Teacher evaluation in the health professions

This paper reviews current concepts and practices of teacher evaluation as it exists in health professions educational programs. Problems associated with teacher evaluation and the necessity for well designed evaluation systems are explored. Recommendations are made for the development of objective teacher evaluation procedures.     

Accreditation in the allied health professions

Specialized accreditation in the allied health professions can and will fulfill its basic purpose if its efforts are guided by the principle that evaluation must place its emphasis on the outcome of the educational process, no matter how difficult it may be to assess. This requires the commitment and cooperation of both the accrediting body and the institution and program under review. Accreditation is a vitally important and valuable system in higher education in general, and the allied health professions are no exception. If the system is to be effective, however, every temptation must be resisted by all involved parties to debase it by using it for self-serving purposes. A recognized accrediting agency not only has the right, but indeed the responsibility, to ensure that the graduates of a program under review possess the prerequisite knowledge and skills essential for entrance into a given allied health profession. In cases where that minimal standard is not attained, the program should be required to remove those deficiencies in a timely manner or, if sufficiently serious, have its accreditation withheld or withdrawn. There should be no exceptions to this course of action. Every standard or essential adopted should be defensible on sound educational grounds, and every program should be evaluated according to whether it is in compliance. Accrediting bodies must direct their efforts toward evaluating educational quality. They must respect institutional rights and responsibilities and not even attempt to prescribe what will be taught or by whom, or who will administer a given program. The entire accreditation process must account for institutional diversity and should not discourage experimentation, innovation, or modernization. However, the standards and essentials that are ultimately adopted must be applied uniformly and fairly and not in an arbitrary or capricious manner. Hence, it is imperative that the standards and essentials be stated in such a way that they are clear and understandable. For those programs in which an enhancement or upgrading is deemed necessary for one or more aspects of the educational experience, it would be a genuine service to the institution and its consistuency if the accrediting agency could offer sound advice and suggestions for remedying those factors that may be causing or contributing to the observed deficiencies in the educational outcome. Any responsible institution would welcome such an approach, and the outcome should be an upgrading of the program under review with a concomitant enhancement of the profession involved.(ABSTRACT TRUNCATED AT 400 WORDS)     

Recredentialing in the allied health professions

Credentialing of allied health professionals is used to assure the public that they are receiving care from competent individuals, and recredentialing is a means to demonstrate continuing competence. There is considerable variability in the requirements that allied health professions have for recredentialing. Of the 16 national credentials representing 14 allied health professions that were included in this study, 50% had no continuing education (CE) or retesting requirement in order to maintain the credential. The remaining 50% required CE in amounts ranging from 10 to 50 hours per year, with a mean of 18.5 hours. One credential requires both CE and retesting. A review of the literature reveals that CE requirements are not linked to improved patient outcomes, and evidence linking retesting to improved outcomes is lacking. Therefore, even though there is external pressure to implement recredentialing requirements for the allied health professions, care needs to be taken to assure that the tools used to ensure continued competence are valid and reliable.     

Two models for change in the health services in Zimbabwe

The health situation in pre-Independence Zimbabwe was much as elsewhere in the Third World. While the majority suffered excess mortality and morbidity, the affluent enjoyed a health status similar to that of the populations of developed countries. The health services also showed the familiar pattern, with expenditure concentrated on sophisticated facilities in the towns, leaving the rural majority with practically no services at all. With the coming of Majority Rule, the previous pattern of controlling access to facilities on the basis of race could not continue. Two broad routes forward were defined. On the one hand, the private doctors, the private insurance companies, and the settler state proposed a model based on improving urban facilities, depending on a trickle-down to eventually answer the needs of the rural people. On the other hand, the post-Independence Ministry of Health advocated a policy of concentrating on developing services in the rural areas. The pattern of the future health service will depend on the capacity of the senior health planners and on the enthusiasm of front-line health workers but, of overriding importance will be the political commitment to answer the needs of the majority and the outcome of the inevitable struggle for access to scarce health sector resources.     

The place of science in the health professions

The central premise of this paper is that medical education today is being driven by intellectual and social imperatives to make fundamental changes in the way it prepares students to be the doctors of tomorrow. Fully aware that over the past 50 years at least eight major national commissions in the USA alone have made similar claims, the present reality is such that the pressure for change has greater force than at any time since the beginning of the century, when the overall form of modern medical education was set. The new science base of medicine requires the activation of its students. Although medical educators have recognized for at least half a century that active student learning is preferable to the passive student roles of didactic methods, we no longer have a choice. Not only is the activated student a requisite for learning that is intrinsic to the new intellectual paradigm, it is necessary for its application in clinical practice. At the same time, it is important to recognize that the social organization of medical education is structured to resist the kinds of changes that are inherent to the basic knowledge and practice requirements of contemporary medicine. The modern medical centre contains vested bureaucratic and financial interests, shared by both scientists and practitioners, which form a highly resistent structural barrier to change.     

Gender differences in leadership in the health professions

The leadership characteristics and behaviors of men and women differ. As increasing numbers of women enter positions of leadership, understanding of these differences can increase the quality and productiveness of relationships in the workplace. This article describes the evolution of women in leadership, gender differences in leadership style, and the way gender may affect behaviors in the workplace.     

The professions of public health

Law has been an essential tool of public health practice for centuries. From the 19th century until recent decades, however, most histories of public health described, approvingly, the progression of the field from marginally useful policy, made by persons learned in law, to effective policy, made by persons employing the methods of biomedical and behavioral science. Historians have recently begun to change this standard account by documenting the centrality of law in the development of public health practice.The revised history of public health offers additional justification for the program of public health law reform proposed in this issue of the Journal by Gostin and by Moulton and Matthews, who describe the new program in public health law of the Centers for Disease Control and Prevention.     

Constructing the cost of health professions education

Pressures at the national, state, and institutional levels are forcing health professions education administrators to justify their budget requests. Because unit cost studies traditionally used by higher education have proved unsatisfactory, program constructed cost models have been developed. The advantages of the model for administrators lie in the fact that any input unit of the model can be adjusted and the effects of that adjustment can be measured against the cost per student. In times of budget restrictions, these adjustments permit administrators to model various combinations of student enrollment, faculty involvement, class size, and basic program structure to obtain the optimal education experience from available resources. The model is applied by way of example to all nonbaccalaureate dental hygiene education programs in the United States.     

Overseas careers in allied health professions

As the allied health services gain recognition in other countries, an increasing number of overseas positions are becoming available to American professionals. There is considerable confusion as to the realities of international employment. This article provides information intended to guide persons who might be interested in careers abroad.     

Increasing minority representation in the health care professions

Although race is a social construct with no scientific credibility, it is a powerful predictor of diminished health outcomes and health care delivery in the United States. Minorities who enter health professions provide a disproportionate quantity of health care services to minorities, the underserved, and poor. The goal of having a health care delivery system with similar demographics to the population it serves is seriously lacking in most health care professions. The author of this commentary proposes that health care educators should be more aggressive in admitting and recruiting students from minority communities through the use of affirmative action. The recent U.S. Supreme Court ruling, Grutter v. Bollinger, not only supports this approach but also gives guidance for implementation. Under the general category of admission strategies, two strategies are proposed: (1) a defensible structure for admission using race/ethnicity as a factor and (2) expanded criteria for student selection. Under recruitment strategies, four strategies are offered: (1) outreach to kindergarten through 12th grade, (2) better informing school career counselors, (3) advertising possibilities, and (4) community involvement through local school boards. Because affirmative action in admissions is the most controversial and complex set of strategies, this report focuses particularly on this area.     

Recertification and relicensure in the allied health professions

This article identifies and clarifies some of the major issues concerning recertification and relicensure of allied health practitioners. Various methods of recredentialing are discussed; while mandatory continuing education may not provide evidence of competency, it may be more acceptable to health care practitioners than any other type of requirement. However, statewide peer review/audit, on-the-job performance evaluation, and a national written examination may be more suitable as recredentialing methods if certain conditions are met. Criteria are suggested for the evaluation of any proposed recredentialing program; for example, the program should be criterion-referenced based, valid, reliable, accessible, cost-effective, and acceptable. If such a recredentialing program is developed, the credentialing board and the practitioners--and ultimately employers, third-party payers, and consumers--must bear the additional costs. The major questions are "Is it necessary?" and "Is it worth it?"     

The structure of competence in health professions

The past decade has seen widespread research on systematic evaluation of the competence of health professionals. Such activity usually has been carried out in accordance with the prevailing psychological paradigms, in which competence is represented as a trait, or as an intrapsychic factor. However, even when competence has been delimited as problem-solving, the research generally identified a strong situational influence on performance. In this article are assembled a set of diverse but complementary arguments for dispensing with the conventional representations of professional competence. In their place is proposed a relational model in which competence in health professions is seen as the aggregated adaptations of practitioners to the set of special social circumstances that obtain within the situational boundaries of their profession. It is argued that a thorough understanding of the content of professional situations is a necessary prerequisite for successful evaluation of professional competence, since competent behavior is lodged in a network of probabilistic relationships with the surroundings. Also discussed are selected procedural implications of this new model for the conduct of investigations of professional situations.     

Gender, health professions and public health

In this article we review the main results of historical-social research on gender and medical practice, propose a model for applying a gender perspective to the study of healthcare professions, and analyze some current forms of gender bias in Spanish public health societies and publications. The main conclusions indicate: the historic construction of gendered professional identities; the existence of vertical segregation by sex in scientific societies and in journal editorial boards; the existence of androcentric practices in the scientific journals, exemplified by the style of using the initial letter of the authors' first name; the fact that scientific societies do not collect data by sex; the difficulties that all of this implies for quantitative investigations that study the sex variable and adopt a gender perspective; and the need to promote qualitative research on the issue.