient teaching.

The purpose of this study was to assess an instrument for the peer review of inpatient teaching at Mayo. The Mayo Teaching Evaluation Form (MTEF) is an instrument, based on the Stanford seven-category educational framework, which was developed for the peer review of inpatient teaching. The MTEF has 28 Likert-scaled items derived from the Stanford Faculty Development Program form (SFDP-26), the Mayo electronic evaluation form and three additional items. In this study three physician-evaluators used the MTEF to evaluate 10 attending physicians on the Mayo general internal medicine hospital services. Cronbach's alphas were used to assess the internal consistency of the MTEF, and Kendall's coefficient of concordance was used to summarize the inter-rater reliability. Results of this study reveal that the MTEF is internally consistent, based on average ratings across all evaluators (Cronbach's alpha=0.894). Stanford categories with the highest alphas are Self-Directed Learning, Learning Climate, Communication of Goals, and Evaluation. Categories with lower alphas are Feedback, Understanding and Retention, and Control of Teaching Session. Additionally, the majority of items on the MTEF show significant agreement across all evaluators, and teacher enthusiasm was among the most reliable items. In conclusion, the MTEF is overall internally consistent for the peer review of inpatient teaching at Mayo. Hence, the MTEF may be a useful element in the peer evaluation of teaching at our institution.

Education, Medical↗
PubMed2002

Syncope in an adult with uncontrolled asthma.

Cough syncope occurs primarily in middle-aged male smokers with chronic obstructive pulmonary disease (COPD). It has also been described in children with asthma. I report the case of a 34-year-old nonsmoker who had syncope due to coughing, and who also related a 1-year history of cough with wheezing. Chest examination revealed diffuse wheezing and a prolonged expiratory phase, and pulmonary function testing with a methacholine challenge confirmed hyperreactive airways. Notably, while undergoing spirometric testing he had a recurrent syncopal episode. His syncope resolved with medical therapy for asthma.

Adult↗