Aspects Of Clinical Competence Research Articles

Correlation between moral distress and clinical competence in COVID-19 ICU nurses

BackgroundNurses’ clinical competence is one of the fundamental necessities for providing safe and effective care. Moral distress, as one type of occupational stressors, can affect various aspects of clinical competence, especially under conditions of complicated medical settings such as the coronavirus disease 2019 (COVID-19) epidemic. This study was conducted with the aim of determining the relationship between moral distress and clinical competence in nurses working in COVID-19 intensive care units (ICUs).MethodsThe study was a cross-sectional study. A total of 194 nurses working in COVID-19 ICU affiliated to Shahid Sadoughi University of Medical Sciences, Yazd, central Iran, participated in the study. Data were collected using Demographic Information Questionnaire, Moral Distress Scale, and Clinical Competence Checklist. Data were analyzed with SPSS20 using descriptive and analytical statistics.ResultsThe mean score of moral distress, clinical competence, and skills application were 1.79 ± 0/68, 65.16 ± 15.38, and 145.10 ± 38.20, respectively. Based on Pearson correlation coefficient, there was an inverse and significant relationship between the moral distress score and its dimensions with clinical competence and skills application (P < 0.001). Moral distress was a significant negative predictor that accounted for 17.9% of the variance in clinical competence (R2 = 0.179, P < 0.001) and 16% of the variance in utilization of clinical competence (R2 = 0.160, P < 0.001).ConclusionConsidering the relationship between moral distress, clinical competence and skills application, to maintain the quality of nursing services, nursing managers can strengthen clinical competence and skills application by using strategies to deal with and reduce moral distress in nurses, especially in critical situations.

Burnout and Its Association With Competence Among Dental Interns in China.

Intern physicians are generally more burdened by stress than the general population. This cross-sectional study aimed to evaluate the current situation regarding burnout and explore its association with the self-evaluation of competence among Chinese dental interns. A self-administered anonymous survey was conducted on 91 dental interns in the Peking University School of Stomatology, from August 2019 to June 2020. It consisted of a psychological stress questionnaire, including burnout and self-evaluation of clinical competence. The Wilcoxon signed rank test was used to determine the differences between self-evaluation scores of clinical competence. Results showed average scores for emotional exhaustion, depersonalization, and personal accomplishment of 22.22 ± 9.04, 8.16 ± 5.21, and 36.08 ± 7.76, respectively. Dental clinical technology was considered more useful than other clinical competencies, and there was a correlation between its importance and the stress caused by its deficiency (r = −0.201, p = 0.056). Significant associations were found between stress due to a lack of dental clinical technology and high emotional exhaustion (r = 0.273, p < 0.05). Burnout was common among the dental interns, which may be a valuable finding. Among the six different aspects of clinical competence, “dental clinical technology” represented the most stressful item. Strengthening pre-clinical training and promptly conducting targeted training in the early clinical process may be considered as decompression measures.

The International Council of Ophthalmology Ophthalmic clinical evaluation exercise

Purpose:Fifteen years after the publication of the Ophthalmic Clinical Evaluation Exercise (OCEX), it was deemed necessary to review and revise it, and to validate it for an international audience of ophthalmologists. This study to revise the OCEX and validate it for international use.Methods:The OCEX rubric was changed to a modified Dreyfus scale; a behavioral descriptor was created for each category. An international panel of ophthalmic educators reviewed the international applicability and appropriateness of the tool.Results:A tool for assessing and giving feedback on four aspects of clinical competence during the ophthalmic consultation (interview skills, examination, interpersonal and communication skills, and case presentation) was revised. The original scoring tool was improved to a new behavioral one, and relevant comments and suggestions from international reviewers were incorporated. The new tool has face and content validity for an international audience.Conclusion:The OCEX is the only tool for workplace assessment and feedback specifically for ophthalmology residents and the ophthalmic consultation. This improved and simplified version will facilitate its use and implementation to diverse programs around the world.

The effect of portfolio training and clinical evaluation method on the clinical competence of nursing students

Context: Nowadays, nurses in addition to acquiring knowledge should have sufficient clinical skills. One of the methods that have recently been taken into consideration in nursing students' clinical education is the method of portfolio. Aims: The purpose of this study was to affect the portfolio training and clinical evaluation method on the clinical competence of nursing students. Settings and Design: This semi-experimental study was carried out at the Faculty of Nursing and Midwifery of Qaen. Material and Methods: The research population was all senior nursing students who were randomly divided into control groups and intervention to available sampling method. Education and clinical evaluation in the field of clinical competency in the internal and surgical departments were conducted in the intervention group of students with portfolio method and in the control group of students with conventional method from the viewpoint of professors and students. Statistical Analysis Used: The data were analyzed by SPSS 24 and paired and independent t-test. Results: According to the students' viewpoint in all aspects of clinical competence (except individual management) and clinical competency, the portfolio group had a higher mean, but there was no significant difference between the two groups (P > 0.05). However, according to the professor's view, there was a significant difference between the two groups in all aspects of clinical competency and total clinical competency. Conclusions: Portfolio training and clinical evaluation can improve students' clinical competence. Therefore method can be used to create either motivation or interest to participate in learning and improve the level of clinical competence. Therefore, those interested and those in charge of educational affairs can benefit from this new educational method for the purpose of training and clinical evaluation of trainee students in the field.

Pharmacy Students’ Perception and Evaluation of Objective Structured Clinical Examination: Near East University Experience

Background: Pharmacy educators have always been desirous of the best methods for formative and summative evaluation of trainees. The Objective Structured Clinical Examination (OSCE) is an approach for student assessment in which aspects of clinical competence are evaluated in a comprehensive, consistent, and structured manner. Though recently become popular in pharmacy schools globally, its use in North Cyprus and Turkey pharmacy schools appears limited.&#x0D; Objectives: To assess pharmacy students’ evaluation and overall perception of OSCE.&#x0D; Methods: A cross-sectional survey was conducted on pharmacy students, who participated in the final OSCE examination in 2015-2016.The study sample consisted of fifth-year Pharmacy students who took the OSCE assessment during their studies. A24-item self-administered structured questionnaire was employed to obtain relevant data on OSCE evaluation in terms of content reliability and structure of the examination. Students’ responses were based on a 4-point Likert scales ranging from disagree to no comment. The data were analyzed using SPSS, version 22.&#x0D; Results: Of 81 eligible students, 74 completed self- administered questionnaire representing 91.35% response rate. A total of 68(90.7%) students agreed that wide knowledge area and clinical skills were covered in the exam. Over 80% of the students saw that OSCE besides it provided them with an opportunity to learn real life scenario, it was well administered and run in the faculty and better organized compared to a previous pilot OSCE (68%). Around 77% of the students saw that 7 minutes time allocated per station was adequate, while a close percentage also agreed that standardized patients were competent in their role playing. Majority of students though they identify that OSCEs highlighted areas of weakness in their skills and knowledge but still disagree with incorporating OSCEs marks into final marks and thus prefer it as an formative assessment.&#x0D; Conclusions: Students highly perceived the exam feeling that it is more resembles actual practice providing them with self-confidence, and more clearly their defects and what they need to improve regarding both skills and knowledge. They saw OSCEs as being a beneficial formative assessment that should not be included as marks into finals.

Multisource feedback as part of the Medical Board of Australia\u2019s Professional Performance Framework: outcomes from a preliminary study

BackgroundThe recent introduction of the Professional Performance Framework by the Medical Board of Australia is intended to strengthen continuing professional development for the 100,000 or so medical practitioners in Australia. An important option within the Framework is the use of multisource feedback from patients, colleagues and self-evaluations to allow doctors to reflect on their performance and identify methods for self-improvement. The aim of this study is to explore the relationships between patient feedback, colleague feedback, and self-evaluation using the same questionnaires as used by patients and colleagues.MethodsFeedback data for around 2000 doctors belonging to four different groups were collected through non-probability sampling from nearly 100,000 patients and 24,000 colleagues. Reliability analysis was performed using single measures intraclass coefficients, Cronbach’ alpha and signal-to-noise ratios. Analysis of variance was used to identify significant differences in scores between items and sub-populations of doctors; principal component analysis involving Kaiser-Meyer-Olkin (KMO) sampling adequacy and Bartlett’s test for sphericity was used to reveal components of doctor performance; and correlation analysis was used for identifying convergence between sets of scores from different sources.ResultsPatients rated doctors highest on respect shown and lowest on reassurance provided. Colleagues rated doctors highest on trustworthiness and lowest on ability to say ‘no’. With regard to self-evaluation, doctors gave themselves lower scores on the patient questionnaire and the colleague questionnaire (10 and 12%, respectively) than they received from their patients and colleagues. There were weak but positive correlations between self-scores and scores received indicating some convergence of agreement, with doctors feeling more comfortable with self-evaluation from the perspective of patients than from colleagues.ConclusionsSupplementing patient and colleague feedback with self-evaluation may help doctors confirm for themselves areas for enhanced CPD through convergence. If self-evaluation is used, the colleague questionnaire may be sufficient, since aspects of clinical competence, management, communication and leadership as well as patient care can be addressed through colleague items. Mentoring of doctors in CPD should aim to make doctors feel more comfortable about being rated by colleagues to enhance convergence between self-scores and evaluations from the perspective of colleagues.

Medical Students’ Perception of Objective Structured Clinical Examination: A Feedback for Process Improvement

Medical educators have always been desirous of the best methods for formative and summative evaluation of trainees. The Objective Structured Clinical Examination (OSCE) is an approach for student assessment in which aspects of clinical competence are evaluated in a comprehensive, consistent, and structured manner with close attention to the objectivity of the process. Though popular in most medical schools globally, its use in Nigeria medical schools appears limited. This study was conceived to explore students' perception about the acceptability of OSCE process and to provide feedback to be used to improve the assessment technique. A cross-sectional survey was conducted on final-year medical students, who participated in the final MBBS surgery examination in June 2011. A 19-item self-administered structured questionnaire was employed to obtain relevant data on demographics of respondents and questions evaluating the OSCE stations in terms of the quality of instructions and organization, learning opportunities, authenticity and transparency of the process, and usefulness of the OSCE as an assessment instrument compared with other formats. Students' responses were based on a 5-point Likert scales ranging from strongly disagree to strongly agree. The data were analyzed using SPSS, version 15 (SPSS, Inc, Chicago, IL). The study took place at the University of Ilorin, College of Health Science. A total of 187 final-year medical students were enrolled in to the survey. Of 187 eligible students, 151 completed the self-administered questionnaire representing 80.7% response rate. A total of 61 (40.4%) students felt that it was easy to understand written instructions at the OSCE stations. In total, 106 (70.2%) students felt that the time allocated to each station was adequate. A total of 89 (58.9%) students agreed that the OSCE accurately measured their knowledge and skill, and 85 (56.3%) reported that OSCE enhanced their communication skill. Of the respondents, 80 (53%) felt that OSCE caused them to be nervous, and 73 (48.3%) expressed their concern about the interevaluator variability at manned stations. OSCE was perceived to be the second most fair test format by 53 (35.1%) respondents, and 56 (37.1%) also suggested that OSCE needs to be used much more than the other assessment formats. The findings in this survey appear reassuring regarding students' perception about the validity, objectivity, comprehensiveness, and overall organization of OSCE in the department of surgery. The need to introduce OSCE early in the surgical curriculum is also underscored. The overall feedback was very useful and will facilitate a critical review of the process.

Student evaluation of an OSCE in general medicine at Mamata Medical College, Andhra Pradesh

The assessment of student's clinical competence is of paramount importance, and there are several means of evaluating student performance in medical examinations. The OSCE is an approach to student assessment in which aspects of clinical competence are evaluated in a comprehensive, consistent and structured manner with close attention to the objectivity of the process. The faculty of general medicine in collaboration with other clinical departments, Mamata Medical College, Khammam first implemented the objective structured clinical examination (OSCE) in the final MBBS Part-II examination during the internal assessment examination for the 2011–2012 academic years. The study was set out to explore student acceptance of the OSCE as part of an evaluation of final MBBS students. A self-administered questionnaire was completed by successive groups of students immediately after the OSCE. Main outcome measures were student perception of examination attributes, which included the quality of instructions and organization, the quality of performance, authenticity and transparency of the process, and usefulness of the OSCE as an assessment instrument compared to other formats. There was an overwhelming acceptance of OSCE in general medicine with respect to comprehensiveness (90%) transparency (90%) & authenticity of required tasks. Students felt that it was a useful form of examination. Student's feedback was invaluable in influencing faculty teaching curriculum direction and appreciation of student opinion and overall the students were agreeable with newer form of OSCE. The majority of the students felt that OSCE is a fair assessment tool compared to traditional long and short cases and it covers a wide range of knowledge and clinical skills in general medicine.

Evaluating clinical competence assessment

To evaluate clinical competence assessment in pre-registration BSc nursing programmes in one geographical area in the Republic of Ireland. A mixed method approach comprising focus group interviews and survey questionnaires was used. The sample comprised preceptors and nursing students across three disciplines of nursing--general, mental health and intellectual (learning) disability. Methods of analysis were thematic analysis and the Statistical Package for Social Sciences (SPSS) (Version 15). Students' and preceptors' views of competence assessment and the process of competence assessment are reported. The study focused on language complexity, the assessment framework, the amount of time allocated for interviews and achievement of purpose. The main conclusions were that language needs to be user-friendly, the process needs to be easy to follow and all aspects of clinical competence must be assessed. The response rate from students was 87% but the preceptor response rate was lower (30%). Competence based assessment in the clinical environment is a core component of pre-registration nurse education programmes. Competing demands in the clinical environment challenge both the student and preceptor during the competence assessment process.

Global overall rating for assessing clinical competence: what does it really show?

Single-item global overall ratings are often used as a method of assessing learners' clinical competence at the end of a clerkship. The purpose of this study was to identify which aspects of clinical competence are assessed through these ratings. At the end of a clinical clerkship in primary health units, 106 Year 4 students are routinely assessed by faculty staff of three disciplines (obstetrics and gynaecology, internal medicine, paediatrics), using a single global numeric rating (on a scale of 0-10). Faculty scores across disciplines for each learner are averaged to produce a global overall rating (GOR). In this study, the same students were assessed by the same faculty staff 2 weeks later using a newly developed, more detailed form composed of 13 domains, of which six related to technical skills and seven to humanistic skills, each scored on a scale of 0-10. Scores for each domain across disciplines were averaged as global itemised ratings (GIRs). Statistical analysis included Cronbach's alpha coefficient and Pearson's correlation coefficients. Statistical significance was set at P < or = 0.05. The internal consistency of GIR items was high (alpha coefficient = 0.935). Global overall rating scores were higher than most technical domains of GIRs and lower than the humanistic domains of GIRs. The highest significant correlations were found between the GOR and the technical domains of the GIR. When faculty staff attribute a global single-item overall rating to a student's clinical competence, they tend to focus more on technical skills.

Teaching and Learning Communication in Veterinary Medicine

Drawing on extensive evidence and experience in human medicine, this article offers a practical conceptual framework for thinking more precisely about how to teach and learn communication systematically and intentionally in veterinary medicine. The overarching goal is to promote the development of communication programs so as to improve communication in veterinary practice to a professional level of competence. A three-part conceptual framework is presented that first explores the rationale behind teaching and learning communication, including the evidence base regarding the impact of communication on clinician-client interactions and outcomes of care and the research on teaching and learning communication skills in medicine. The second part considers four ways to conceptualize what to teach and learn, as explicated by (a) the domains of communication in veterinary medicine; (b) ''first principles'' of effective communication; (c) evidence-based goals or outcomes for communication programs; and (d) delineation and definition of the specific individual skills that research evidence supports, as presented in the Calgary-Cambridge Guides. The last part of the conceptual framework examines how to teach communication, including the use of models, a primary focus on skill development as the backbone of communication programs, and the value of other methods supported by the evidence, such as simulated patients, videotape, small groups, and feedback and facilitation skills. Communication impacts the clinician- client interaction and outcomes of care in very significant ways. Communication can and should be taught and learned with as much rigor as other aspects of clinical competence. Veterinary programs at all levels should include the teaching of communication.

Temporary henna tattooing—a risky procedure: Case report and literature review

Medical educators have always been desirous of the best methods for formative and summative evaluation of trainees. The Objective Structured Clinical Examination (OSCE) is an approach for student assessment in which aspects of clinical competence are evaluated in a comprehensive, consistent, and structured manner with close attention to the objectivity of the process. Though popular in most medical schools globally, its use in Nigeria medical schools appears limited.This study was conceived to explore students’ perception about the acceptability of OSCE process and to provide feedback to be used to improve the assessment technique.A cross-sectional survey was conducted on final-year medical students, who participated in the final MBBS surgery examination in June 2011. A 19-item self-administered structured questionnaire was employed to obtain relevant data on demographics of respondents and questions evaluating the OSCE stations in terms of the quality of instructions and organization, learning opportunities, authenticity and transparency of the process, and usefulness of the OSCE as an assessment instrument compared with other formats. Students’ responses were based on a 5-point Likert scales ranging from strongly disagree to strongly agree. The data were analyzed using SPSS, version 15 (SPSS, Inc, Chicago, IL).The study took place at the University of Ilorin, College of Health Science.A total of 187 final-year medical students were enrolled in to the survey.Of 187 eligible students, 151 completed the self-administered questionnaire representing 80.7% response rate. A total of 61 (40.4%) students felt that it was easy to understand written instructions at the OSCE stations. In total, 106 (70.2%) students felt that the time allocated to each station was adequate. A total of 89 (58.9%) students agreed that the OSCE accurately measured their knowledge and skill, and 85 (56.3%) reported that OSCE enhanced their communication skill. Of the respondents, 80 (53%) felt that OSCE caused them to be nervous, and 73 (48.3%) expressed their concern about the interevaluator variability at manned stations. OSCE was perceived to be the second most fair test format by 53 (35.1%) respondents, and 56 (37.1%) also suggested that OSCE needs to be used much more than the other assessment formats.The findings in this survey appear reassuring regarding students’ perception about the validity, objectivity, comprehensiveness, and overall organization of OSCE in the department of surgery. The need to introduce OSCE early in the surgical curriculum is also underscored. The overall feedback was very useful and will facilitate a critical review of the process.

Does PBL Matter? Relations Between Instructional Context, Learning Strategies, and Learning Outcomes.

Purpose: To compare learning strategies used in Problem based learning (PBL) and lectures, and the relations between learning strategies and learning outcomes to determine how different learning strategies associated with PBL and lectures contribute to aspects of clinical competence. Design: The 52-item learning strategies questionnaire was given to preclinical medical students during lecture and PBL sessions in first and third year from 1994 to 1998. Response patterns were compared across the two contexts and factor structures investigated. Regression analyses examined relations between learning strategies and outcomes. Main Outcome Measures/Results: Comparison of responses on the 326 complete pairs of lecture and PBL questionnaires indicated differences at the 0.05 level on 44 of the 52 items. The mean differences were greater than 0.5 (on a 5 point scale) at the 0.001 level for 20 items. Of these, five strategies were used more often in PBL and 15 in lectures. Comparisons of learning strategy use across years showed significant changes with time in both instructional contexts. Principal component analysis revealed a stable factor structure with 4 factors distinctly associated with PBL and 4 factors with the lecture learning context. The remaining 6 factors were mixed and independent of context. Exploratory regression analysis revealed that learning outcomes in examinations were influenced by learning strategies. Multiple choice performance was positively predicted by learning associated with lecture class notes and negatively by group work, whereas the OSCE (objective structured clinical exam) performance was positively predicted by class participation in PBL, self-directed note making and lecture class notes. Conclusion: We have developed a learning strategies questionnaire that shows that students' learning strategies are influenced by instructional context, and patterns of learning strategy use change over time. There is tentative evidence that the students' learning strategies influence learning outcomes.

Predictive validity of a national examination for medical graduates in the Peopleʼs Republic of China

National examinations for medical graduates were introduced on an experimental basis in the People's Republic of China in 1982. To estimate the predictive validity of the National Medical Examination (NME), an investigation of the postgraduate competence of a sample of the participating examinees was conducted in 1984. The sample consisted of 1,717 of the 4,995 graduates from 13 medical colleges who had taken the initial NME. Their scores on the NME and the ratings given them by directors of postgraduate programs in nine aspects of clinical competence were compared by frequency distribution and product-moment correlation coefficients. Scores on the NME were consistent with measures of postgraduate clinical competence and, as a whole, correlated significantly with the ratings of clinical competence, supporting the use of the score on the NME as a predictor of postgraduate clinical competence. However, the extent of the relationship between the NME score and postgraduate clinical competence varied according to the specialty program of postgraduate medical training.

The Association Between Peer Consultations and Three Aspects of Clinical Competence

The relationship between the clinical competence of general practitioners and the degree of peer consultation about diagnostic and therapeutic problems was studied. Three aspects of clinical competence are discerned: attention paid to somatic aspects, patient-orientation and risk of unnecessary harm of the management. Clinical competence has been measured by a written simulation of patient-doctor encounters using five patients and assessment procedures in a study with a correlational design. For this study 49 subjects were selected from a population of 184 GPs who completed their vocational training in general practice at the University of Utrecht between 1975 and 1980. They were selected from those who consult their colleagues frequently and systematically about a variety of patients' problems and from those who do so little or not at all. The 49 subjects did not differ from the remainder in several relevant aspects such as practice setting, subscription to medical journals, etc. The 49 GPs are relatively consistent in the quality of attention they pay to somatic aspects. The consistency with regard to the two other aspects is rather low, especially regarding the risk of unnecessary harm. Attention paid to somatic aspects is connected with patient orientation. The latter is also connected with risk of unnecessary harm, but the former is not. The three aspects are more or less separate aspects of clinical competence. Peer consultation has a direct relationship with quality of attention paid to somatic aspects; GPs who do not consult among peers anyway display a lower quality of attention to somatic aspects in comparison to those who do so.(ABSTRACT TRUNCATED AT 250 WORDS)

A Diagnostic Fourth-Year Performance Assessment

The University of Massachusetts Medical Center, Worcester, attempted to develop a standardized, performance-based test battery aimed directly at assessing the critical aspects of clinical competence required for graduation from medical school. The battery used a blend of standardized patient-based and written test materials and was designed to yield a profile of scores, providing a "diagnosis" of student strengths and weaknesses on a skill-by-skill basis. Results indicate that a stable, reproducible assessment of clinical skills can be achieved in a one- to two-day test battery, depending on the specific skills measured. The resulting score profile provides faculty with important information about the clinical competence of students that is not readily available from other sources, thus improving the breadth and accuracy of student assessment. A long-term goal is that performance-based testing techniques will be incorporated into the licensure process to evaluate clinical skills and ensure the competence of graduating physicians.

ASSESSMENT OF CLINICAL COMPETENCE: WRITTEN AND COMPUTER‐BASED SIMULATIONS

ABSTRACT Written and computer‐based clinical simulations have been used in the health professions to assess aspects of clinical competence for many years. However, this review of the dozens of studies of their psychometric characteristics fmds little evidence to justify their continued use. While studies of the fidelity of simulations have demonstrated that examinees feel they are realistic and have good face validity, reliability studies have repeatedly shown that scores are too imprecise for meaningful interpretation, unless unpractically large numbers of simulations are included in a test. Validity studies have demonstrated that simulations have the expected relationships with a host of criterion measures, but it appears that similar assessment information can be obtained using clinically‐oriented multiple choice questions in much less testing time. Some common methodological weaknesses in study design and analysis are identified, and some research directions are suggested to improve the psychometric c...

The use of natural language entry and laser videodisk technology in CAI.

One reason for the limited use of computer-assisted instruction in medical education has been that the writing of lessons often requires complex programming skills. Recently developed authoring systems for microcomputers now permit teachers unfamiliar with computers to write realistic clinical simulations for use in both instruction and evaluation. The authors in this paper describe the use of an authoring system which incorporates two important features: student interaction with the computer by natural language entry at the keyboard and the use of the microcomputer to direct a random-access laser videodisk player. For the purpose of evaluation, memory registers are employed to assign scores to several aspects of performance and to derive monetary costs for components of patient assessment and treatment. Similar registers are used to codify instructions for altering the clinical state of the simulated patient. The realistic simulations facilitate both problem-based learning and the evaluation of several cognitive aspects of clinical competence.

The presence of distinct and stable skills among students assessed for clinical competence in oncology.

Several aspects of clinical competence in oncology were assessed among sixty-one fourth-year medical students, and results correlated with success in other areas of the curriculum as well as the extent of previous exposure to cancer patients. The inter-relationships identified by factor analysis among the outcome and predictor measures suggest that several distinct competencies were being assessed. In addition, certain skills, such as the ability to generate appropriate diagnostic hypotheses and to perform well on multiple-choice exams, appear to have been stable across time. These findings imply that there are distinct components to clinical competence, and that various methods of evaluation reflect these competencies differently.