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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↗

Validating interpretive arguments for licensure and certification examinations.

To validate the interpretation assigned to test scores is to support the rationale for this interpretation. The interpretations for licensure and certification tests involve a sequence of inferences, or an argument, leading from the test score to decisions about licensure or certification. This article examines several possible interpretive arguments for licensure and certification test scores and analyzes the evidence required to support each type of argument. Particular attention is given to a competency-based argument that involves a sequence of several inferences leading from test scores to statements about competence, and then to conclusions about expected performance in practice. Decisions about licensure or certification are based on expected performance in practice.

Certification↗

Identifying and comparing competencies for social work management: a practice driven approach.

The study explicates a competency-based model of contemporary social work management practice and compares this model with frameworks derived from earlier studies. Using a purposive sample of 184 social work managers throughout the country, an exploratory factor analysis yielded twelve sets of competencies required of today's social work manager. A comparison of the present model to earlier management frameworks reveals that substantive changes in the nature, scope, complexity, and priorities assigned to management competencies and skills have transformed the role of the social work manager over the last decade. Implications for social work manager education are reviewed and future research directions are proposed.

Administrative Personnel↗

The Federated Council of Internal Medicine's resource guide for residency education: an instrument for curricular change.

The Federated Council of Internal Medicine has developed a resource guide to help internal medicine residency programs produce internists who are prepared for today's practice of internal medicine and the challenges of practice in the future. The guide situates general internal medicine as the primary care profession that focuses on preventive, short-term, and long-term care of adult patients. It assumes that a single pathway is sufficient for educating general internists and subspecialty-bound trainees. It identifies the learning experiences that should be part of general internal medicine residency training, lists the clinical competencies that are important for primary care practice, and describes the role of the integrative disciplines that should inform the care of every patient. It also describes a process that program directors and local program committees can use to develop competency-based curricula.

Curriculum↗

The role of the primary care PA.

At a time when roles of various allied health care providers frequently overlap, it is important to clearly delineate who does what, so there is less provider and patient confusion. In the case of the PA, it is also advantageous to determine periodically whether there are new functions to the role previously not described in the literature. The roles of primary care PAs were validated by using a mail survey developed through a review of PA roles frequently mentioned in the literature. The survey was sent to 47 training programs and 222 Emory University PA graduates working in primary care and non-primary care practices. Mean and median scores for each role per respondent category are reported and compared with mean differences between groups about role perceptions. Strong agreement occurred between and among respondent groups for PA roles dealing with documentation of health status, analysis of data, formulation and conduction of treatment and/or management plan, management of life-threatening emergencies, and patient education. From these data, competencies, performance criteria, and objectives can be generated for each validated role to assist in creating a competency-based curriculum for PAs.

Georgia↗

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↗