Publications (10)18.1 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: To examine the increase in self-perceived clinical competence during a three-year postgraduate training in general practice and to explore the relation between the growth of self-perceived competence and several background variables. Cohort, 1995-1998. Three-year Postgraduate Training for General practice in the Netherlands All Dutch trainees who followed postgraduate training from September 1995 to September 1998 (N=191). We asked the trainees at the start and at the end of their postgraduate training to complete a questionnaire, which assessed their self-perceived knowledge, clinical skills and consultations skills. We collected information about potentially influencing background variables. Amongst these were variables such as: age, gender, prior medical experience, the effort someone has spent upon her/his education, insight in weak and strong areas of clinical competence and knowledge and skills levels. Self-perceived competence. A total of 127 trainees completed both questionnaires (190 at the first administration and 128 at the second one). We found statistically significant growth of self-perceived clinical competence. Self-perceived consultation skills increased more than self-perceived knowledge and clinical skills. The afore mentioned background variables did not relate in any way with the growth of self-perceived clinical competence. This study shows that a 3-year postgraduate training in general practice enhances self-perceived clinical competence. However, we still do not know how to explain this improvement. Further study into the theoretical concept of self-assessment in medical education and into the factors contributing to the feeling of being competent, is required.
- [Show abstract] [Hide abstract] ABSTRACT: Samenvatting Klik voor de inhoud van dit artikel op de bovenstaande pdf-knop.
- [Show abstract] [Hide abstract] ABSTRACT: The evidence suggests that a longitudinal training of communication skills embedded in a rich clinical context is most effective. In this study we evaluated the acquisition of communication skills under such conditions. In a longitudinal design the communication skills of a randomly selected sample of 25 trainees of a three-year postgraduate training programme for general practice were assessed at the start and at the end of training. Eight videotaped real life consultations were rated per measurement and per trainee, using the MAAS-Global scoring list. The results were compared with each other and with those of a reference group of 94 experienced GPs. The mean score of the MAAS-Global was slightly increased at the end of training (2.4) compared with the start (2.2). No significant difference was found between the final results of the trainees and the reference group. According to the criteria of the rating scale the performance of both trainees and GPs was unsatisfactory. The results of this study indicate that communication skills do not improve in a three-year postgraduate training comprising both a rich clinical context and a longitudinal training of communication skills, and that an unsatisfactory level still exists at the end of training. Moreover, GPs do not acquire communication skills during independent practice as they perform comparably to the trainees. Further research into the measurement of communication skills, the teaching procedures, the role of the GP-trainer as a model and the influence of rotations through hospitals and the like, is required.
- [Show abstract] [Hide abstract] ABSTRACT: To examine the validity of a written knowledge test of skills for performance on an OSCE in postgraduate training for general practice. A randomly-selected sample of 47 trainees in general practice took a knowledge test of skills, a general knowledge test and an OSCE. The OSCE included technical stations and stations including complete patient encounters. Each station was checklist rated and global rated. The knowledge test of skills was better correlated to the OSCE than the general knowledge test. Technical stations were better correlated to the knowledge test of skills than stations including complete patient encounters. For the technical stations the rating system had no influence on the correlation. For the stations including complete patient encounters the checklist rating correlated better to the knowledge test of skills than the global rating. The results of this study support the predictive validity of the knowledge test of skills. In postgraduate training for general practice a written knowledge test of skills can be used as an instrument to estimate the level of clinical skills, especially for group evaluation, such as in studies examining the efficacy of a training programme or as a screening instrument for deciding about courses to be offered. This estimation is more accurate when the content of the test matches the skills under study. However, written testing of skills cannot replace direct observation of performance of skills.
- [Show abstract] [Hide abstract] ABSTRACT: Samenvatting In het kader van de evaluatie van de driejarige huisartsopleiding werd onderzocht of de huisartsen-in-opleiding (haio’s) aan het einde van hun opleiding medisch-technische vaardigheden voldoende beheersen. Methode Een vaardighedentoets (zestien stations) werd afgenomen en met een borderlinegroupmethode werd een cesuur bepaald voor voldoende vaardighedenbeheersing. Deelnemers aan de toets waren 87 haio’s en 36 huisartsen. Resultaten De gemiddelde totaalscore van de haio’s (68.7%) was hoger dan die van de huisartsen (63.3%). Ten opzichte van de cesuur (56.4%) scoorde 2.5% van de haio’s en 12.1% van de huisartsen onder de norm. Er werden verschillen gevonden tussen de afdelingen huisartsopleiding. Discussie Bij de haio’s is gemiddeld aan het einde van de opleiding sprake van een goede vaardighedenbeheersing. Ruim 10% van de huisartsen scoort echter lager dan de vastgestelde norm voor vaardighedenbeheersing. Daar lijkt ruimte voor verbetering. De resultaten roepen vragen op over de betekenis van de huisartsopleider en het afdelingsonderwijs voor de vaardigheidsontwikkeling van de haio. (Jansen JJM, Kramer AWM, Scherpbier AJJA, Vleuten CPM van der, Tan LHC. Beheersing van medisch technische vaardigheden door huisartsenin-opleiding en huisartsopleiders. Tijdschrift voor Medisch Onderwijs 2001;20(1): 25-31.)
- [Show abstract] [Hide abstract] ABSTRACT: Evaluation of the efficacy of a short course of technical clinical skills to change performance in general practice. Subjects were self-selected general practitioners (n=59) who were unaware of the study design. They were assigned to the intervention group (n=31) or control group (n=28) according to their preference for course date. The course covered four different technical clinical skills (shoulder injection technique, PAP-smear, laboratory examination of vaginal discharge, ophthalmoscopic control in diabetes mellitus). Main outcome measures used were pre- and post-training scores on a knowledge test of skills (60 multiple choice items), and pre- and post-training performance of procedures in practice using a log-diary covering 20 days. University of Maastricht, The Netherlands. Self-selected general practitioners. Competence, as measured by the knowledge test of skills, improved significantly as a result of the training and skills test scores were satisfactory after training. A significant effect on performance in practice was found for PAP-smear and shoulder injection technique, whereas no effect could be demonstrated for examination of vaginal discharge and ophthalmoscopic control in diabetes mellitus. A good degree of competence is a necessary but not always sufficient condition for a physician to change his performance in practice. While some skills training seems adequate to bring about desired changes, for other skills more complex interventions are probably needed.
- [Show abstract] [Hide abstract] ABSTRACT: Klik voor de inhoud van dit artikel op de bovenstaande pdf-knop.
- [Show abstract] [Hide abstract] ABSTRACT: The use of performance-based assessment has been extended to postgraduate education and practising doctors, despite criticism of validity. While differences in expertise at this level are easily reflected in scores on a written test, these differences are relatively small on performance-based tests. However, scores on written tests and performance-based tests of clinical competence generally show moderate correlations. A study was designed to evaluate construct validity of a performance-based test for technical clinical skills in continuing medical education for general practitioners, and to explore the correlation between performance and knowledge of specific skills. A 1-day skills training was given to 71 general practitioners, covering four different technical clinical skills. The effect of the training on performance was measured with a performance-based test using a randomized controlled trial design, while the effect on knowledge was measured with a written test administered 1 month before and directly after the training. A training effect could be shown by the performance-based test for all four clinical skills. The written test also demonstrated a training effect for all but one skill. However, correlations between scores on the written test and on the performance-based test were low for all skills. It is concluded that construct validity of a performance-based test for technical clinical skills of general practitioners was demonstrated, while the knowledge test score was shown to be a poor predictor of competence for specific technical skills.
- [Show abstract] [Hide abstract] ABSTRACT: Technical clinical procedures constitute an important part of the work of general practitioners. Assessment of competence in the relevant skills is important from the perspective of quality assurance. In this study, the psychometric characteristics of three different methods for assessment of competence in technical clinical skills in general practice were evaluated. A performance-based test (8 stations), a written knowledge test of skills (125 items) and a self-assessment questionnaire (41 items) on technical clinical skills were administered to 49 GPs and 47 trainees in general practice. The mean scores on the performance-based test and the written knowledge test of skills showed no substantial differences between GPs and trainees, whereas the GPs scored higher on the self-assessment questionnaire. While the correlation of the score on the knowledge test of skills with the score on the performance-based test was moderately high, the score on the self-assessment questionnaire showed a rather low correlation with the performance-based test. Although performance-based testing is obviously the best method to assess proficiency in hands-on skills, a written test can serve as a reasonable alternative, particularly for screening and research purposes.
Maestricht, Limburg, Netherlands
- Department of General Practice
Transnationale Universiteit LimburgBox Elder, South Dakota, United States