Changing habits of practice

Bowen, Judith L.; Salerno, Stephen; Chamberlain, John; Eckstrom, Elizabeth; Chen, Helen L.; Brandenburg, Suzanne

doi:10.1111/j.1525-1497.2005.0248.x

Cited by 63 publications

(28 citation statements)

References 77 publications

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“…In Canada, the Royal College of Physicians and Surgeons of Canada (RCPSC) objectives of training in the specialty of Internal Medicine (IM) define the internist as a physician who cares for hospitalized and ambulatory patients thus making the ambulatory clinic setting an important workplace environment for IM trainees [ 3 ]. Given that the majority of health care is now delivered within the ambulatory setting [ 4 ], we must ensure that our trainees are given the opportunity to become competent at providing care within this setting.…”

Section: Introductionmentioning

confidence: 99%

Avoid reinventing the wheel: implementation of the Ottawa Clinic Assessment Tool (OCAT) in Internal Medicine

et al. 2018

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BackgroundWorkplace based assessment (WBA) is crucial to competency-based education. The majority of healthcare is delivered in the ambulatory setting making the ability to run an entire clinic a crucial core competency for Internal Medicine (IM) trainees. Current WBA tools used in IM do not allow a thorough assessment of this skill. Further, most tools are not aligned with the way clinical assessors conceptualize performances. To address this, many tools aligned with entrustment decisions have recently been published. The Ottawa Clinic Assessment Tool (OCAT) is an entrustment-aligned tool that allows for such an assessment but was developed in the surgical setting and it is not known if it can perform well in an entirely different context. The aim of this study was to implement the OCAT in an IM program and collect psychometric data in this different setting. Using one tool across multiple contexts may reduce the need for tool development and ensure that tools used have proper psychometric data to support them.MethodsPsychometrics characteristics were determined. Descriptive statistics and effect sizes were calculated. Scores were compared between levels of training (juniors (PGY1), seniors (PGY2s and PGY3s) & fellows (PGY4s and PGY5s)) using a one-way ANOVA. Safety for independent practice was analyzed with a dichotomous score. Variance components were generated and used to estimate the reliability of the OCAT.ResultsThree hundred ninety OCATs were completed over 52 weeks by 86 physicians assessing 44 residents. The range of ratings varied from 2 (I had to talk them through) to 5 (I did not need to be there) for most items. Mean scores differed significantly by training level (p < .001) with juniors having lower ratings (M = 3.80 (out of 5), SD = 0.49) than seniors (M = 4.22, SD = − 0.47) who had lower ratings than fellows (4.70, SD = 0.36). Trainees deemed safe to run the clinic independently had significantly higher mean scores than those deemed not safe (p < .001). The generalizability coefficient that corresponds to internal consistency is 0.92.ConclusionsThis study’s psychometric data demonstrates that we can reliably use the OCAT in IM. We support assessing existing tools within different contexts rather than continuous developing discipline-specific instruments.Electronic supplementary materialThe online version of this article (10.1186/s12909-018-1327-7) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

Avoid reinventing the wheel: implementation of the Ottawa Clinic Assessment Tool (OCAT) in Internal Medicine

et al. 2018

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“…It should be noted that evaluations analyzed were inpatient rotations, excluding outpatient rotations. As has been well documented in prior literature, the disproportionately higher amount of inpatient experience, as compared to outpatient experience [18], led us to this decision, but should be factored into its interpretation.…”

Section: Discussionmentioning

confidence: 99%

Effects of gender in resident evaluations and certifying examination pass rates

et al. 2019

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BackgroundThough the proportion of female Internal Medicine (IM) residents and faculty has increased, there is minimal large scale modern data comparing resident performance by gender. This study sought to examine the effects of resident and faculty gender on resident evaluations.MethodsRetrospective observational study over 5 years in a single IM program. IM certifying examination pass rates were obtained from the American Board of IM.ResultsFour hundred eighty-eight residents (195 women, 293 men), evaluated by 430 attending physicians (163 women, 270 men) were included. Twelve thousand six hundred eighty-one evaluations between 2007 and 2012 were analyzed. Female residents scored higher in two domains (Medical Interviewing, and Interpersonal and Communication Skills) (p < 0.01 for each), with no significant difference between genders for the other domains (Medical Knowledge, Overall Patient Care, Physical Examination, Procedural Skills, Professionalism, Practice Based Learning and Improvement, System Based Practices and Overall score). There were no differences in scoring between female and male attending physicians. There were no differences in certifying examination scores between women and men among graduating residents. National pass rates for women were not statistically different to pass rates for men from 1987 to 2015.ConclusionsData from one large academic medical center demonstrate higher ratings for female residents on performance domains reflecting bedside care and interpersonal skills, with similar scores for medical knowledge and remaining domains. No significant difference was seen locally in certifying examination scores, nor in recent national pass rates, an objective measure of medical knowledge. Despite imbalanced female representation in areas of medicine, our data suggest that gender-based disparities in Internal Medicine resident medical knowledge and physician competency are no longer present.Electronic supplementary materialThe online version of this article (10.1186/s12909-018-1440-7) contains supplementary material, which is available to authorized users.

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“…In addition to qualitative assessment, we plan to use some existing instruments, for example, the Diabetes Attitude Scale, and adapt other instruments, eg Beliefs about Barriers to (Optimal) Self Care 21 22. Other potential methods of assessment include resident portfolios, a self-management mini-CEX, 360 degree evaluation, and direct observation with checklist 6 7 23. An assessment of competence and/or capability24 will come from measurement of quality of care provided by the trainees in their own primary-care panels.…”

Section: Initial Experiences Of Trainees In Smasmentioning

confidence: 99%

“…Although all six competencies apply to management of chronic illness, these two have been the most difficult for residency programmes to address in any comprehensive manner 4 – 6. Training venues that mesh a systems approach to high-quality outpatient care for chronic illness with effective teaching are needed 7 – 10. Among the models proposed for healthcare system redesign is the chronic-care model (CCM) of Wagner et al .…”

mentioning

confidence: 99%