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PubMed1997

Training for Norplant implant removal: assessment of learning curves and competency.

OBJECTIVE: To determine the learning curves and rapidity with which clinicians become competent in implant removal using two Norplant removal techniques. METHODS: Twenty-four physicians, none of whom were experienced in the use of Norplant implants, were randomly assigned to learn either the "U" removal technique or the standard technique. The physicians in the two groups received identical training in all other respects. Each physician then performed ten supervised removals. Removal times, procedure problem rates, and the number of procedures performed by the clinicians before they were judged "competent" were assessed for both groups. RESULTS: Data from 240 removals were analyzed. Mean removal times were 38% faster in the "U" group than in the standard group. None of the "U" group procedures took longer than 20 minutes, compared with 11% of removals in the standard group (P < .001). The mean number of cases required before the provider consistently performed all steps adequately was significantly (P < .02) higher in the standard group (5.8 cases) than in the "U" group (3.9 cases). CONCLUSIONS: Using competency-based training methods, the "U" removal technique was learned easily by inexperienced clinicians. It appears to offer significant improvements in speed and achievement of proficiency over the standard technique recommended by the manufacturer. Large-scale programs should consider using competency-based training and the "U" technique as the removal method of choice when providing training in implant removal.

Clinical Competence↗
PubMed1997

Using a performance improvement team to reinvent a mandatory education program.

BACKGROUND: To improve employee attendance at Annual Review Day, the day when all mandatory hospitalwide education requirements are presented. The Finley Hospital (Dubuque, Iowa) initiated a performance improvement team in March 1993. Data collected previous to 1993 indicated that the compliance goal of 90% was being met only with difficulty. PERFORMANCE IMPROVEMENT TEAM: Data indicated three main areas where improvements could be made-communication, enforcement, and curriculum. Recommendations of task forces, with team members as leaders, were implemented. Decisions were made to change Annual Review Day to a full-day format to include all mandatory education, make outcomes competency based, and maintain cost-effectiveness. TRIAL RUN AND EVALUATION: The one-year trial run began in 1994 with gradual changes in the program from a lecture and video format to an interactive game format. For example, at one point a crossword puzzle with information on infection control and bloodborne pathogens was added. The Jeopardy Game format, used to teach the principles of emergency preparedness, was added in June 1994. Full implementation of the curriculum, communication, and enforcement recommendations have resulted in 100% compliance. MAINTAINING THE GAIN: The performance improvement team has continued to monitor results and submit quarterly reports to the quality management department. All participants must complete and pass a competency-based test on the information covered; all 760 participants have passed. The curriculum task force continues to meet on a yearly basis to evaluate the ever-evolving format, analyze attendee evaluations, and consider annual changes to the format.

Accreditation↗
PubMed1976

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↗
PubMed1978

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↗
PubMed1983

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↗
PubMed1978

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↗
PubMed1983

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↗
PubMedDate not supplied

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↗
PubMedDate not supplied

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↗
PubMed1978

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↗
PubMed1982

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↗
PubMed1981

Competency-based advancement program for pharmacists.

A competency-based advancement program for practicing pharmacists is presented. The criteria for selecting this method of providing incentives for pharmacists are outlined. Procedures for developing and implementing this competency-based program are described. Five competency levels for pharmacists were developed based on the pharmacist's educational background, training, and experience. Differentiated position titles and competency expectations for each level are summarized. Criteria for pharmacist placement and promotion from one completely level to another are outlined. The administration of the program is described, including budget considerations and methods for evaluating its effectiveness. This system recognizes and rewards accomplishments of staff pharmacists without removing them from patient care roles.

Budgets↗