L’évaluation de la compétence dans le contexte professionnel

Toute profession est organisée autour d'un corpus global de connaissances, de savoir-faire, d'applications pratiques et de règles qui imposent qu'il y ait une formation et un entraînement particuliers des individus qui en font partie. La compétence professionnelle, définie comme la capacité d'un professionnel à utiliser son jugement, de même que les connaissances, les habiletés et les attitudes associées à sa profession pour résoudre des problèmes complexes, est un construit non observable directement. Pour l'évaluer, il faut faire des inferences à partir d'éléments observables et mesurables. Mais comment faire?Le présent article explique pourquoi on doit évaluer la compétence professionnelle et comment l'évaluer. Les auteurs décrivent l'expertise du Centre d'évaluation des sciences de la santé de l'Université Laval qui, depuis plus de dix ans, utilise l'examen clinique objectif structuré, ECOS, pour la certification des candidats à la pratique de la médecine de famille au Québec, un instrument qui a largement démontré sa validité et sa fidélité.Every profession is organized around a body of knowledge, expertise, practical applications and rules which impose a particular kind of education and training for members of that profession. The professional competency, defined as the degree to which one uses knowledge, skills and judgment in situations that arise in the course of professional practice, is a construct not directly observable. Hence, we have to draw inferences from observable and measurable elements. But how?This article explains why must professional competency be evaluated and how to evaluate. Authors describe the Centre for Evaluation in the Health Sciences expertise, which has been using for 10 years the Objective Clinical Structured Examination (OSCE) for the certification of family medicine candidates. The validityand the reliability of this toolhave been widely demonstrated

Country, Sex, EDSS Change and Therapy Choice Independently Predict Treatment Discontinuation in Multiple Sclerosis and Clinically Isolated Syndrome

We conducted a prospective study, MSBASIS, to assess factors leading to first treatment discontinuation in patients with a clinically isolated syndrome (CIS) and early relapsing-remitting multiple sclerosis (RRMS). The MSBASIS Study, conducted by MSBase Study Group members, enrols patients seen from CIS onset, reporting baseline demographics, cerebral magnetic resonance imaging (MRI) features and Expanded Disability Status Scale (EDSS) scores. Follow-up visits report relapses, EDSS scores, and the start and end dates of MS-specific therapies. We performed a multivariable survival analysis to determine factors within this dataset that predict first treatment discontinuation. A total of 2314 CIS patients from 44 centres were followed for a median of 2.7 years, during which time 1247 commenced immunomodulatory drug (IMD) treatment. Ninety percent initiated IMD after a diagnosis of MS was confirmed, and 10% while still in CIS status. Over 40% of these patients stopped their first IMD during the observation period. Females were more likely to cease medication than males (HR 1.36, p = 0.003). Patients treated in Australia were twice as likely to cease their first IMD than patients treated in Spain (HR 1.98, p = 0.001). Increasing EDSS was associated with higher rate of IMD cessation (HR 1.21 per EDSS unit, p<0.001), and intramuscular interferon-β-1a (HR 1.38, p = 0.028) and subcutaneous interferon-β-1a (HR 1.45, p = 0.012) had higher rates of discontinuation than glatiramer acetate, although this varied widely in different countries. Onset cerebral MRI features, age, time to treatment initiation or relapse on treatment were not associated with IMD cessation. In this multivariable survival analysis, female sex, country of residence, EDSS change and IMD choice independently predicted time to first IMD cessation

Kaplan-Meier survival estimates for treatment discontinuation by patient sex in CIS an early MS.

<p><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038661#pone-0038661-g001" target="_blank">Figure 1</a> demonstrates that female sex is associated with a higher IMD discontinuation rate compared to male sex in our prospectively followed multinational, multicentre cohort.</p

Kaplan-Meier survival estimates for first treatment discontinuation by IMD in CIS an early MS.

<p><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0038661#pone-0038661-g002" target="_blank">Figure 2</a> demonstrates a greater rate of IMD discontinuation in early RRMS and CIS populations prescribed IM IFNbeta-1a and SC IFNbeta-1a as compared with IFNbeta-1b and Glatiramer Acetate.</p

Characteristics of the CIS and RRMS patients treated by IMD.

<p>Abbreviations: IM: intramuscular, SC: subcutaneous, IFN: interferon, GA: glatiramer acetate.</p

Predictors of discontinuation of immunomodulatory treatments in CIS an early MS (Cox Regression).

<p>Abbreviations: CI: Confidence Interval, HR: Hazard Ratio, IM: intramuscular, SC: subcutaneous, IFN: interferon, GA: glatiramer acetate.</p>*<p>Italy combined with ‘Other’ in multivariable (adjusted) analysis to satisfy hazard proportionality assumption.</p>**<p>Analysis of scaled Schoenfeld residuals: test of proportional hazards, p = 0.07.</p

Predictors of discontinuation by immunomodulatory treatment in early MS and CIS (Univariable Cox Regression).

<p>Abbreviations: CI: Confidence Interval, UHR: Unadjusted Hazard Ratio, IM: intramuscular, SC: subcutaneous, IFN: interferon.</p><p>GA: glatiramer acetate.</p