Identifying context factors explaining physician's low performance in communication assessment: an explorative study in general practice

BACKGROUND Communication is a key competence for health care professionals. Analysis of registrar and GP communication performance in daily practice, however, suggests a suboptimal application of communication skills. The influence of context factors could reveal why communication performance levels, on average, do not appear adequate. The context of daily practice may require different skills or specific ways of handling these skills, whereas communication skills are mostly treated as generic. So far no empirical analysis of the context has been made. Our aim was to identify context factors that could be related to GP communication. METHODS A purposive sample of real-life videotaped GP consultations was analyzed (N = 17). As a frame of reference we chose the MAAS-Global, a widely used assessment instrument for medical communication. By inductive reasoning, we analyzed the GP behaviour in the consultation leading to poor item scores on the MAAS-Global. In these cases we looked for the presence of an intervening context factor, and how this might explain the actual GP communication behaviour. RESULTS We reached saturation after having viewed 17 consultations. We identified 19 context factors that could potentially explain the deviation from generic recommendations on communication skills. These context factors can be categorized into doctor-related, patient-related, and consultation-related factors. CONCLUSIONS Several context factors seem to influence doctor-patient communication, requiring the GP to apply communication skills differently from recommendations on communication. From this study we conclude that there is a need to explicitly account for context factors in the assessment of GP (and GP registrar) communication performance. The next step is to validate our findings.We also thank the Dutch Ministry of Health for funding the collection and videotaping of routine GP consultations

The role of education in selection and allocation on the labour market; An empirical study in the medical field

In this study, we explore the role of education in explaining the labour market outcomes for graduates in medicine. More specifically, we focus on the question: To what extent are labour market outcomes of physicians explained by the skills acquired in education, as argued in the theory of Human Capital, by competences already present at the start of education, as suggested by the Screening theory literature, or by having attained the medical degree as such, as suggested by the literature on Credentialism? The study uses separate measurements of competence at the start and at the end of academic education. These are grade point averages (GPA’s) of secondary school, available at the start of the first year of study, versus the final (medical) Skills test at the end of the study. Moreover, we use a direct measurement of competence development during medical education in the form of Progress Test results; the first Progress Test result in the first year, versus the final Progress Test result in the fourth year of study. This enables us to disentangle the effects of the three suggested mechanisms. The results suggest that after graduation the human capital factors available do not explain subsequent differences in labour market outcomes. The data therefore suggest evidence for Credentialism. However, selection processes during education and in the response to the labour market survey, take place on human capital acquired before and during education.labour market entry and occupational careers;

Problem Based Learning ou APP – Apprentissage Par Problèmes

editorial reviewedCet article décrit la stratégie pédagogique adoptée tout au long des 6 années de formation des étudiants en médecine à l'Université de Maastricht depuis 1974. Cette stratégie comporte plusieurs méthodes : (1) Les groupes tutoriels où 8 étudiants se rencontrent un patient simulé (un acteur) qui expose son cas et auquel les étudiants peuvent poser des questions. Un des 8 étudiants écrit sur un tableau-papier les décisions d'étude du groupe. Un tuteur gère la procédure (appelée les seven steps ou sept sauts) mais ne fournit pas d'informations médicales. (2) Les étudiants ont deux jours pour explorer les ressources (en bibliothèque appelée Study Landscape) en livres, revues (physiques ou sur internet). (3) Les 8 étudiants se revoient pour partager les informations recueillies et rencontrer un autre cas. (4) Tous les 3 mois (donc 4 fois par an, d'où le nom "Tests de progression", ) tous les étudiants (des 6 années) sont testés le m^me jour sur le même test portant sur toute a médecine et constitué de 250 QVF (Questions Vrai-Faux). (5) Les réponses correcte sont publiées et les étudiants ont une semaine pour les contester (par écrit). (6) Des recherches comparatives (avec la méthode traditionnelle de formation des étudiants en médecine) ont produit des résultats sur plusieurs volets (connaissances, raisonnement clinique, relation avec les patients, revenus professionnels, choix de spécialités, etc.) ; ces réusltats sont exprimées en Ampleurs d'Effets

Context factors in general practitioner - patient encounters and their impact on assessing communication skills - an exploratory study

BACKGROUND Assessment of medical communication performance usually focuses on rating generically applicable, well-defined communication skills. However, in daily practice, communication is determined by (specific) context factors, such as acquaintance with the patient, or the presented problem. Merely valuing the presence of generic skills may not do justice to the doctor's proficiency.Our aim was to perform an exploratory study on how assessment of general practitioner (GP) communication performance changes if context factors are explicitly taken into account. METHODS We used a mixed method design to explore how ratings would change. A random sample of 40 everyday GP consultations was used to see if previously identified context factors could be observed again. The sample was rated twice using a widely used assessment instrument (the MAAS-Global), first in the standard way and secondly after context factors were explicitly taken into account, by using a context-specific rating protocol to assess communication performance in the workplace. In between first and second rating, the presence of context factors was established. Item score differences were calculated using paired sample t-tests. RESULTS In 38 out of 40 consultations, context factors prompted application of the context-specific rating protocol. Mean overall score on the 7-point MAAS-Global scale increased from 2.98 in standard to 3.66 in the context-specific rating (p<0.00); the effect size for the total mean score was 0.84. In earlier research the minimum standard score for adequate communication was set at 3.17. CONCLUSIONS Applying the protocol, the mean overall score rose above the level set in an earlier study for the MAAS-Global scores to represent 'adequate GP communication behaviour'. Our findings indicate that incorporating context factors in communication assessment thus makes a meaningful difference and shows that context factors should be considered as 'signal' instead of 'noise' in GP communication assessment. Explicating context factors leads to a more deliberate and transparent rating of GP communication performance.The study was funded by the SBOH Foundation, employer of Dutch Family Medicine Residents and funder of the national residency program for GPs in the Netherlands

Competence indicators in academic education and early labour market success of graduates in health sciences

In this study, the effects of several educational and non-educational indicators of (aspects of) competence on short-term labour market outcomes for university graduates are estimated. The research question we address is: To what extent do indications of specific and generic competence during the educational program predict labour market outcomes? Labour market outcomes in this study pertain to employment chances and quality of the job (having a job, academic level, matching occupational domain and wages). We use data on specific and generic aspects of competence, all of which were assessed during the academic study course, i.e. test scores on the attainment of domain specific knowledge, scores on group functioning, and the Masters’ thesis result. In addition, some other indicators of human capital acquired outside education are used, i.e. relevant work experience and managerial experience. The results indicate a rather differentiated pattern for the value of specific and generic competence acquired during education for the labour market.labour market entry and occupational careers;

Contextual attributes to promote positive social interdependence in problem-based learning:a focus group study

Background Problem-based learning (PBL) is classified as a collaborative learning approach, wherein students learn while contributing meaning to experiences and interactions with others. An important theoretical fundament of PBL is social interdependence theory (SIT) because positive social interdependence within a group has been found to be key to better learning performance and future attitudes towards team practice. However, most previous studies in health professions education focused on cognitive outcomes, and few studies have focused on collaborative behaviors in PBL groups. The lack of this empirical insight makes implementation of PBL difficult, especially in contexts where there is limited experience with collaborative learning. Therefore, the aim of this study was to elucidate what promotes or hinders positive social interdependence and how the attributes work during PBL. Methods We conducted four focus groups among clinical year medical students (n = 26) who participated in PBL tutorials in the formal curriculum. We asked semi-structured questions that corresponded with the overall concept of SIT. We analyzed the transcript using constructivist grounded theory and developed a model to explain contextual attributes that promote or hinder positive social interdependence in PBL. Results Two contextual attributes of "academic inquisition" and "desire for efficiency" affect social interdependence among a student group in PBL. Academic inquisition is students' desire to engage in their academic learning, and desire for efficiency is students' attitude toward learning as an imposed duty and desire to complete it as quickly as possible. These attributes are initially mutually conflicting and constructing social interdependence through multiple steps including inquisition from a case, seeking efficient work, sharing interest in problem solving, expecting mutual contributions, and complementing learning objectives. Conclusion These findings will contribute to understanding collaborative learning environments in PBL and may help explain contexts where PBL is less successful. The model can also be used as a tool to support innovation of PBL as collaborative learning

The Wheel of Competency Assessment: Presenting Quality Criteria for Competency Assessment Programs

Baartman, L. K. J., Bastiaens, T. J., Kirschner, P. A., & Van der Vleuten, C. P. M. (2006). The wheel of competency assessment: Presenting quality criteria for Competency Assessment Programmes. Studies in Educational Evaluation, 32, 153-170.Instruction and learning are increasingly based on competencies, causing a call for assessment methods to adequately determine competency acquisition. Because competency assessment is such a complex endeavor, one single assessment method seems not to be sufficient. This necessitates Competency Assessment Programs (CAPs) that combine different methods, ranging from classical tests to recently developed assessment methods. However, many of the quality criteria used for classical tests cannot be applied to CAPs, since they use a combination of different methods rather than just one. This article presents a framework of 10 quality criteria for CAPs. An expert focus group was used to validate this framework. The results confirm the framework (9 out of 10 criteria) and expand it with 3 additional criteria. Based on the results, an adapted and layered new framework is presented

Research in medical education: pratical impact on medical training and future challenges

Medical education research has changed over the years from merely descriptive studies towards justification or curriculum comparison studies and, nowadays, towards a slow introduction of more clarification studies. In clarification studies quantitative and qualitative methods are used to explain why or how educational interventions work or do not work. This shift is described in this paper. In addition, it is explained how research into workplace learning and assessment has impacted developments in educational practice. Finally, it is argued that the participation of teachers within the medical domain in conducting and disseminating research should be cherished, because they play a crucial role in ensuring that medical education research is applied in educational practice