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Research paper thumbnail of Setting performance standards for medical practice: a theoretical framework

Medical Education, 2001

Conclusion Standards that re¯ect the complexity of medical practice may best be developed through... more Conclusion Standards that re¯ect the complexity of medical practice may best be developed through aǹ expert systems' analysis of clinical conditions for which desired health care outcomes re¯ect the contribution of several health professionals within a complex, threedimensional, contextual model. Examples of the model are provided, but further work is needed to test validity and measurability.

Research paper thumbnail of Setting performance standards for medical practice: a theoretical framework

Background The assessment of performance in the real world of medical practice is now widely acce... more Background The assessment of performance in the real world of medical practice is now widely accepted as the goal of assessment at the postgraduate level. This is largely a validity issue, as it is recognised that tests of knowledge and in clinical simulations cannot on their own really measure how medical practitioners function in the broader health care system. However, the development of standards for performance-based assessment is not as well understood as in competency assessment, where simulations can more readily re¯ect narrower issues of knowledge and skills. This paper proposes a theoretical framework for the development of standards that re¯ect the more complex world in which experienced medical practitioners work. Methods The paper re¯ects the combined experiences of a group of education researchers and the results of literature searches that included identifying current health system data sources that might contribute information to the measurement of standards. Conclusion Standards that re¯ect the complexity of medical practice may best be developed through anèxpert systems' analysis of clinical conditions for which desired health care outcomes re¯ect the contribution of several health professionals within a complex, three-dimensional, contextual model. Examples of the model are provided, but further work is needed to test validity and measurability. Performance-based assessment is the goal of assessment of experienced medical practitioners, but the development of standards that re¯ect the more complex world in which medical practitioners work is not well understood. Each health care system collects data in various ways that purport to measure performance, at least from particular perspectives, but the challenge is to de®ne, gather and interpret data that truly re¯ects what doctors do against reasonable evidence-based expectations of health outcomes.

Research paper thumbnail of Specific classification of elibrary resources says more about users' preferences

Studies in health technology and informatics, 2006

Medical Subject Headings (MeSH) are a hierarchical taxonomy of over 42,000 descriptors designed t... more Medical Subject Headings (MeSH) are a hierarchical taxonomy of over 42,000 descriptors designed to classify scientific literature; it is hierarchical with generic high order headings and specific low order headings. Over 1,000 resources in the Primary Care Electronic Library (PCEL - www.pcel.info) were classified with MeSH. Each of the entries or resources in the primary care digital library was assigned up to five MeSH terms. We compared whether the most generic or specific MeSH term ascribed to each resource best predicted user preferences. over the four month period analysed statistically significant differences were found for resources according to specific key MeSH terms they were classified by. This result was not repeated for generic key MeSH terms. Analysis of the use of specific MeSH terms reveals user preferences that would have otherwise remained obscured. These preferences are not found if more generic MeSH terms are analysed.

Research paper thumbnail of Training the assessors for the General Medical Council’s Performance Procedures

Research paper thumbnail of The General Medical Council’s Performance Procedures: peer review of performance in the workplace

Research paper thumbnail of The threat of the dyscompetent resident: A plea to make the implicit more explicit!

Advances in health sciences education : theory and practice, Jan 14, 2014

Although several examples of frameworks dealing with students' unprofessional behaviour are a... more Although several examples of frameworks dealing with students' unprofessional behaviour are available, guidance on how to deal locally or regionally with dysfunctional residents is limited (Hickson et al. in Acad Med 82(11):1040-1048, 2007b; Leape and Fromson in Ann Intern Med 144(2):107-115, 2006). Any 'rules' are mostly unwritten, and often emerge by trial and error within the specialty training programme (Stern and Papadakis in N Engl J Med 355(17):1794-1799, 2006). It is nevertheless of utmost importance that objectives, rules and guidelines comparable to those existing in undergraduate training (Project Team Consilium Abeundi van Luijk in Professional behaviour: teaching, assessing and coaching students. Final report and appendices. Mosae Libris, 2005; van Mook et al. in Neth J Crit Care 16(4):162-173, 2010a) are developed for postgraduate training. And that implicit rules are made explicit. This article outlines a framework based on the lessons learned from contemp...

Research paper thumbnail of Explorations in consultation of the public and health professionals on priority setting in an inner London health district

Social Science & Medicine, 1993

The methodology for eliciting the public's priorities for health services is in its infancy. This... more The methodology for eliciting the public's priorities for health services is in its infancy. This paper presents the results from a series of exploratory exercises on priorities in City and Hackney. The authors surveyed the opinions of members of community groups and tenants' associations, and compared their responses with those of a random sample of the public as well as general practitioners, consultants and public health doctors. This revealed some disagreement on priorities between these groups. The public, in consistency with the results from other studies, prioritised perceived life saving technologies as high, in contrast to community services and services for people with mental illnesses, which they priori&d as medium to low, in contrast to all the samples of doctors; the public also prioritised health education and family planning as fairly low, as did the GPs and consultants, in contrast to the public health doctors who priori&d them as high. Before DHAs embark on these studies as part of priority setting, they must answer the question: "what will they do if they disagree with the results?"

Research paper thumbnail of Relicensure, Recertification and Practice-Based Assessment

International Handbook of Research in Medical Education, 2002

Research paper thumbnail of Professionalism in medical education

Teaching and Teacher Education, 2007

Medical professionalism in today's society requires the exhibition of a range of qualities deploy... more Medical professionalism in today's society requires the exhibition of a range of qualities deployed in the service of patients, rather than more traditionally defined aspects such as mastery, autonomy and self-regulation. These qualities incorporate demonstrated clinical competence; aspiring to excellence in practice while demonstrating humility and recognition of personal limitations; exercising professional judgement; and maintaining a fiduciary relationship with patients by the earning and maintenance of trust.

Research paper thumbnail of Postgraduate medical education: Modifying trainees’ study approaches by changing the examination

Teaching and Learning in Medicine, 1992

Research paper thumbnail of An evaluation of a computer based education program for the diagnosis and management of dementia in primary care. An international study of the transcultural adaptations necessary for European dissemination

Medical Teacher, 2009

Objectives: The aim of this study is to make an inventory of the changes that are needed to make ... more Objectives: The aim of this study is to make an inventory of the changes that are needed to make an interactive computer based training program (ICBT) with a specific educational content, acceptable to professional communities with different linguistic, cultural and health care backgrounds in different European countries. Methods: Existing educational software, written in two languages was reviewed by GPs and primary care professionals in three different countries. Reviewers worked through the program using a structured critical reading grid. Results: A 'simple' translation of the program is not sufficient. Minor changes are needed to take account of linguistic differences and medical semantics. Major changes are needed in respect of the existing clinical guidelines in every country related to differences in the existing health care systems. Conclusions: ICTB programs cannot easily be used in different countries and cultures. The development of a structured educational program needs collaboration between educationalists, domain experts, information technology advisers and software engineers. Simple validation of the content by local expert groups will not guarantee the program's exportability. It is essential to involve different national expert groups at every phase of the development process in order to disseminate it in other countries.

Research paper thumbnail of Procedures for establishing defensible programmes for assessing practice performance

Medical Education, 2002

The assessment of the performance of doctors in practice is becoming more widely accepted. While ... more The assessment of the performance of doctors in practice is becoming more widely accepted. While there are many potential purposes for such assessments, sometimes the consequences of the assessments will be Ôhigh stakesÕ. In these circumstances, any of the many elements of the assessment programme may potentially be challenged. These assessment programmes therefore need to be robust, fair and defensible, taken from the perspectives of consumer, assessee and assessor. In order to inform the design of defensible programmes for assessing practice performance, a group of education researchers at the 10th Cambridge Conference adopted a project man-agement approach to designing practice performance assessment programmes. This paper describes issues to consider in the articulation of the purposes and outcomes of the assessment, planning the programme, the administrative processes involved, including communication and preparation of assessees.

Research paper thumbnail of When enough is enough: a conceptual basis for fair and defensible practice performance assessment

Medical Education, 2002

Introduction An essential element of practice performance assessment involves combining the resul... more Introduction An essential element of practice performance assessment involves combining the results of various procedures in order to see the whole picture. This must be derived from both objective and subjective assessment, as well as a combination of quantitative and qualitative assessment procedures. Because of the severe consequences an assessment of practice performance may have, it is essential that the procedure is both defensible to the stakeholders and fair in that it distinguishes well between good performers and underperformers.

Research paper thumbnail of The relationship between competence and performance: implications for assessing practice performance

Medical Education, 2002

Objective This paper aims to describe current views of the relationship between competence and pe... more Objective This paper aims to describe current views of the relationship between competence and performance and to delineate some of the implications of the distinctions between the two areas for the purpose of assessing doctors in practice.

Research paper thumbnail of Training the assessors for the General Medical Council's Performance Procedures

Research paper thumbnail of The General Medical Council's Performance Procedures: peer review of performance in the workplace

Research paper thumbnail of The assessment of poorly performing doctors: the development of the assessment programmes for the General Medical Council's Performance Procedures

Research paper thumbnail of Specialty-specific multi-source feedback: assuring validity, informing training

Medical Education, 2008

The white paper 'Trust, A... more The white paper 'Trust, Assurance and Safety: the Regulation of Health Professionals in the 21st Century' proposes a single, generic multi-source feedback (MSF) instrument in the UK. Multi-source feedback was proposed as part of the assessment programme for Year 1 specialty training in histopathology. An existing instrument was modified following blueprinting against the histopathology curriculum to establish content validity. Trainees were also assessed using an objective structured practical examination (OSPE). Factor analysis and correlation between trainees' OSPE performance and the MSF were used to explore validity. All 92 trainees participated and the assessor response rate was 93%. Reliability was acceptable with eight assessors (95% confidence interval 0.38). Factor analysis revealed two factors: 'generic' and 'histopathology'. Pearson correlation of MSF scores with OSPE performances was 0.48 (P = 0.001) and the histopathology factor correlated more highly (histopathology r = 0.54, generic r = 0.42; t = - 2.76, d.f. = 89, P < 0.01). Trainees scored least highly in relation to ability to use histopathology to solve clinical problems (mean = 4.39) and provision of good reports (mean = 4.39). Three of six doctors whose means were < 4.0 received free text comments about report writing. There were 83 forms with aggregate scores of < 4. Of these, 19.2% included comments about report writing. Specialty-specific MSF is feasible and achieves satisfactory reliability. The higher correlation of the 'histopathology' factor with the OSPE supports validity. This paper highlights the importance of validating an MSF instrument within the specialty-specific context as, in addition to assuring content validity, the PATH-SPRAT (Histopathology-Sheffield Peer Review Assessment Tool) also demonstrates the potential to inform training as part of a quality improvement model.

Research paper thumbnail of A conversation about the role of medical regulators

Research paper thumbnail of CeMENT: evaluation of a regional development programme integrating hospital and general practice clinical teaching for medical undergraduates

Medical Education, 2001

To determine the feasibility and effectiveness of shared hospital and general practice clinical t... more To determine the feasibility and effectiveness of shared hospital and general practice clinical teaching for medical undergraduates. A multifaceted approach employing quantitative and qualitative techniques. All medical schools in North Thames Region. Students, GP tutors and hospital specialists. The model was successfully adopted in a broad range of clinical specialties in all of the participating medical schools, resulting in a doubling of the involvement of general practice in clinical teaching. Participating students provided an overwhelmingly positive evaluation of the attachments and there was a clear perception of benefit amongst the participating GPs. However, the views of the participating hospital clinicians were less positive and the true nature and extent of the educational impact proved difficult to assess. This model of collaborative clinical teaching between hospital and general practice can be implemented in accordance with the project's key aims, but the enthusiastic involvement of hospital clinicians may be difficult to secure.

Research paper thumbnail of Setting performance standards for medical practice: a theoretical framework

Medical Education, 2001

Conclusion Standards that re¯ect the complexity of medical practice may best be developed through... more Conclusion Standards that re¯ect the complexity of medical practice may best be developed through aǹ expert systems' analysis of clinical conditions for which desired health care outcomes re¯ect the contribution of several health professionals within a complex, threedimensional, contextual model. Examples of the model are provided, but further work is needed to test validity and measurability.

Research paper thumbnail of Setting performance standards for medical practice: a theoretical framework

Background The assessment of performance in the real world of medical practice is now widely acce... more Background The assessment of performance in the real world of medical practice is now widely accepted as the goal of assessment at the postgraduate level. This is largely a validity issue, as it is recognised that tests of knowledge and in clinical simulations cannot on their own really measure how medical practitioners function in the broader health care system. However, the development of standards for performance-based assessment is not as well understood as in competency assessment, where simulations can more readily re¯ect narrower issues of knowledge and skills. This paper proposes a theoretical framework for the development of standards that re¯ect the more complex world in which experienced medical practitioners work. Methods The paper re¯ects the combined experiences of a group of education researchers and the results of literature searches that included identifying current health system data sources that might contribute information to the measurement of standards. Conclusion Standards that re¯ect the complexity of medical practice may best be developed through anèxpert systems' analysis of clinical conditions for which desired health care outcomes re¯ect the contribution of several health professionals within a complex, three-dimensional, contextual model. Examples of the model are provided, but further work is needed to test validity and measurability. Performance-based assessment is the goal of assessment of experienced medical practitioners, but the development of standards that re¯ect the more complex world in which medical practitioners work is not well understood. Each health care system collects data in various ways that purport to measure performance, at least from particular perspectives, but the challenge is to de®ne, gather and interpret data that truly re¯ects what doctors do against reasonable evidence-based expectations of health outcomes.

Research paper thumbnail of Specific classification of elibrary resources says more about users' preferences

Studies in health technology and informatics, 2006

Medical Subject Headings (MeSH) are a hierarchical taxonomy of over 42,000 descriptors designed t... more Medical Subject Headings (MeSH) are a hierarchical taxonomy of over 42,000 descriptors designed to classify scientific literature; it is hierarchical with generic high order headings and specific low order headings. Over 1,000 resources in the Primary Care Electronic Library (PCEL - www.pcel.info) were classified with MeSH. Each of the entries or resources in the primary care digital library was assigned up to five MeSH terms. We compared whether the most generic or specific MeSH term ascribed to each resource best predicted user preferences. over the four month period analysed statistically significant differences were found for resources according to specific key MeSH terms they were classified by. This result was not repeated for generic key MeSH terms. Analysis of the use of specific MeSH terms reveals user preferences that would have otherwise remained obscured. These preferences are not found if more generic MeSH terms are analysed.

Research paper thumbnail of Training the assessors for the General Medical Council’s Performance Procedures

Research paper thumbnail of The General Medical Council’s Performance Procedures: peer review of performance in the workplace

Research paper thumbnail of The threat of the dyscompetent resident: A plea to make the implicit more explicit!

Advances in health sciences education : theory and practice, Jan 14, 2014

Although several examples of frameworks dealing with students' unprofessional behaviour are a... more Although several examples of frameworks dealing with students' unprofessional behaviour are available, guidance on how to deal locally or regionally with dysfunctional residents is limited (Hickson et al. in Acad Med 82(11):1040-1048, 2007b; Leape and Fromson in Ann Intern Med 144(2):107-115, 2006). Any 'rules' are mostly unwritten, and often emerge by trial and error within the specialty training programme (Stern and Papadakis in N Engl J Med 355(17):1794-1799, 2006). It is nevertheless of utmost importance that objectives, rules and guidelines comparable to those existing in undergraduate training (Project Team Consilium Abeundi van Luijk in Professional behaviour: teaching, assessing and coaching students. Final report and appendices. Mosae Libris, 2005; van Mook et al. in Neth J Crit Care 16(4):162-173, 2010a) are developed for postgraduate training. And that implicit rules are made explicit. This article outlines a framework based on the lessons learned from contemp...

Research paper thumbnail of Explorations in consultation of the public and health professionals on priority setting in an inner London health district

Social Science & Medicine, 1993

The methodology for eliciting the public's priorities for health services is in its infancy. This... more The methodology for eliciting the public's priorities for health services is in its infancy. This paper presents the results from a series of exploratory exercises on priorities in City and Hackney. The authors surveyed the opinions of members of community groups and tenants' associations, and compared their responses with those of a random sample of the public as well as general practitioners, consultants and public health doctors. This revealed some disagreement on priorities between these groups. The public, in consistency with the results from other studies, prioritised perceived life saving technologies as high, in contrast to community services and services for people with mental illnesses, which they priori&d as medium to low, in contrast to all the samples of doctors; the public also prioritised health education and family planning as fairly low, as did the GPs and consultants, in contrast to the public health doctors who priori&d them as high. Before DHAs embark on these studies as part of priority setting, they must answer the question: "what will they do if they disagree with the results?"

Research paper thumbnail of Relicensure, Recertification and Practice-Based Assessment

International Handbook of Research in Medical Education, 2002

Research paper thumbnail of Professionalism in medical education

Teaching and Teacher Education, 2007

Medical professionalism in today's society requires the exhibition of a range of qualities deploy... more Medical professionalism in today's society requires the exhibition of a range of qualities deployed in the service of patients, rather than more traditionally defined aspects such as mastery, autonomy and self-regulation. These qualities incorporate demonstrated clinical competence; aspiring to excellence in practice while demonstrating humility and recognition of personal limitations; exercising professional judgement; and maintaining a fiduciary relationship with patients by the earning and maintenance of trust.

Research paper thumbnail of Postgraduate medical education: Modifying trainees’ study approaches by changing the examination

Teaching and Learning in Medicine, 1992

Research paper thumbnail of An evaluation of a computer based education program for the diagnosis and management of dementia in primary care. An international study of the transcultural adaptations necessary for European dissemination

Medical Teacher, 2009

Objectives: The aim of this study is to make an inventory of the changes that are needed to make ... more Objectives: The aim of this study is to make an inventory of the changes that are needed to make an interactive computer based training program (ICBT) with a specific educational content, acceptable to professional communities with different linguistic, cultural and health care backgrounds in different European countries. Methods: Existing educational software, written in two languages was reviewed by GPs and primary care professionals in three different countries. Reviewers worked through the program using a structured critical reading grid. Results: A 'simple' translation of the program is not sufficient. Minor changes are needed to take account of linguistic differences and medical semantics. Major changes are needed in respect of the existing clinical guidelines in every country related to differences in the existing health care systems. Conclusions: ICTB programs cannot easily be used in different countries and cultures. The development of a structured educational program needs collaboration between educationalists, domain experts, information technology advisers and software engineers. Simple validation of the content by local expert groups will not guarantee the program's exportability. It is essential to involve different national expert groups at every phase of the development process in order to disseminate it in other countries.

Research paper thumbnail of Procedures for establishing defensible programmes for assessing practice performance

Medical Education, 2002

The assessment of the performance of doctors in practice is becoming more widely accepted. While ... more The assessment of the performance of doctors in practice is becoming more widely accepted. While there are many potential purposes for such assessments, sometimes the consequences of the assessments will be Ôhigh stakesÕ. In these circumstances, any of the many elements of the assessment programme may potentially be challenged. These assessment programmes therefore need to be robust, fair and defensible, taken from the perspectives of consumer, assessee and assessor. In order to inform the design of defensible programmes for assessing practice performance, a group of education researchers at the 10th Cambridge Conference adopted a project man-agement approach to designing practice performance assessment programmes. This paper describes issues to consider in the articulation of the purposes and outcomes of the assessment, planning the programme, the administrative processes involved, including communication and preparation of assessees.

Research paper thumbnail of When enough is enough: a conceptual basis for fair and defensible practice performance assessment

Medical Education, 2002

Introduction An essential element of practice performance assessment involves combining the resul... more Introduction An essential element of practice performance assessment involves combining the results of various procedures in order to see the whole picture. This must be derived from both objective and subjective assessment, as well as a combination of quantitative and qualitative assessment procedures. Because of the severe consequences an assessment of practice performance may have, it is essential that the procedure is both defensible to the stakeholders and fair in that it distinguishes well between good performers and underperformers.

Research paper thumbnail of The relationship between competence and performance: implications for assessing practice performance

Medical Education, 2002

Objective This paper aims to describe current views of the relationship between competence and pe... more Objective This paper aims to describe current views of the relationship between competence and performance and to delineate some of the implications of the distinctions between the two areas for the purpose of assessing doctors in practice.

Research paper thumbnail of Training the assessors for the General Medical Council's Performance Procedures

Research paper thumbnail of The General Medical Council's Performance Procedures: peer review of performance in the workplace

Research paper thumbnail of The assessment of poorly performing doctors: the development of the assessment programmes for the General Medical Council's Performance Procedures

Research paper thumbnail of Specialty-specific multi-source feedback: assuring validity, informing training

Medical Education, 2008

The white paper 'Trust, A... more The white paper 'Trust, Assurance and Safety: the Regulation of Health Professionals in the 21st Century' proposes a single, generic multi-source feedback (MSF) instrument in the UK. Multi-source feedback was proposed as part of the assessment programme for Year 1 specialty training in histopathology. An existing instrument was modified following blueprinting against the histopathology curriculum to establish content validity. Trainees were also assessed using an objective structured practical examination (OSPE). Factor analysis and correlation between trainees' OSPE performance and the MSF were used to explore validity. All 92 trainees participated and the assessor response rate was 93%. Reliability was acceptable with eight assessors (95% confidence interval 0.38). Factor analysis revealed two factors: 'generic' and 'histopathology'. Pearson correlation of MSF scores with OSPE performances was 0.48 (P = 0.001) and the histopathology factor correlated more highly (histopathology r = 0.54, generic r = 0.42; t = - 2.76, d.f. = 89, P < 0.01). Trainees scored least highly in relation to ability to use histopathology to solve clinical problems (mean = 4.39) and provision of good reports (mean = 4.39). Three of six doctors whose means were < 4.0 received free text comments about report writing. There were 83 forms with aggregate scores of < 4. Of these, 19.2% included comments about report writing. Specialty-specific MSF is feasible and achieves satisfactory reliability. The higher correlation of the 'histopathology' factor with the OSPE supports validity. This paper highlights the importance of validating an MSF instrument within the specialty-specific context as, in addition to assuring content validity, the PATH-SPRAT (Histopathology-Sheffield Peer Review Assessment Tool) also demonstrates the potential to inform training as part of a quality improvement model.

Research paper thumbnail of A conversation about the role of medical regulators

Research paper thumbnail of CeMENT: evaluation of a regional development programme integrating hospital and general practice clinical teaching for medical undergraduates

Medical Education, 2001

To determine the feasibility and effectiveness of shared hospital and general practice clinical t... more To determine the feasibility and effectiveness of shared hospital and general practice clinical teaching for medical undergraduates. A multifaceted approach employing quantitative and qualitative techniques. All medical schools in North Thames Region. Students, GP tutors and hospital specialists. The model was successfully adopted in a broad range of clinical specialties in all of the participating medical schools, resulting in a doubling of the involvement of general practice in clinical teaching. Participating students provided an overwhelmingly positive evaluation of the attachments and there was a clear perception of benefit amongst the participating GPs. However, the views of the participating hospital clinicians were less positive and the true nature and extent of the educational impact proved difficult to assess. This model of collaborative clinical teaching between hospital and general practice can be implemented in accordance with the project's key aims, but the enthusiastic involvement of hospital clinicians may be difficult to secure.