Assessment Of Clinical Performance Research Articles

The association between visuospatial neglect and balance and mobility post-stroke onset: A systematic review.

Although previous narrative reviews have highlighted a potential association between visuospatial neglect (VSN) and balance disorders, to what extent different areas of balance and mobility could be affected is still unclear. This systematic review updates previous literature findings and systematically reviews sitting balance, standing balance and mobility outcomes. PubMed, Web of Science, ScienceDirect, Naric-Rehabdata, PEDro and the Cochrane Trials Library were systematically searched. Methodological quality was assessed by the National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The association between VSN and sitting balance, standing balance and mobility (walking, stair climbing/descending and transfers) was investigated. In total, 48 studies were included (4595 stroke survivors): at least 1319 (29%) showed symptoms of VSN. VSN was associated with less independence during sitting, with an asymmetric posture toward the affected body side. For standing balance, we revealed a significant negative association between VSN and mediolateral stability and weight shifting, whereas only activities of daily living-related VSN was associated with weight-bearing asymmetry during static stance. While walking, patients with VSN laterally deviated from their path. Results were inconclusive regarding other aspects of mobility. The association between VSN and balance/mobility seemed to decrease over time. Despite great heterogeneity in results, this study suggests that stroke survivors with VSN show specific deviations in posture and movement in the mediolateral direction. Although the association between VSN and balance/mobility has been extensively investigated, explanatory studies evaluating underlying mechanisms of the frequently present association are lacking. Future studies should address this by combining clinical and instrumented assessment of balance and gait performance, preferably longitudinally to investigate the associations over time.

Use of Simulation Methods in Social Work Research on Clinical Decision-Making

While simulation has become an increasingly sophisticated and standardized method of clinical teaching and performance assessment in social work, unlike other clinical and health care fields, it is not generally used in other areas of social work research. Yet, it has the potential to address challenges and limitations in several areas of social work research. For instance, in the area of professional decision-making, research has demonstrated high variability in the conclusions of not only different professionals encountering the same case, but also in a single professional encountering a case at different times. However, research that would elucidate differences in professional decision-making is complicated by logistical and ethical constraints of real-life practice, and the fact that professional decision-making occurs outside the realm of conscious deliberation rendering the individual unable to fully articulate the process by which they arrived at their final conclusion. Simulation research methods can address some of these challenges through providing the opportunity to: observe professional decision-making in real time; reflect on the decisional process while reviewing recordings; and compare the approaches of professionals to standardized cases. This paper reviews the use of simulation research methods in clinical and health science fields and the types of simulation research. It then describes the manner in which simulation methods have been applied to a specific program of social work research that examines professional decision-making in high stakes situations, contributing to clinical practice.

A Qualitative Exploration of the Intern Experience in Assessing Medical Student Performance.

Interns play a key role in medical student education, often observing behaviors that others do not. Their role in assessment, however, is less clear. Despite accreditation standards pertaining to residents' assessment skills, they receive little guidance or formal training in it. In order to better prepare residents for their role in medical student assessment, we need to understand their current experience. We aimed to describe the first-year resident experience assessing students' performance and providing input to faculty for student clinical performance assessments and grades in the inpatient setting. Pediatric interns at Children's National Hospital (CN) from February 2018 to February 2019 were invited to participate in semistructured interviews about their experience assessing students. Constant comparative methodology was used to develop themes. Ten interviews were conducted, at which point thematic saturation was reached. We identified 4 major themes: 1) Interns feel as though they assess students in meaningful, unique ways. 2) Interns encounter multiple barriers and facilitators to assessing students. 3) Interns voice varying levels of comfort and motivation assessing different areas of student work. 4) Interns see their role in assessment limited to formative rather than summative assessment. These findings depict the intern experience with assessment of medical students at a large pediatric residency program and can help inform ways to develop and utilize the assessment skills of interns.

Embracing Change in the Pursuit of Excellence: Transitioning to the Clinical Internship Evaluation Tool for Student Clinical Performance Assessment

Background and Purpose. The assessment of physical therapist student competence in the clinical learning environment is valuable and necessary. However, educators and clinicians are becoming increasingly disenchanted with their chosen assessment tools and delivery platforms. The profession recently called for a pursuit of excellence that includes an analysis of performance evaluation practices and consideration of assessment tools. In line with this call, the purpose of this report was to disseminate one academic institution's exploration, implementation, and early outcomes of the transition from the Clinical Performance Instrument (CPI) to the Clinical Internship Evaluation Tool (CIET) for full-time student clinical performance assessment. Case Description. After identification of key stakeholders, the authors completed an initial exploration and comparison of CPI versus CIET, executed a pilot trial of CIET use, and implemented a transition from CPI to CIET for all full-time clinical experiences. Outcomes. This report presents the outcomes of the initial exploration and comparison of assessment tools, the CIET pilot, the academic processes in transitioning to the CIET, and the post-implementation evaluation results, each with consideration of unique stakeholder perspectives. Discussion and Conclusion. The transition from CPI to CIET for full-time student clinical performance assessment was successful in meeting the needs of key stakeholders. This report presents the first known addition to the literature regarding CIET implementation since the original institution's publications. Ongoing use and evaluation of the CIET and other alternative tools for student performance assessment, both within and across institutions, is necessary to address the profession's pursuit of excellence and to better meet the demand for contemporary educational practices in the clinical learning environment.

Rutgers Robert Wood Johnson Medical School.

Rutgers Robert Wood Johnson Medical School.

Northwestern University Feinberg School of Medicine.

Northwestern University Feinberg School of Medicine.

Development, application, and evaluation of a problem-based learning method in clinical laboratory education

BackgroundThere is a big gap between theory and real clinical practice with respect to the structure of clinical laboratory medicine (CLM) education in China. An integrated teaching method is urgently required, to improve student competency and prepare students to deal with complex challenges in the working environment. MethodsA total of 122 fourth-year CLM students studying at Hubei University between 2018 and 2019 were randomly assigned to a traditional teaching methods group or a problem-based learning (PBL) group. In the PBL group students were instructed to exchange their thoughts, identify information gaps, rehearse and perform simulated clinical scenarios, and incorporate the new information into cases in small groups. Theory tests, questionnaires, and clinical performance assessments were used to evaluate the effectiveness of PBL and compare it with that of traditional teaching methods. ResultsPBL resulted in significantly better theory test scores, better student feedback scores, and clinical performance assessments, and a higher rate of satisfaction among students and teachers. ConclusionPBL is an effective way to help CLM students develop comprehensive abilities to deal with real clinical laboratory work. It is a promising education method and should be generalized to all subtypes of clinical laboratory curriculums in the future.

High clinical performance and quantitative assessment of antibody kinetics using a dual recognition assay for the detection of SARS-CoV-2 IgM and IgG antibodies

ObjectivesSeveral serological SARS-CoV-2 immunoassays have been developed recently but require external validation before widespread use. This study aims at assessing the analytical and clinical performance of the iFlash® anti-SARS-CoV-2 chemiluminescence assay for the detection of both IgM and IgG antibodies. The kinetics of the antibody response was also evaluated. Design & MethodsThe precision, carry-over, linearity, limit of blank, detection and quantification were assessed. Sensitivity analysis was performed by using 178 sera collected from 154 RT-PCR confirmed COVID-19 patients. The specificity analysis was performed from 75 selected non-SARS-CoV-2 sera with a potential cross-reaction to the SARS-CoV-2 immunoassay. ResultsThis iFlash® SARS-CoV-2 assay showed excellent analytical performance. After 2 weeks since symptom onset, the sensitivities for IgM and IgG were 62.2% (95% CI: 52.3–71.2%) and 92.9%% (95% CI: 85.7–96.7%), respectively by using the cut-off provided by the manufacturer. After cut-off optimization (i.e. >2.81 for IgM and >4.86 for IgG), the sensitivity for IgM and IgG were 81.6 (95% CI: 72.7–88.1%) and 95.9% (95% CI: 89.4–98.7%), respectively. Optimized cut-off for IgG improved the sensitivity to reach 100% (95%CI: 87.6–100) from 28 days since symptom onset. ConclusionsThis study shows that the iFlash® SARS-CoV-2 assay from YHLO biotechnology, has satisfactory analytical performance. Nevertheless, the sensitivity of the IgM is limited for a proper clinical use compared to IgG. The determination of anti-SARS-CoV-2 IgG antibodies from 28 days since symptom onset was associated with high sensitivity, especially using optimized cut-offs (i.e. 100%).

The University of Texas Health Science Center at San Antonio, Joe R. and Teresa Lozano Long School of Medicine.

The University of Texas Health Science Center at San Antonio, Joe R. and Teresa Lozano Long School of Medicine.

Dell Medical School at the University of Texas, Austin.

Dell Medical School at the University of Texas, Austin.

Sociocultural learning in emergency medicine: a holistic examination of competence.

Objectives In the medical community of practice, the resident is situated in systems of professional and cultural activities. How diagnostic competence manifests in their sociocultural context is examined through situativity and systems theories. A holistic model is proposed that could examine diagnostic competence across micro (individual), meso (activity), and macro (cultural) systems. Methods Two short scenarios are presented resulting from observations of emergency medicine residents and their supervising physicians. These scenarios are analyzed using a trans-theoretical model of situativity and systems theories to understand how diagnostic competence manifests in practice (activity system). Results Assessment of diagnostic competence in a sociocultural context may require assessment of responses to contextual factors that seem immaterial to clinical reasoning. This information may signal that the resident also has the skills to identify appropriate information channels within an activity system and can accurately collect and prioritize clinical information within those channels. Therefore, the formal assessment of competent clinical reasoning performance, as a situated practice, may benefit from delineating how much of the context of an activity system is required to be competently managed and synthesized across the competency milestones. Conclusions The examination of diagnostic competence as a sociocultural practice can provide a unique and holistic examination of clinical reasoning performance and assessment.

The Effect of Evaluator Training on Inter- and Intrarater Reliability in High-Stakes Assessment in Simulation.

The aim of this study was to evaluate the effectiveness of a training intervention in achieving inter- and intrarater reliability among faculty raters conducting high-stakes assessment of clinical performance in simulation. High-stakes assessment of simulation performance is being adopted in nursing education. However, limited research exists to guide best practices in training raters, which is essential to ensure fair and defensible assessment. A nationwide sample of 75 prelicensure RN program faculty participated in an experimental, randomized, controlled study. Participants completing a training intervention achieved higher inter- and intrarater reliability than control group participants when using a checklist evaluation tool. Mixed results were achieved by participants when completing a global competency assessment. The training intervention was effective in helping participants to achieve a shared mental model for use of a checklist, but more time may be necessary to achieve consistent global competence decisions.

From Knowing to Doing: Integrating Systems-Ready Physician Competencies in the Clerkship Setting.

There are increasing calls to graduate physicians with a strong understanding of health systems science (HSS). Many schools have incorporated didactics on health systems science content such as quality improvement, patient safety, or interprofessional education. Creating a systems-ready physician requires more than teaching content in classroom settings. Using Miller's pyramid of assessment of clinical performance, we have developed strategies to move our learners from the cognitive-based "knows" level to the behavior-based "does" level of understanding of the HSS competencies. Our medical students begin learning HSS in classroom settings. Next, the students apply this knowledge during their core clerkships. This gives them an opportunity to get feedback increasingly from high-fidelity clinical settings. We embedded assessment strategies and tools in the clerkship year to facilitate the demonstration, observation, and assessment of HSS competencies in the setting of our core clerkships. We also have students self-assess their competence in our graduation competencies at the end of each year. Student self-assessment from the beginning of the clerkship year to the end showed significant increases in the HSS competencies. Our clerkship student assessment data from our first cohort suggest that faculty had difficulty observing and assessing some of the competencies unique to health systems science. The clerkships have developed multiple projects and assignments to allow students to demonstrate HSS competencies. Faculty and resident training to prompt, observe, and assess these competencies is ongoing to close the assessment gap. In the area of professionalism, student self-assessment and faculty clinical assessment correlate strongly.

Clinical Instructors' Perceptions of Internationally Educated Physical Therapists' Readiness to Practise during Supervised Clinical Internships in a Bridging Programme.

Purpose: The purpose of this study was to describe clinical instructors' (CIs) comments on the Canadian Physiotherapy Assessment of Clinical Performance (ACP) that reflect areas of strength and areas requiring improvement among internationally educated physical therapists (IEPTs) during supervised clinical internships in a bridging programme. Method: We reviewed the assessment records of 100 IEPTs' clinical performance during two internships each for three successive cohorts of learners in a Canadian bridging programme. We extracted the CIs' text from 385 comment sections of the ACP completed during these internships and analyzed them using qualitative content analysis. Results: The iterative deductive coding process resulted in 36 subcategories: 14 for areas of strength and 22 for areas requiring improvement. We merged the 36 subcategories to produce nine categories: four areas of strength (subjective assessment, treatment, patient confidentiality, and professionalism) and five areas for improvement (objective assessment, clinical reasoning, establishment of treatment goals, communication, confidence, and time management). We then grouped these categories into two broad themes: professional practice and professional conduct. Conclusions: The CIs commended the IEPTs for their clinical competence in subjective assessment, treatment, patient confidentiality, and professionalism. The areas requiring improvement typically required more complex clinical decision-making skills, which may have been challenging for these IEPTs to demonstrate as competently during a short internship.

The Effect of Logbook on the Clinical Training Aspects of Oral Medicine from the Perspective of Students and Faculties of Ahvaz School of Dentistry

Introduction: Assessment of student clinical performance is one of the most difficult tasks of faculty members. Logbook is one of the most effective methods for educational assessment. The aim of the present study was to assess the efficacy of logbook from the viewpoints of Ahvaz dental students and faculty members of Department of Oral and Maxillofacial medicine. Methods: The present cross-sectional study was conducted on the 70 students and six faculty members of Department of Oral and Maxillofacial medicine, School of Dental Medicine, Ahvaz Jundishapur University of Medical Sciences. The questionnaire was prepared from previous studies and included four areas of necessity, quality, format, and implementation process and how to complete the logbook. Data were analyzed using descriptive statistical analysis, independent t-test, and SPSS ver.18. Results: The viewpoint of faculty members regarding the four features of logbook and the overall view of the logbook was more than the students. However, no significant difference was found between the viewpoint of students and faculty members. 50.7% of the students and more than 50% of the faculties considered the use of the logbook necessary to ensure consistent educational standards in clinical training. They also showed that the logbook meets all 50% of the educational standards both in format and implementation process. Conclusion: Faculty members and students showed a positive view of logbook, but positive overall view of the faculty members was more than the students. Therefore, reviewing the logbook is not necessary, but more familiarity with the logbook content seems necessary.

A situated cognition model for clinical reasoning performance assessment: a narrative review.

Background Clinical reasoning performance assessment is challenging because it is a complex, multi-dimensional construct. In addition, clinical reasoning performance can be impacted by contextual factors, leading to significant variation in performance. This phenomenon called context specificity has been described by social cognitive theories. Situated cognition theory, one of the social cognitive theories, posits that cognition emerges from the complex interplay of human beings with each other and the environment. It has been used as a valuable conceptual framework to explore context specificity in clinical reasoning and its assessment. We developed a conceptual model of clinical reasoning performance assessment based on situated cognition theory. In this paper, we use situated cognition theory and the conceptual model to explore how this lens alters the interpretation of articles or provides additional insights into the interactions between the assessee, patient, rater, environment, assessment method, and task. Methods We culled 17 articles from a systematic literature search of clinical reasoning performance assessment that explicitly or implicitly demonstrated a situated cognition perspective to provide an "enriched" sample with which to explore how contextual factors impact clinical reasoning performance assessment. Results We found evidence for dyadic, triadic, and quadratic interactions between different contextual factors, some of which led to dramatic changes in the assessment of clinical reasoning performance, even when knowledge requirements were not significantly different. Conclusions The analysis of the selected articles highlighted the value of a situated cognition perspective in understanding variations in clinical reasoning performance assessment. Prospective studies that evaluate the impact of modifying various contextual factors, while holding others constant, can provide deeper insights into the mechanisms by which context impacts clinical reasoning performance assessment.

The Assessment of Physiotherapy Practice tool provides informative assessments of clinical and professional dimensions of student performance in undergraduate placements: a longitudinal validity and reliability study.

Do one or two factors best represent clinical performance scores obtained via the Assessment of Physiotherapy Practice (APP) and what is the nature of their characterisation? To what extent are the same number of factors and their interpretation, and item scaling captured equally over time and across contexts (eg, clinical subdisciplines) for assessments of clinical performance via the APP? Archival and longitudinal study of undergraduate students' clinical performances for each of four final-year clinical placements. A total of 561 undergraduate physiotherapy students from one Australian university who were enrolled to complete their final-year clinical placements between 2014 and2017. Clinical educators' assessments of student performance across seven key domains of clinical practice: professional behaviour, communication, assessment, analysis and planning, intervention, evidence-based practice and risk management. Factor analyses supported the superiority of a two-factor representation of the APP, including dimensions characterised by professional and clinical domains, when compared with a unidimensional structure of an overarching 'clinical performance' factor. It was also found that the two-factor representation and item scaling was consistent across four clinical placements covering typical areas of physiotherapy practice. In other words, the same constructs are being assessed equally well across context and time. The APP is the nationally adopted assessment tool that is used to evaluate clinical competence to practise as a physiotherapist in Australia and New Zealand. These findings provide new evidence for an updated scoring protocol in which clinical factors are distinguished from professional competencies.

Relationship of Clinical Skills Performance in Medical School With COMLEX-USA Level 2-Performance Evaluation.

Osteopathic medical students are required to pass the Comprehensive Osteopathic Medical Licensing Examination-USA (COMLEX-USA) Levels 1- and 2-Cognitive Evaluation and COMLEX-USA Level 2-Performance Evaluation (PE) to graduate. Predictors of COMLEX-USA cognitive exam performance are well established, but relatively few studies have explored factors associated with performance on the Level 2-PE. To evaluate the relationship between school-based clinical competency assessments (written, simulation, and workplace evaluations) and Level 2-PE performance to ensure that these assessment efforts are effective and grounded in evidence to support student readiness. School-based performance measures for 451 first-time takers of COMLEX-USA Level 2-PE were analyzed. A series of Mann-Whitney analyses were applied to compare 3 types of clinical performance assessments against COMLEX-USA Level 2-PE pass-fail performance: (1) internal objective structured clinical examinations (OSCE; average discipline-specific OSCE score and a comprehensive OSCE); (2) national examination performance (average clinical subject Comprehensive Osteopathic Medical Achievement Test, or COMAT, scores and Comprehensive Osteopathic Medical Self-Assessment Examination, or COMSAE, Phase 2 scores); and (3) a workplace-based clinical evaluation by preceptors. Students who passed the Level 2-PE had a significantly higher average discipline-specific OSCE score, COMSAE Phase 2 performance score, average COMAT score, and individual subject COMAT scores in all subjects except Psychiatry. Students who passed the Level 2-PE humanistic domain also had significantly higher scores in the communication skill component of the school's comprehensive OSCE. Similarly, students who passed the Level 2-PE biomedical domain had significantly higher scores in the data gathering and subjective, objective, assessment, and plan documentation scores on the internal OSCE. The size of these differences (η2) was relatively small. Student performance on the competency-based preceptor evaluation showed no significant relationship with pass-fail performance on the Level 2-PE. High-stakes OSCEs aligned with the level 2-PE blueprint are effective predictors of performance and are an important way to support student readiness for the Level 2-PE. Other assessments, such as subject-based COMATs and COMSAE Phase 2, add value to school-based assessments over workplace-based assessments.

Bifocal and Multifocal Contact Lenses for Presbyopia and Myopia Control.

Bifocal and multifocal optical devices are intended to get images into focus from objects placed at different distances from the observer. Spectacles, contact lenses, and intraocular lenses can meet the requirements to provide such a solution. Contact lenses provide unique characteristics as a platform for implementing bifocality and multifocality. Compared to spectacles, they are closer to the eye, providing a wider field of view, less distortion, and their use is more consistent as they are not so easily removed along the day. In addition, contact lenses are also minimally invasive, can be easily exchangeable, and, therefore, suitable for conditions in which surgical procedures are not indicated. Contact lenses can remain centered with the eye despite eye movements, providing the possibility for simultaneous imaging from different object distances. The main current indications for bifocal and multifocal contact lenses include presbyopia correction in adult population and myopia control in children. Considering the large numbers of potential candidates for optical correction of presbyopia and the demographic trends in myopia, the potential impact of contact lenses for presbyopia and myopia applications is undoubtedly tremendous. However, the ocular characteristics and expectations vary significantly between young and older candidates and impose different challenges in fitting bifocal and multifocal contact lenses for the correction of presbyopia and myopia control. This review presents the recent developments in material platforms, optical designs, simulated visual performance, and the clinical performance assessment of bifocal and multifocal contact lenses for presbyopia correction and/or myopia progression control.

Development of the Uncertainty Communication Checklist: A Patient-Centered Approach to Patient Discharge From the Emergency Department.

Clear communication with patients upon emergency department (ED) discharge is important for patient safety during the transition to outpatient care. Over one-third of patients are discharged from the ED with diagnostic uncertainty, yet there is no established approach for effective discharge communication in this scenario. From 2017 to 2019, the authors developed the Uncertainty Communication Checklist for use in simulation-based training and assessment of emergency physician communication skills when discharging patients with diagnostic uncertainty. This development process followed the established 12-step Checklist Development Checklist framework and integrated patient feedback into 6 of the 12 steps. Patient input was included as it has potential to improve patient-centeredness of checklists related to assessment of clinical performance. Focus group patient participants from 2 clinical sites were included: Thomas Jefferson University Hospital, Philadelphia, PA, and Northwestern University Hospital, Chicago, Illinois.The authors developed a preliminary instrument based on existing checklists, clinical experience, literature review, and input from an expert panel comprising health care professionals and patient advocates. They then refined the instrument based on feedback from 2 waves of patient focus groups, resulting in a final 21-item checklist. The checklist items assess if uncertainty was addressed in each step of the discharge communication, including the following major categories: introduction, test results/ED summary, no/uncertain diagnosis, next steps/follow-up, home care, reasons to return, and general communication skills. Patient input influenced both what items were included and the wording of items in the final checklist. This patient-centered, systematic approach to checklist development is built upon the rigor of the Checklist Development Checklist and provides an illustration of how to integrate patient feedback into the design of assessment tools when appropriate.