What steps are necessary to create written or web-based selected-response assessments?

Before we work out what constitutes an assessment’s value for a given cost in medical education, we must first outline the steps necessary to create an assessment, and then assign a cost to each step. In this study we undertook the first phase of this process: we sought to work out all the steps necessary to create written selected-response assessments. First, the lead author created an initial list of potential steps for developing written assessments. This was then distributed to the other three authors. These authors independently added further steps to the list. The lead author incorporated the contributions of these others and created a second draft. This process was repeated until consensus was achieved amongst the study’s authors. Next, the list was shared by means of an online questionnaire with 100 healthcare professionals with experience in medical education. The results of the authors’ and healthcare professionals’ thoughts and feedback on the steps, needed to create written assessment, are outlined below in full. We outlined the steps that are necessary to create written or web-based selected-response assessments

What steps are necessary to create written or web-based selected-response assessments?

Before we work out what constitutes an assessment’s value for a given cost in medical education, we must first outline the steps necessary to create an assessment, and then assign a cost to each step. In this study we undertook the first phase of this process: we sought to work out all the steps necessary to create written selected-response assessments. First, the lead author created an initial list of potential steps for developing written assessments. This was then distributed to the other three authors. These authors independently added further steps to the list. The lead author incorporated the contributions of these others and created a second draft. This process was repeated until consensus was achieved amongst the study’s authors. Next, the list was shared by means of an online questionnaire with 100 healthcare professionals with experience in medical education. The results of the authors’ and healthcare professionals’ thoughts and feedback on the steps, needed to create written assessment, are outlined below in full. We outlined the steps that are necessary to create written or web-based selected-response assessments

Can ill-structured problems reveal beliefs about medical knowledge and knowing? A focus-group approach.

Epistemological beliefs (EB) are an individual's cognitions about knowledge and knowing. In several non-medical domains, EB have been found to contribute to the way individuals reason when faced with ill-structured problems (i.e. problems with no clear-cut, right or wrong solutions). Such problems are very common in medical practice. Determining whether EB are also influential in reasoning processes with regard to medical issues to which there is no straightforward answer, could have implications for medical education. This study focused on 2 research questions: 1. Can ill-structured problems be used to elicit general practice trainees' and trainers' EB? and 2. What are the views of general practice trainees and trainers about knowledge and how do they justify knowing

The perception of the clinical relevance of the MDS-Home Care(C) tool by trainers in general practice in Belgium

BACKGROUND: Comprehensive geriatric assessment has been advocated as an effective way to first identify multidimensional needs and second to establish priorities for organizing an individual health care plan for community-dwelling elderly. This paper reports on the perception of an internationally evaluated assessment system for use in community care programmes, the Minimal Data Set-Home Care (MDS-HC(c)), by a group of experienced GP trainers. OBJECTIVE: The primary study aim was to determine the perception of a standardized home care assessment system (MDS-HC(c)) by GP trainers in terms of acceptability, perceived clinical relevance, care planning empowerment and valorization of the GP. METHODS: Sixty-five first-year GP trainees were educated about the MDS-HC(c) and the use of a first version of an electronic interface. Each trainee included two elderly patients, based on strict inclusion criteria. Prior to the assessment, GP trainers and trainees were invited to complete together a basic medical record on the basis of their knowledge of the included patients. Next, the collected data, covering the multiple domains by MDS-HC(c), were introduced in the electronic interface by the trainee. Based on the collected data for each patient, a series of clinical assessment protocols (CAP's) were generated. Afterwards, these CAP's were critically discussed with the trainer. To investigate how the application of the MDS-HC(c) was perceived, a 21 Likert-type item scale was drawn up based on four dimensions regarding the tool. RESULTS: The perception questionnaire had a good internal consistency (Cronbach's alpha 0.93). The first version of the electronic interface was considered not 'user-friendly' enough and the introduction of data time-consuming. The perception of the GP's about the overall clinical relevance of the MDS-HC(c) was found to have little added value for the GP in the establishment of a personal management plan. CONCLUSIONS: Many developments in health care result in an increasing demand for a standardized home care assessment system. In Belgium, the federal public health service advised to promote the MDS-HC(c) for use in the community setting. In this study, it appears that its added value was not perceived by this sample of 37 experienced GP trainers as an empowering tool in term of management of the patient and valorization of the role of GP.status: publishe

From Context Comes Expertise: How Do Expert Emergency Physicians Use Their Know-Who to Make Decisions?

International audienceStudy objective: Decision making is influenced by the environment in which it takes place. The objective of our study was to explore the influence of the specific features of the emergency department (ED) environment on decision making. In this paper, we specifically report on the way emergency physicians use their knowledge of their collaborators to make their decisions. Methods: We conducted a qualitative study on emergency physicians recruited in 3 French hospitals. Physicians were equipped with a microcamera to record their clinical activity from their ``own-point-of-view perspective.'' Semistructured interviews, based on viewing the video, were held with each physician after an actual clinical encounter with a patient. They were then analyzed thematically, using constant comparison and matrices, to identify the central themes. Results: Fifteen expert emergency physicians were interviewed. Almost all of them reported using their knowledge of other health care professionals to assess the seriousness of the patient's overall condition (sometimes even before his or her arrival in the ED) to optimize the patient's treatment and to anticipate future care. Conclusion: Emergency physicians interact with many other health care workers during the different stages of the patient's management. The many ways in which experts use their knowledge of other health care professionals to make decisions puts traditional conceptions of expert knowledge into perspective and opens avenues for future research

Do emergency physicians trust their patients?

International audienceThe primary focus of research on the physician-patient relationship has been on patients' trust in their physicians. In this study, we explored physicians' trust in their patients. We held semi-structured interviews with expert emergency physicians concerning a patient they had just been managing. The physicians had been equipped with a head-mounted micro camera to film the encounter from an ``own point of view perspective''. The footage was used to stimulate recall during the interviews. Several participants made judgments on the reliability of their patients' accounts from the very beginning of the encounter. If accounts were not deemed reliable, participants implemented a variety of specific strategies in pursuing their history taking, i.e. checking for consistency by asking the same question at several points in the interview, cross-referencing information, questioning third-parties, examining the patient record, and systematically collecting data held to be objective. Our study raises the question of the influence of labeling patients as ``reliable'' or ``unreliable'' on their subsequent treatment in the emergency department. Further work is necessary to examine the accuracy of these judgments, the underlying cognitive processes (i.e. analytic versus intuitive) and their influence on decision-making