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Developing prospective managers. Part 1. A unique project.

This is the first in a series of three articles that describes a project to determine how feasible and effective it would be to train selected nurses as managers before actual appointment. This management trainee program is unique in that participants were specifically limited to BSN graduates with a maximum 1 year of clinical experience. Participants also were expected to complete an individualized competency-based development program, not a traditional course. The first article describes development of the project at Stanford University Medical Center. Subsequent articles will describe the evaluation, assessment, and learning methods used; the problems of candidate selection; and participant experiences and program results.

Administrative Personnel↗

The contribution of social science to international health training.

Today the comprehensive scope of many international health programs calls for personnel--planners, educators, researchers, and practitioners--trained in a wide range of health related areas. This article explores the contributions which social science knowledge and skills can make to such training. First, it documents the growing importance of social science in international health and delineates several topical areas--ecological, political-economic, socio-cultural, and organizational--where a social science perspective can be particularly useful. Next, it discusses strategies for developing a curriculum that will integrate relevant social science material into health care training. These include the selection of appropriate training staff and the development of competency-based curricula based upon actual work situations. Finally, the article describes specific 'experiential' training techniques which can be employed in the classroom as well as in the field to achieve program objectives.

Curriculum↗

A strategy to teach medical decision making within a medical school curriculum.

One of the goals of our medical school is to teach our students how to learn. In theory, this is a noble goal, but, in practice, our style is often to "impart" our knowledge to the students without allowing them to question it, to practice with it, and to really understand it. To address this problem, we are developing a vertically integrated four-year program in medical decision making funded by the Culpeper Foundation. The curriculum begins with classic epidemiology in year one. In year-two courses, principles of clinical epidemiology (diagnosis, variability, etc) and the elements of quantitative decision making are woven into our organ system courses. In year three, these skills are practiced in clerkships, and critical thinking sessions occur in several clerkships. The curriculum culminates in year four with sessions on expected value decision analysis in one of our required courses. Built into this experience are computer interactive programs, faculty and housestaff development sessions, and availability of consultation from a medical decision making team. We are developing competency-based exams in which students will have to demonstrate skills in medical decision making, critical thinking, and problem solving. We hope this will help teach our students "how to" make decisions and understand such things as critical thinking, probability, uncertainty, and variability. Through this, we hope the decisions they will help their patients make will lead to the "best" outcomes for these patients.

Clinical Clerkship↗

Competency mandate: a model for teaching skills in the administration of the WAIS-R.

The Standards for Educational and Psychological Tests as well as other official policy statements of the American Psychological Association call for competent assessment skills. However, a thorough review of the literature evidences only a handful of models that transmit these mandates into practice. The MASTERY model, a competency-based training procedure, was employed in this investigation as a cost-effective means of actualizing these professional standards. This systematic procedure brought 31 graduate students in clinical psychology to criterion level for competent administration of the WAIS-R after less than 10 hours and two administrations. Practical and research implications of this training model for clinical psychology were discussed.

Curriculum↗

Evolution of a Family Nurse Practitioner Program to improve primary care distribution.

The Family Nurse Practitioner Program of the Univeristy of California, Davis, has effectively improved the distribution of primary health care manpower in medically underserved areas. This has been accomplished by selecting students, preceptors, and faculty from areas of need; decentralizing the clinical and didactic training sites; developing a competency-based, portable curriculum; and coordinating it all with a circuit-riding, institutionally based faculty.

California↗

Using a competency-based program to assess interviewing skills of pediatric house staff.

A program has been initiated to assess objectively the interviewing skills of pediatric house staff. Each entering house staff member interviews and is evaluated by a nonphysician mother who presents the medical history of her child. Remedial instruction is provided for all who do not perform in accordance with established minimum criteria. As a result of this competency-based program, all house staff members are now known to have attained at least a minimum level of competence in interviewing technique.

Educational Measurement↗

Six years of experience using patient instructors to teach interviewing skills.

In 1974 a competency-based program was developed at the University of Arizona College of Medicine that used patient instructors (PIs) to evaluate interviewing skills objectively. PIs are nonphysicians who are taught to function in the multiple roles of patient, teacher, and evaluator. For each specialty area, objective evaluation instruments have been developed to measure the student's interviewing technique (interview process) and the amount of relevant historical information obtained from the patient (interview content). Data from the six most recent classes of second-year medical students demonstrate that: (a) there is a positive correlation between process and content scores; (b) students learn from their interviews with PIs; and (c) there is a positive relationship between the scores students obtain on their first interview with each of two different PIs in two different specialty areas. It is concluded that the PI program provides an effective way to teach interviewing skills to medical students.

Clinical Competence↗

Guidelines for competency-based instruction in psychiatry.

This paper presents guidelines for teachers who wish to design competency-based instructional activities in psychiatry. Developed over a 3 year period, these guidelines outline the methods used by teachers to construct competency-based seminars and clinical rotations. The guidelines describe the process of stating knowledge objectives, performance objectives and experiential objectives for psychiatric trainees to attain prior to completion of training in a given area. Selection of appropriate teaching strategies as well as criteria and conditions for assessment of the residents' abilities are also reviewed. Comments regarding the authors' experience using these guidelines with teachers are offered.

California↗

Critical performance analysis of rotating resident doctors in Iraq.

The present study was undertaken to evaluate the competence of rotating residents in handling clinical problems, falling under the purview of the major clinical disciplines, which they come across during their routine work. Three hundred and one rotating residents (55% of the total) who graduated in June 1981 from the four universities of Iraq, namely, Mustansiryia, Basrah, Mosul and Baghdad, and were currently undergoing their residency posting in the various hospitals of Iraq were selected for the study. Two approaches were used to assess the level of competence: first, on the basis of the resident's responses to fifty simulated patient-management problems and, secondly, their critical performance in patient care adjudged by their respective supervisors. A minimum passing level (MPL) was fixed for patient management problems (PMP). The score for the consultant's observations could range from -70 to +100 to represent the very poor and the very good performance. Only 2% of the residents were found to have reached the minimum pass level of competence taking their overall performance in the various disciplines. No significant variation in performance was observed in relation to the university of graduation. None of the residents could reach the MPL in the case of obstetrics and gynaecology. In the case of medicine and medical emergency the findings were almost similar. The residents put up a much better performance in orthopaedics and paediatrics (45.0% and 27.5% respectively). According to the supervisors' assessment nearly two-thirds of the residents secured at least 50% of the maximum score. The study underscores the need to redefine our educational objectives specifically, with aim of developing competences at a defined level in the learner befitting the needs of the health system through a competency-based curriculum.

Clinical Competence↗

Second skill educational development of personnel for a single-room maternity care system.

A modified cross-training approach was used to train nurses for a single-room maternity care unit. This cross-training program included development of a skills list for the labor/delivery and nursery/postpartum areas and an instruction program including formal lectures, independent study, and clinical experience. The clinical part of the program was a preceptor-based experience. The results of this program indicated that competency-based skills and objective selection criteria are mandatory for a successful cross-training program.

Female↗

Strategies for integrating clinical preventive medicine into family medicine clerkships.

The value of integrating preventive medicine into primary care is widely accepted, although practical teaching methods to model this integration into medical student clerkships are not well developed. This paper reports on a competency-based clinical preventive medicine curriculum developed within an existing family medicine clinical clerkship. Evaluation of the curriculum during its first full year of implementation shows that students can significantly improve their perceived levels of competence in discussing specific healthy behaviors and risk factors as well as their fund of knowledge in preventive medicine content areas. However, the greatest effect of the curriculum was on increasing students' knowledge of basic health promotion concepts. Results from this clerkship suggest that collaborative efforts to integrate clinical preventive medicine into primary care education and to support the teaching of health promotion and disease prevention in clinical clerkships can be successful.

Age Factors↗

Development of competency-based, career-entry examination for clinical laboratory personnel.

The process of developing a competency-based credentialing examination for career-entry practitioners is described, including a review of pertinent literature. A modified Delphi technique was used to achieve consensus among a panel of experts with respect to Career-Entry Statements of Competence. Items were written which were referenced specifically to one or more of the statements. The resulting genralist examination for the technologist and technician personnel levels is the first such examination to be reported in the field of clinical laboratory sciences which utilized a formal process involving such large numbers of practicing professionals.

Career Choice↗

Pediatric training in family practice: a core curriculum.

Official residency guidelines for pediatric training of family practice residents focus on the number of months of block time on pediatric rotations and the percentage of pediatric patients in the resident's model practice. These guidelines do not ensure competence in pediatrics. Family practice residencies need a competency-based curriculum derived from actual pediatric experience in family practice. Such a curriculum should define specific knowledge, skills, and attitudes required, define the family physician's role in handling each issue or condition, be used on a daily basis, and form a basis for evaluation of residents and curriculum. This paper describes the development and implementation of such a pediatric core curriculum at the University of Colorado Family Practice Residency.

Clinical Competence↗