Physicians’ clinical experience and its association with healthcare quality: a systematised review

Ajmi, Soffien Chadli; Aase, Karina

doi:10.1136/bmjoq-2021-001545

Cited by 18 publications

(16 citation statements)

References 55 publications

(42 reference statements)

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“…51 Multiple other studies also confirm that clinical experience is not a proxy for skill or patient care quality. 25,45,[52][53][54][55][56] Our results indicate that it is not evidence based to rely on the number of procedures performed to ensure patients undergoing CRC screening undergo high-quality polypectomy procedures. SBML provides a potential solution because this method requires all learners to meet or exceed a rigorous MPS before completion of training.…”

Section: Discussionmentioning

confidence: 87%

“…This finding is not surprising because other studies have also demonstrated that experienced practicing physicians have variable skills performance in procedures such as central venous catheter insertion, 33 temporary hemodialysis catheter insertion, 34 fundamentals of laparoscopic surgery, 38 anesthesia maintenance of certification, 37 and laparoscopic bariatric surgery 51 . Multiple other studies also confirm that clinical experience is not a proxy for skill or patient care quality 25,45,52–56 …”

Section: Discussionmentioning

confidence: 94%

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Effect of Polypectomy Simulation-Based Mastery Learning on Skill Retention Among Practicing Endoscopists

Barsuk,

Cohen,

Patel

et al. 2023

Acad Med

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Purpose Practicing endoscopists frequently perform and teach screening colonoscopies and polypectomies, but there is no standardized method to train and assess physicians who perform polypectomy procedures. The authors created a polypectomy simulation-based mastery learning (SBML) curriculum and hypothesized that completion of the curriculum would lead to immediate improvement in polypectomy skills and skill retention at 6 and 12 months after training. Method The authors performed a pretest-posttest cohort study with endoscopists who completed SBML and were randomized to follow-up at 6 or 12 months from May 2021 to August 2022. Participants underwent SBML training, including a pretest, a video lecture, deliberate practice, and a posttest. All learners were required to meet or exceed a minimum passing standard on a 17-item skills checklist before completing training and were randomized to follow-up at 6 or 12 months. The authors compared simulated polypectomy skills performance on the checklist from pretest to posttest and posttest to 6- or 12-month follow-up test. Results Twenty-four of 30 eligible participants (80.0%) completed the SBML intervention, and 20 of 24 (83.3%) completed follow-up testing. The minimum passing standard was set at 93% of checklist items correct. The pretest passing rate was 4 of 24 participants (16.7%) compared with 24 of 24 participants (100%) at posttest (P < .001). There were no significant differences in passing rates from posttest to combined 6- and 12-month posttest in which 18 of 20 participants (90.0%) passed. Conclusions Before training and despite years of clinical experience, practicing endoscopists demonstrated poor performance of polypectomy skills. SBML was an effective method for practicing endoscopists to acquire and maintain polypectomy skills during a 6- to 12-month period.

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Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 94%

Effect of Polypectomy Simulation-Based Mastery Learning on Skill Retention Among Practicing Endoscopists

Barsuk,

Cohen,

Patel

et al. 2023

Acad Med

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“…90 This is exacerbated by polypharmacy, 91 incorrect indications, 92 and the clinical experience of prescribers. 93,94 All of which can increase hospital stays, costs, mortality, and morbidity. 95,96 This calls for an integrated multidisciplinary strategy to improve the appropriate use of antibiotics, with particular attention to extreme-aged patients with pneumonia.…”

Section: Discussionmentioning

confidence: 99%

Appropriateness of antimicrobial selection for treatment of pneumonia in selected public hospitals of Eastern Ethiopia: A cross-sectional study

et al. 2023

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Objective: Inappropriate antimicrobial use leads to drug resistance and poor clinical outcomes. Considering the lack of data regarding the drug use patterns in the treatment of pneumonia in selected study areas, the authors felt compelled to assess the appropriateness of antimicrobial usage in the treatment of pneumonia at Hiwot Fana Specialized Comprehensive University Hospital and Jugal Hospital from May 1 to 31, 2021. Methods: A cross-sectional retrospective study was conducted using the medical cards of 693 admitted patients with pneumonia. The collected data were analyzed using SPSS version 26. Bivariable and multivariable logistic regression analyses were used to identify the factors associated with an initial inappropriate antibiotic use. A p value of 0.05 was used to determine the statistical significance of the association using an adjusted odds ratio with 95% confidence interval. Results: Of the total participants, 116 (16.74%, 95% confidence interval: 14.1–19.6) of them received an initial inappropriate antimicrobial regimen. Ceftriaxone plus azithromycin was the most prescribed antimicrobial agent. Patients who were younger than 5 years (adjusted odds ratio = 1.71; 95% confidence interval: 1.00–2.94), between 6 and 14 years (adjusted odds ratio = 3.14; 95% confidence interval: 1.64–6.00), and older than 65 years (adjusted odds ratio = 2.97; 95% confidence interval: 1.07–2.66), with comorbid conditions (adjusted odds ratio = 1.74; 95% confidence interval: 1.10–2.72) and prescribed by medical interns (adjusted odds ratio = 1.80; 95% confidence interval: 1.14–2.84) were associated with an initial inappropriate antimicrobial use. Conclusion: Around one out of every six patients had received initial inappropriate treatments. Adherence to the recommendation of guidelines and attention to extreme-aged groups and comorbidity may improve antimicrobial use.

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“…However, the research on physician experience and its relationship to performance is surprisingly inconclusive. A systematic review of physician experience studies found 43% of the evaluations reviewed had a positive association, while 35% had no association and 22% showed a negative association (Ajmi and Aase, 2021). On the other hand, a review by Choudhry et al (2005) showed primarily a negative relationship between physician experience and performance, where performance reflected factual knowledge, adherence to standards of care and patient outcomes.…”

Section: Physicians' Performance In Us Hospitalsmentioning

confidence: 99%

The effects of physicians on operational and financial performance in United States hospitals: staffing, human capital and knowledge spillovers

Stock

McDermott

2023

IJOPM

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PurposeThe authors examine how physician staffing, human capital and knowledge spillovers are related to multiple dimensions of hospital operational and financial performance at the organizational level.Design/methodology/approachThe authors use a data set assembled from multiple sources for more than 1,300 US hospitals and employ hierarchical linear regression to test this study’s hypotheses. The authors use multiple quality, efficiency and financial measures of performance for these hospitals.FindingsThe authors find that higher levels of staffing, skills and knowledge spillovers associated with physicians were positively associated with multiple dimensions of hospital performance. The authors find linear and nonlinear relationships between experience and performance, with the relationships primarily negative, and nonlinear relationships between spillovers and quality performance.Practical implicationsHospital managers should consider increasing physician staffing levels if possible. In addition, the overall Final MIPS Score from the Centers for Medicare and Medicaid Services might be included as a factor in determining which physicians practice in a hospital. Finally, if possible, encouraging physicians to practice at multiple hospitals will likely be beneficial to hospital performance.Originality/valueThis study’s findings are original in that they explore how physician-specific staffing and human capital, which have received comparatively little attention in the literature, are related to several different dimensions of hospital-level operational and financial performance. To the best of the authors’ knowledge, this paper is also the first to examine the relationship between the construct of physician knowledge spillovers and hospital-level operational and financial performance.

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Physicians’ clinical experience and its association with healthcare quality: a systematised review

Cited by 18 publications

References 55 publications

Effect of Polypectomy Simulation-Based Mastery Learning on Skill Retention Among Practicing Endoscopists

Effect of Polypectomy Simulation-Based Mastery Learning on Skill Retention Among Practicing Endoscopists

Appropriateness of antimicrobial selection for treatment of pneumonia in selected public hospitals of Eastern Ethiopia: A cross-sectional study

The effects of physicians on operational and financial performance in United States hospitals: staffing, human capital and knowledge spillovers

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