17 research outputs found
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Variable trajectory: a systematic review, analytic synthesis and construct domain consolidation of international measures of competence in doctors and medical students
ABSTRACT
Background
Competence is assessed throughout a doctorâs career. Failure to identify and manage impaired competence can have critical consequences. Consistent conceptualisation and accurate measurement of this construct is imperative. Therefore, the objective of this review was to identify and evaluate measures used to assess competence in doctors and medical students.
Methods
A systematic search of the published literature was undertaken between December 2019 and February 2020 for articles reporting on the measurement of competence in doctors and/or medical students. Searches were conducted in the PsychSOURCE, US National Library of Medicine National Institutes of Health, MEDLINE (PubMed), The Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science electronic databases. Citation screening and forward citation tracking of included studies was carried out to identify any further relevant papers for inclusion. One thousand one-hundred and thirty-six potentially relevant articles were screened. An analytic synthesis approach was implemented to the identification, organization and interpretation of homogenous study and measure characteristics.
Results
Twelve competence domains were identified from the 153 identified measures. Knowledge and Procedural competence domains were the dominant focus of publications reporting current medical practice, but less so in research-based studies which more frequently assessed interpersonal, psychological, physiological and ethical competencies. In the 105 included articles, the reporting of measurement instrument quality was varied, with comprehensive reporting only present in 53.6% of measures; validation for some of the measures was particularly limited.
Discussion
Whilst this review included a considerable number of publications reporting the measurement of competence in doctors and medical students, the heterogeneity of the measures and variation of findings limit the ability to evaluate their validity and generalisability. However, this review presents a resource for researchers and medical educators which may inform operational practice and future research.
Keywords: Competence · Doctor · Medical student · Physician · Performanc
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What influences our ability to make fantasy-reality judgments?
The ability to make reality-status judgments requires an individual to distinguish between what is real and what is fantasy. While researchers have explored how this ability develops in typically developing (TD) children and adults, there is a paucity of literature that examines factors that influence the ability to make reality-status judgments. However, new directions include the role of affect, context, evidence, language ability and false-belief These new directions will be explored in TD children and adults across 5 experiments. Furthermore, when considering the role of false-belief, this raises the question ofhow children with Autism Spectrum Disorder (ASD), who have difficulty in understanding false-beliefs, make reality-status judgments. In an exploratory experiment, we aim to see whether children with ASD make reality-status judgments differently to TD children. Our research aims to explore what influences how TD children, children with ASD and adults make realityÂŹstatus judgments. Across 6 experiments we showed that affect, evidence and context (both local and between- and within-world) all play a role in children's reality-status judgments that show clear developmental progression. In one of the experiments, we additionally show that children with ASD show similar patterns of response to matched TD children, though they differ in their justifications. The implications of these findings are a) the potential role of affect in children's decision-making and b) the use of context and evidence as part of children's early years learning
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Exploring clinical perfectionism in higher education students: key recommendations and reflections on a partnership
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The importance of student partnership in rubric construction, discussion and evaluation
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Clinician experiences on training and awareness of sexual orientation in NHS Talking Therapies Services for Anxiety and Depression
Previous research that explored sexual minority service usersâ experiences of accessing NHS Talking Therapies for Anxiety and Depression Services highlighted the need for specific sexual orientation training. Inconsistent or lack of training may contribute to disparities in treatment outcomes between sexual minority service users and heterosexual service users. The aim of the study was to explore cliniciansâ competencies working with sexual minority service users, their experiences of sexual orientation training, their view of current gaps in training provision, and ways to improve training. Self-reported sexual orientation competency scales and open-ended questions were used to address the aims of the study. Participants (n=83) included Psychological Wellbeing Practitioners (PWPs) and High Intensity CBT Therapists (HITs). Responses on competency scales were analysed using Kruskl Wallis Test and thematic analysis was used to analyse qualitative responses. Participants who identified as 25-29 years old had higher scores on the knowledge scale than 45+ year olds. Bisexual participants also had higher scores on the knowledge subscale than heterosexual participants. Three overarching themes were identified: (a) Training received on sexual minority issues by Talking Therapies clinicians, (b) Cliniciansâ experiences of accessing and receiving sexual minority training, (c) Perceived gaps in current sexual minority training and ways to improve training. Findings were linked to previous literature and recommendations to stakeholders were made throughout the discussion section with the view of improving sexual orientation training
Serum IRAP, a Novel Direct Biomarker of Prediabetes and Type 2 Diabetes?
International audienceInsulin resistance (IR), currently called prediabetes (PD), affects more than half of the adult population worldwide. Type 2 diabetes (T2D), which often follows in the absence of treatment, affects more than 475 million people and represents 10â20% of the health budget in industrialized countries. A preventive public health policy is urgently needed in order to stop this constantly progressing epidemic. Indeed, early management of prediabetes does not only strongly reduce its evolution toward T2D but also strongly reduces the appearance of cardiovascular comorbidity as well as that of associated cancers. There is however currently no simple and reliable test available for the diagnosis or screening of prediabetes and it is generally estimated that 20â60% of diabetics are not diagnosed. We therefore developed an ELISA for the quantitative determination of serum Insulin-Regulated AminoPeptidase (IRAP). IRAP is associated with and translocated in a stoechiometric fashion to the plasma membrane together with GLUT4 in response to insulin in skeletal muscle and adipose tissue which are the two major glucose storage sites. Its extracellular domain (IRAPs) is subsequently cleaved and secreted in the blood stream. In T2D, IRAP translocation in response to insulin is strongly decreased. Our patented sandwich ELISA is highly sensitive (â„10.000-fold ânormalâ fasting concentrations) and specific, robust and very cost-effective. Dispersion of fasting plasma concentration values in a healthy population is very low (101.4 ± 15.9 ÎŒg/ml) as compared to those of insulin (21â181 pmol/l) and C-peptide (0.4â1.7 nmol/l). Results of pilot studies indicate a clear correlation between IRAPs levels and insulin sensitivity. We therefore think that plasma IRAPs may be a direct marker of insulin sensitivity and that the quantitative determination of its plasma levels should allow large-scale screening of populations at risk for PD and T2D, thereby allow the enforcement of a preventive health policy aiming at efficiently reducing this epidemic