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PubMed1997

Performance of "standardized examinees" in a standardized-patient examination of clinical skills.

PURPOSE: As a first step in testing the utility of using trained "standardized examinees" (SEs) as a quality-assurance measure for the scoring process in a standardized-patient (SP) examination, to test whether medical residents could simulate students in an SP examination and perform consistently to specified levels under test conditions. METHOD: Fourth-year students from the Baltimore-Washington Consortium for SPs participated in a National Board of Medical Examiners Prototype Examination of clinical skills consisting of twelve 15-minute student-patient encounters in 1994-95. For this examination, internal medicine residents were trained to act as ordinary candidates and to achieve target scores by performing to a set level on specific checklist items used by SPs for recording interviewing, physical-examination, and communication skills. The "strong SEs" were trained to score 80% correct on six of the examination's 12 cases (study cases), and the "weak SEs" were trained to score 40% correct on the same six cases. The strong and weak SEs' checklist scores on the study cases were compared through independent, two-tailed t-tests. When there was less than 85% agreement on specific checklist items in each case between the SE training and the SP recording, videotapes of the cases were reviewed; in such cases an SE's performance was the final score agreed upon after review. RESULTS: Seven SEs took the SP examination and were not detected by the SPs. There was a total of 84 discrepancies between predicted and recorded checklist scores across 659 checklist items in 40 encounters scored by the SPs. After correcting the discrepancies based on videotape review, the estimated actual mean score was 77.3% for the strong SEs and 44.0% for the weak SEs, and was higher for the strong SEs in each study case. The overall fidelity of the SEs to their training was estimated to be 97%, and the overall SP accuracy was estimated to be 91%. The videotape review revealed 47 training-scoring discrepancies, most in the area of communication skills. CONCLUSION: This study suggests that SEs can be trained to specific performance levels and may be an effective internal control for a high-stakes SP examination. They may also provide a mechanism for refining scoring checklists and for exploring the validity of SP examinations.

Clinical Competence↗
PubMed2005

The development of a new measure for the assessment of psychopathology in adults with intellectual disability.

BACKGROUND: People with intellectual disability (ID) and untreated psychiatric disorder lead unnecessarily difficult and unhappy lives. The prevalence of mental illness in children and adults with ID is greater than that found in the general population. A carer-completed checklist of psychopathology that could be used with both children and adults would help identify those individuals with ID most likely to have a mental health problem, help ensure that they receive the limited services that are usually available and also assist the process of clinical assessment, diagnosis and management. METHOD: This research aimed to develop a reliable and valid carer-completed checklist of psychopathology for adults with ID by redeveloping an existing measure for children with ID, the Developmental Behaviour Checklist (DBC-P). The new checklist, The Developmental Behaviour Checklist for Adults (DBC-A) was devised by changing, deleting and adding to DBC-P items. Reliability studies were conducted with paid and family carers, and DBC-A scores were compared with the results from two other measures of psychopathology. RESULTS: One DBC-P item was deleted, seven items changed and 12 items added. The psychometric properties of this new checklist, the DBC for Adults with ID (DBC-A), were investigated and found to be satisfactory. Intraclass correlations for test-retest and inter-rater reliability ranged from 0.72 to 0.85, and concurrent validity with two measures of emotional and behavioural disturbance was satisfactory. CONCLUSIONS: The carer-completed DBC-A provides a broad and comprehensive survey of the emotional and behavioural problems of adults with ID. It has satisfactory psychometric properties and therefore can be used with confidence in clinical, research and service settings, and its development allows continuous assessment of psychopathology across the lifespan for all people with ID.

Adolescent↗
PubMed1989

Listening carefully. Improving communication about behavior and development. Recognizing parental concerns.

A simple checklist was developed for completion by parents prior to their regular meetings with their pediatricians for health supervision. Its efficacy in improving communication between pediatricians and parents about behavioral and developmental concerns was evaluated. Without the checklist, 30 percent of parents' concerns were discussed. More items overall, and more items that were concerns of the parent, were discussed with the use of the checklist than without it (p less than 0.05). An intermediate but statistically significant effect was observed even when the pediatrician did not see the completed checklist (43% of concerns were discussed); this effect was increased when he did (53% of concerns discussed). There were marked differences among pediatricians in the number of concerns that were discussed both with and without use of the checklist. Items regarding patterns of family life and child care, death or illness, siblings, and other stresses of modern families were frequently indicated as concerns on the checklist but were less frequently discussed. The data demonstrate the effectiveness of a simple and efficient method to improve communication about childrens' behavior and development between their parents and their pediatricians.

Child↗
PubMed2006

Protocol of the COSMIN study: COnsensus-based Standards for the selection of health Measurement INstruments.

BACKGROUND: Choosing an adequate measurement instrument depends on the proposed use of the instrument, the concept to be measured, the measurement properties (e.g. internal consistency, reproducibility, content and construct validity, responsiveness, and interpretability), the requirements, the burden for subjects, and costs of the available instruments. As far as measurement properties are concerned, there are no sufficiently specific standards for the evaluation of measurement properties of instruments to measure health status, and also no explicit criteria for what constitutes good measurement properties. In this paper we describe the protocol for the COSMIN study, the objective of which is to develop a checklist that contains COnsensus-based Standards for the selection of health Measurement INstruments, including explicit criteria for satisfying these standards. We will focus on evaluative health related patient-reported outcomes (HR-PROs), i.e. patient-reported health measurement instruments used in a longitudinal design as an outcome measure, excluding health care related PROs, such as satisfaction with care or adherence. The COSMIN standards will be made available in the form of an easily applicable checklist. METHOD: An international Delphi study will be performed to reach consensus on which and how measurement properties should be assessed, and on criteria for good measurement properties. Two sources of input will be used for the Delphi study: (1) a systematic review of properties, standards and criteria of measurement properties found in systematic reviews of measurement instruments, and (2) an additional literature search of methodological articles presenting a comprehensive checklist of standards and criteria. The Delphi study will consist of four (written) Delphi rounds, with approximately 30 expert panel members with different backgrounds in clinical medicine, biostatistics, psychology, and epidemiology. The final checklist will subsequently be field-tested by assessing the inter-rater reproducibility of the checklist. DISCUSSION: Since the study will mainly be anonymous, problems that are commonly encountered in face-to-face group meetings, such as the dominance of certain persons in the communication process, will be avoided. By performing a Delphi study and involving many experts, the likelihood that the checklist will have sufficient credibility to be accepted and implemented will increase.

Clinical Protocols↗
PubMed2003

Assessment of strategies for identifying diagnosed cases of systemic lupus erythematosus through self-report.

The objective of this work was to assess the optimal way to identify potential systemic lupus erythematosus (SLE) cases in large epidemiologic studies through self-reported information about diagnosis of SLE, symptoms and medications, and to investigate the utility of a criteria checklist sent directly to participants' physicians. We used data collected in 1997 from 53322 participants in a study of African-American women, the Black Women's Health Study, including a lupus screening questionnaire (LSQ) and questions about SLE diagnosis and medications. We confirmed self-reported SLE through medical records and criteria checklists sent to participants' physicians. Among those for whom we received medical records and/or criteria checklists, we compared the predictive value and proportion of missed cases of several algorithms using combinations of self-reported SLE diagnosis, LSQ score and medication use to self-reported SLE diagnosis alone. We obtained a physician checklist or medical chart for 251 individuals who reported SLE, of whom 212 (84%) fulfilled ACR criteria for definite or probable SLE, or had clinical lupus (SLE diagnosis recorded in medical charts plus appropriate medication use). The use of LSQ score or medication use in addition to self-report of SLE tended to decrease the false positive rate but also to reduce the proportion of true cases identified. Checklists of ACR criteria completed by subjects' physicians documented more criteria than medical records. In conclusion, among participants who consented to medical record review, SLE prediction algorithms using questions about lupus symptoms and medications offered slightly higher predictive value for detecting cases than self-reported diagnosis alone, but at the cost of case detection. SLE case confirmation strategies can be complemented by the use of criteria checklists sent directly to participants' physicians.

Adult↗
PubMed1992

Assessing the responsiveness of a quality-of-life instrument and the measurement of symptom severity in essential hypertension.

A pilot study was conducted to compare symptoms elicited with an open-ended question versus a checklist and to measure the responsiveness of quality-of-life measures to symptom severity. The pilot study was part of a multicentre, randomised, double-blind, placebo-controlled study of clentiazem, a calcium channel blocker, in the treatment of essential hypertension. Symptom and quality-of-life data were obtained from 88 patients at baseline and after 10 weeks of therapy by a trained telephone interviewer. Comparison of the symptom checklist and open-ended question method suggests that both methods are necessary to capture severe symptomatology. The 24-item checklist failed to elicit approximately 50% of the severe symptoms reported on the open question list. On the other hand, only 18% of the most severe symptoms subsequently reported on the checklist were first reported by the open question method. The responsiveness of quality-of-life measures to symptom severity was tested using a 20% change in symptom severity obtained from the checklist as the minimal clinically significant difference. Using Guyatt's formula, a minimum sample size of approximately 428 (alpha = 0.05, beta = 0.10) patients per treatment group is required to detect differences in measures of general health perception, anxiety, depression and limitations in social activities. A larger sample is required to show differences in leisure activities. Differences in limitations of the capability to perform house or yard work might be demonstrable with as few as 17 patients per group. This pilot study demonstrated that the severity of symptoms associated with hypertension, and the side effects of its treatment with drugs, are adequately captured by a symptom checklist preceded by an open-ended method of questioning. Responsiveness testing estimated the sample size required to show a statistically significant difference, assuming a 20% change in symptom severity.

Diltiazem↗
PubMed1999

Pediatric asthma care in the emergency department: measuring the quality of history-taking and discharge planning.

The National Asthma Education and Prevention Program NAEPP Guidelines include recommendations for history-taking and discharge planning during an asthma visit, but there are no tools to measure performance. The objectives of this study were to define and operationalize key elements of history-taking and discharge planning, to develop a tool for measuring these elements, and to evaluate the quality of history-taking and discharge planning in the emergency department (ED) during visits for asthma using the new tool. Expert opinion and extensive literature review were used to develop a 13-item checklist containing items that should be documented during history-taking and provided during discharge planning for an ED visit for an acute asthma exacerbation by children. A convenience sample of 90 pediatric emergency medicine physicians and allergists rated each item in the checklist. The checklist was used to score audiotapes of asthma visits in the ED. Subjects were 154 parents of asthmatic children aged 4-9 years seeking care in nine inner-city EDs affiliated with asthma centers participating in the National Cooperative Inner-City Asthma Study and the physician/providers who delivered care. Seven of the 13 items on the checklist were rated as required to be performed by more than 90% of the allergist/pediatric emergency medicine physicians. Only 10% of the 154 visits included all seven of the highly rated items, whereas 19% of the visits included three or fewer. Only 7 of the 13 items (54%) were performed in more than 50% of the visits, and 4 items were performed in fewer than 25% of visits. Based on expert ratings, the checklist for measuring elements of history-taking and discharge planning during asthma visits appears to have considerable face validity. In the visits studied, the overall performance of these elements was low. Interventions to improve performance on the checklist might lead to improved care for children with asthma who frequent the ED.

Asthma↗
PubMedDate not supplied

[A catalog of mosquito species (Culicidae family) from the Asian region of Russia].

A new checklist of mosquitoes (Culicidae) recorded in the Asian part of Russia includes 79 species. The checklist is provided with taxonomic comments and compared with ones compiled by previous authors. In a comparison to the checklist of Kukharchuk (1980) including 73 species, 10 species are added into the present checklist and 6 species mentioned by this author are excluded, as far they were not actually found in Asian part of Russia. The names of 9 species are chanced according to the International Code of Zoological Nomenclature (1966). In the checklist of Stojanovich and Scott (1995) including 64 species, 5 species were included erraneously and 21 species were missed. The classification and valid species names are listed according to the Catalog of the Mosquitoes of the World (Knight, Stone, 1977) and its supplements (Knight, 1978; Ward, 1984, 1992; Gaffigan, Ward, 1985), except 5 species. These species (Aedes implicatus, Ae. esoensis, Ae. rossicus, Ae. albescens, Ae. subdiversus) are considered in the comments to the checklist.

Animals↗
PubMed1998

The rational clinical examination. Does this patient have a mole or a melanoma?

Lifetime risk for malignant melanoma has increased from 1 in 1500 in the United States in 1930 to 1 in 75 projected for the year 2000. Because the tumor's thickness at excision is the primary prognostic determinant, early detection through the history and physical examination can play an important role in the patient's clinical course. Two checklists have been developed as diagnostic aids, the ABCD (A indicates asymmetry; B, border irregularity; C, irregular color; and D, diameter >6 mm) and the revised 7-point checklists. These checklists should be interpreted with some discretion, but 2 studies have found the sensitivity for the ABCD checklist to be 92% (95% confidence interval [CI], 82%-96%) and 100% (95% CI, 54%-100%); 1 study found the specificity to be 98% (95% CI, 95%-99%). The revised 7-point checklist has been reported to have a sensitivity of 79% (95% CI, 70%-85%) to 100% (95% CI, 94%-100%) and specificity of 30% (95% CI, 21%-39%) to 37% (95% CI, 28%-46%). Physicians' global assessments for detecting the presence or absence of melanoma are estimated to have a specificity of 96% to 99%, while sensitivity ranges widely from 50% to 97%. Nondermatologists' examinations appear to be less sensitive than examinations performed by dermatologists.

Dermatology↗
PubMed1986

An objective evaluation of special class placement of elementary schoolboys with behavior problems.

Behavioral checklists were employed to identify the type and degree of psychopathology observed in 90 boys who were referred for possible placement in classrooms for the socially and emotionally disturbed (SED). School behavior was assessed by teachers completing the Conners Teacher Rating Scale, while behavior at home was rated by parents with the Child Behavior Checklist. The checklist findings from both environments showed the boys to have high levels of psychological disturbance, especially for externalizing factors such as hyperactivity, aggression, and conduct disorder. This was especially true for those boys for whom SED placement was recommended. Further, the clinical usefulness of these checklists was investigated as an adjunctive method for the determination of the need for SED placement. By the use of discriminant function analysis, about three-fourths of the boys recommended for SED placement were accurately identified; correct classification was maximized when parent and teacher checklists were employed together.

Child↗
PubMed1993

Evaluation of resident performance in an outpatient internal medicine clinic using standardized patients.

OBJECTIVE: To observe and evaluate the performance of primary care internal medicine residents within the outpatient clinic milieu. DESIGN: Longitudinal descriptive study. PATIENTS/PARTICIPANTS: 48 internal medicine resident encounters with two standardized patients at the University of Wisconsin General Internal Medicine Clinics. INTERVENTION: Residents were rated by the standardized patients with a medical skills checklist and an interpersonal skills checklist, and by the staffing physician with a clinical reasoning skills checklist. The investigators reviewed audiotapes of the standardized patient encounters for strategic management skills. MAIN RESULTS: Resident performance on these scales was examined for improvement with years of training; when considered separately, no such effect was seen for either standardized patient case. When the cases were grouped together, however, there was significant improvement on the Clinical Reasoning Instrument. The grouped standardized patient data were compared with data from inpatient faculty evaluations of the residents. Faculty evaluations correlated with standardized patient evaluations of resident performance only on the medical checklist. Finally, comparison of the four assessment scales demonstrated a significant correlation between interpersonal skills, as assessed by the patient, and strategic management skills. CONCLUSION: Resident outpatient performance, measured in a blinded setting, does not improve with year of training. Faculty inpatient assessments of residents correlate with medical "thoroughness" as measured by a medical skills checklist, and interpersonal skills as rated by standardized patients correlate with resident use of strategic medical management.

Adult↗
PubMed2004

Faculty and resident preference for two different forms of lecture evaluation.

OBJECTIVE: This study was undertaken to compare the use of 2 different lecture evaluation forms developed for obstetrics and gynecology residents to evaluate core curriculum lectures given by faculty. STUDY DESIGN: Content and delivery of faculty lectures were evaluated by residents using (1) a 10-question evaluation form that used a 5-point rating scale and (2) a checklist evaluation form that offered multiple options to improve lectures but provided no numerical score. Each form was used exclusively for 4 months. Faculty received feedback from both forms; then faculty and residents were surveyed regarding their preferences. RESULTS: A total of 384 rating scale and 398 checklist evaluation forms were completed during the study period. Residents preferred to complete the rating scale evaluation forms (67%), whereas faculty preferred feedback from the checklist evaluation forms (62%). Faculty were more likely to plan changes to their lecture format with feedback from the checklist evaluation forms (75% vs 25%, P = .031). CONCLUSION: Although devoid of structured positive feedback, the checklist lecture evaluation form was preferred by faculty.

Faculty↗
PubMed1998

Prevalence of back discomfort and estimates of back load in two manufacturing facilities.

This study evaluated the association between the prevalence of back discomfort and estimates of back load posed by nine jobs in two manufacturing facilities. Prevalence of back discomfort experienced was estimated through self-administered questionnaires. A total of 266 questionnaires were distributed to workers randomly selected from nine jobs in two factories. Workers were asked to rate on a 0-5 scale the discomfort level they experienced in the back for a one-month period before and at the time of the survey. The return rate for each job ranges from 57% to 100%. Overall, 14.5% of the survey respondents experienced some discomfort in the back. With the assistance of a checklist, nine supervisors rated each task of the job they supervised by the magnitude of the force (low, moderate, or high) and by the duration, (less than 30% time, 30% to 50% time, and greater than 50% time) that workers typically spent in awkward back postures, such as back flexion, extension, twisting, and lateral bending. An additional total back load estimate was provided independently by an ergonomist. Logistic regression analysis found a positive association between the back discomfort prevalence observed in the present study and the load estimates both by the ergonomist and by task information based on back twisting. Significant concordance was found between the ergonomist's load estimates and the supervisors' estimate of the duration of twisted back. This study demonstrated not only that a checklist approach could provide useful task information for deriving exposure estimates, but also that exposure estimate for a job could be derived from its constituent tasks. Though in this study it was the supervisor who utilized the checklist to estimate the back loads, there is no reason why experienced workers could not use the checklist to provide similar estimates. A large-scale study should be conducted to improve the design of this checklist approach.

Adolescent↗
PubMed1997

The prediction of child maltreatment in Greek families.

OBJECTIVE: The study had two aims: First, to identify characteristics of physically maltreating families in the Attica region of Greece; and second, to produce a checklist of high risk predictors which may be used for screening, as an assessment, to enable secondary prevention of physical abuse and neglect. METHOD: A case control design was used with individual matching. The sample comprised 197 physically abused and neglected children and their families referred to a multidisciplinary team. These were compared with 163 control children and their families attending a community health center. RESULTS: The findings suggest that abusing families differ from controls on a number of variables related to child, parental, and family characteristics. The statistical analysis produced a checklist of 15 Predictors. Their classification into High, Medium, and Low Predictors pointed out that the most prominent characteristics were those associated with parents' own adverse life experiences, mental health problems, bad quality of relationship between spouses, and parental neglect of the child's hygiene. The predictive ability of the checklist produced a sensitivity of 92% and a specificity of 96% (logistic regression) and a sensitivity of 86.8% and a specificity of 96.3% (discriminant function). The use of this checklist for screening is discussed with emphasis on methodological and ethical issues. Special emphasis is given on the cultural relevance of such an application within the Greek cultural milieu. CONCLUSION: The findings indicate that secondary prevention of child maltreatment in Greece is feasible by using a checklist of risk factors as predictors. Such screening should be accompanied by clinical assessment based on qualitative aspects of mother-infant interaction. Special emphasis should be given to the cultural relevance of this approach while ethical issues should be considered.

Adolescent↗
PubMed2000

A tool to improve quality of reporting published economic analyses.

OBJECTIVES: To test the feasibility of obtaining a baseline level of quality of reporting for cost-utility analysis (CUA) studies using the British Medical Journal economic submissions checklist, test interrater reliability of this tool, and discuss its longer term implications. METHODS: CUA studies in peer-reviewed English language journals in 1996, assessed using the British Medical Journal checklist, a quality index, and interrater reliability correlations. RESULTS: Forty-three CUA studies were assessed, with 23 checklist items acceptable and 10 items inadequate. Lowest quality scores were reported in specialist medical journals. Proportional agreement between assessors was over 80%. CONCLUSIONS: The British Medical Journal checklist is a feasible tool to collect baseline information on the quality of reporting in journals other than the British Medical Journal. Editors of specialist medical journals are in greatest need of economic guidance. If handled carefully, they might consider adopting the British Medical Journal checklist.

Cost-Benefit Analysis↗
PubMed2003

A strategy to standardize the learning of core clerkship objectives.

BACKGROUND: Consistent and effective implementation of clinical clerkship objectives remains elusive. Using the behavioral principles of self assessment, active learning and learner differences, we designed an objectives checklist to ensure that all students mastered a core body of internal medicine (IM) knowledge and to facilitate self-directed learning. METHODS: We developed a 54-item learning objectives checklist card in the IM clerkship. In a randomized controlled trial by clerkship site and block, students in the intervention group received the checklist card and were instructed to obtain sign off on objectives by faculty and housestaff and to seek teaching, literature, and clinical experiences to satisfy objectives unmet through routine activities. Intervention group faculty and housestaff were oriented to the use of the checklist. Both intervention and control groups received the course syllabus. We assessed learning with faculty and housestaff evaluations, student knowledge self-assessment, and a written examination. Satisfaction with the cards was assessed with written evaluations. RESULTS: There were no significant differences in ward evaluations, examination scores or self-assessed knowledge between students using the learning objectives cards and control groups. Faculty were more likely than students to agree that objectives cards improved education. CONCLUSIONS: An intervention designed to guide students in the use of a learning objectives card did not enhance learning as assessed by ward evaluations, a written examination, and satisfaction surveys. It is possible that more sensitive outcome measures could detect differences in knowledge for students using learning objectives checklist cards.

Clinical Clerkship↗
PubMed2002

Validity and reliability of the communication and symbolic behavior scales developmental profile with very young children.

Three studies were conducted to evaluate the validity and reliability of the three measures of the Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP): (1) a one-page parent-report checklist; (2) a four-page follow-up caregiver questionnaire (CQ); and (3) a behavior sample (BS), which is a face-to-face evaluation of the child. Participants for these studies were drawn from a pool of 603 children for the checklist and CQ (ages 6-24 months) and 364 children for the BS (ages 12-24 months). Study 1 examined the concurrent relationship of standard scores for the checklist, CQ, and BS. Large correlations were found between the checklist and CQ and moderate to large correlations were found between each of the parent report tools and the BS. Study 2 examined test-retest stability by comparing the raw and standard scores over a 4-month retest interval. The results indicated significantly greater retest raw scores but no significant differences between standard scores from test to retest for the checklist, CQ and BS, providing evidence that the three measures detect growth over short periods but produce relatively stable rankings of children. Study 3 examined the concurrent and predictive relationship of the three CSBS DP measures and children's outcomes on standardized tests of receptive and expressive language at 2 years of age. Moderate to large correlations were found between all of the CSBS DP measures and language outcomes at 2 years of age. Multiple regression analyses indicated that the three composites were a significant predictor of receptive and expressive language outcomes. The findings from these three studies support the use of the CSBS DP as a screening and evaluation tool for identifying children with developmental delays at 12 to 24 months of age.

Child Behavior↗
PubMed1997

COVERS for anaesthetic machines: an audit and standard.

All the anaesthetic machines in one District General Hospital were tested for faults on three occasions for both audit and re-audit using an extended checklist based on that devised by the Association of Anaesthetists of Great Britain and Ireland. Ninety completed checklists were analysed for the audit and 24 tests revealed 236 individual faults (range 1.1-64%). Sixty-five (27.5%) could have occurred on a day-to-day basis and 171 (72.5%) of the faults were non-recurring. Following introduction of COVERS (a pre-use checklist) re-audit of 102 completed checklists showed 20 tests revealing faults on 59 occasions (range 1.0-11.6%), 16 (27%) day to day and 43 (73%) non-recurring. COVERS supported by scheduled regular comprehensive checking delegated to another time and performer is recommended as the mandatory pre-use checklist.

Anesthesiology↗