Verschillende visies van huisartsen en reumatologen op de zorg voor patiënten met reumatoïde artritis

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Assessing the validity of an OSCE developed to assess rare, emergent or complex clinical conditions in endocrinology & metabolism

Background: Assessment of emergent, rare or complex medical conditions in Endocrinology and Metabolism (E&amp;M) is an integral component of training. However, data is lacking on how this could be best achieved. The purpose of this study was to develop and administer an Objective Structured Clinical Examination (OSCE) for E&amp;M residents, and to gather validity evidence for its use.Methods: A needs assessment survey was distributed to all Canadian E&amp;M Program Directors and recent graduates to determine which topics to include in the OSCE. The top 5 topics were selected using a modified Delphi technique. OSCE cases based on these topics were subsequently developed. Five E&amp;M residents (PGY4-5) and five junior Internal Medicine (IM) residents participated in the OSCE. Performance of E&amp;M and IM residents was compared and results were analyzed using a Generalizability study. Examiners and candidates completed a survey following the OSCE to evaluate their experiences.Results: The mean score of IM and E&amp;M residents was 41.7 and 69.3 % (p &lt; 0.001), respectively, with a large effect size (partial eta(2) = 0.75). Overall reliability of the OSCE was 0.74. Standard setting using a borderline regression method resulted in a pass rate of 100 % of E&amp;M residents and 0 % of IM residents. All residents felt the OSCE had high value for learning as a formative exam.Conclusions: The E&amp;M OSCE is a feasible method for assessing emergent, rare and complex medical conditions and this study provides validity evidence to support its use in a competency-based curriculum.</p

Performed-based assessment in continuing medical education for general practitioners : construct validity

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Learning in Pediatric Emergency Situations: A Qualitative Study of Residents' Perspectives*

Objectives: To explore resident learning in the context of emergency situations. The guiding research questions were: How do residents learn in emergency situations? What factors facilitate or hinder their learning? Design: A qualitative approach was used in order to understand the different perspectives of participants and explore the context of emergency situations. Aware of the complex sociocultural interactions in emergency situations, we used the methodology of constructivist grounded theory. Setting: A medium-sized pediatric academic hospital in San Antonio, TX. Subjects: Twenty pediatric residents participated in semi-structured interviews. Interventions: None. Measurements and Main Results: We used an iterative process of data collection and analysis. The process continued until thematic saturation was reached. The data were coded and analyzed using constant comparison. Codes were clustered into themes informed by the theory of situated learning. Several methods were used to ensure trustworthiness of results. Three main themes were identified. First, resident participation in emergency situations takes different forms. Residents participate mostly in helping roles. Watching is an under-recognized form of participation yet offered unique experiences. Managing roles are rarely afforded to residents. Second, resident participation is informed by the context of the emergency situation. Based on contextual clues (e.g., safety, needs), residents infer potential risks and values from their participation, which guides their participatory role. Residents may shift their form of participation, based on changes in the context. Supervisors play a significant role in guiding resident participation. Third, engagement, a state of cognitive and emotional focus, is critical in learning. The context of the emergency situation plays a role in the level of resident engagement. Supervisors may also foster resident engagement. Conclusions: Resident participation in emergency situations is complex and informed by the context. Learning in emergency situations is influenced by residents' level of mental engagement. Supervisors may positively guide resident participation, foster engagement, and enable them to reach their learning goals in emergency situations

Standardized Patients' Perspectives on Workplace Satisfaction and Work-Related Relationships: A Multicenter Study

INTRODUCTION: The use of standardized patients (SPs) in health care education has grown in the last 50 years. In addition, the requirements for SPs have increased steadily, and thus, the work of SPs has become more difficult and demanding. It has been claimed that SP programs are highly contextualized, having emerged from local, institutional, professional, and national conditions, but their effects on SPs have not been investigated. We have studied the effects of this job development on SPs and their programs. METHODS: The study was conducted using a qualitative research design, with semistructured individual in-depth interviews to understand the reactions, values, and perceptions that underlie and influence SP behavior. To cover SP perspectives from more than 1 SP program, a total of 15 SPs from 8 different nursing schools and medical schools in Switzerland were asked to participate. RESULTS: Standardized patients feel motivated, engaged, and willing to invest effort in their task and do not mind demands increasing as long as the social environment in SP programs is supportive. The role of the SP trainer and the use of feedback are considered very important. CONCLUSIONS: Standardized patient programs require concepts in which the SP perspective has been integrated to better serve SPs' well-being. Standardized patients are valuable partners in the training of health professionals-we need to take care of them

Assessment of competence in technical clinical skills of general practitioners

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Videotoetsing van consulten van huisartsen in de eigen praktijk. Een onderzoek naar validiteit, betrouwbaarheid en haalbaarheid.

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