Workplace‐based assessments of junior doctors: do scores predict training difficulties?

Medical Education 2011: 45 : 1190–1198 Objectives Workplace‐based assessment (WPBA) is an increasingly important part of postgraduate medical training and its results may be used as evidence of professional competence. This study evaluates the ability of WPBA to distinguish UK Foundation Programme (FP) doctors with training difficulties and its effectiveness as a surrogate marker for deficiencies in professional competence. Methods We conducted a retrospective observational study using anonymised records for 1646 trainees in a single UK postgraduate deanery. Data for WPBAs conducted from August 2005 to April 2009 were extracted from the e‐portfolio database. These data included all scores submitted by trainees in FP years 1 and 2 on mini‐clinical evaluation exercise (mini‐CEX), case‐based discussion (CbD), direct observation of procedural skills (DOPS) and mini‐peer assessment tool (mini‐PAT) assessments. Records of trainees in difficulty, as identified by their educational supervisors, were tagged as index cases. Main outcome measures were odds ratios (ORs) for associations between mean WPBA scores and training difficulties. Further analyses by the reported aetiology of the training difficulty (health‐, conduct‐ or performance‐related) were performed. Results Of the 1646 trainees, 92 had been identified as being in difficulty. Mean CbD and mini‐CEX scores were lower for trainees in difficulty and an association was found between identified training difficulties and average scores on the mini‐CEX (OR = 0.54; p = 0.034) and CbD (OR = 0.39; p = 0.002). A receiver operator characteristic curve analysis of mean WPBA scores for diagnosing ‘in difficulty’ status yielded an area under the curve of 0.64, indicating weak predictive value. There was no statistical evidence that mean scores on DOPS and mini‐PAT assessments differed between the two groups. Conclusions Analysis of a large dataset of WPBA scores revealed significant associations between training difficulties and lower mean scores on both the mini‐CEX and CbD. Models show that using WPBA scores is, however, not a valid way of screening for trainees in difficulty. Workplace‐based assessments have value as formative assessments that prompt supervision, feedback and reflection. They should not be relied upon to certify competence and their use for such ends may reduce their effectiveness in training. Their results should be interpreted in the context of multiple other methods of assessment, with the aim of achieving a genuinely holistic and representative assessment of professional competence.     

Obesity: does it occur in African children in a rural community in South Africa?

BACKGROUND: Total body fatness and a centripetal fat patterning are recognized as risk indicators of cardiovascular disease in adulthood. In this study, the development of these risk factors in rural South African children during the preschool years and first years of formal schooling is explored. METHOD: The initial cross-sectional data from the Ellisras Longitudinal Investigations in Rural Community Children Project, ongoing since 1996, were used, involving 684 boys and 652 girls, aged 3-10 years, in the Ellisras rural community. Overweight was measured using the body mass index (BMI) (kg/m2). Overfatness was based on the sum of the triceps and subscapular skinfold thicknesses. A centripetal fat patterning was measured by the sum of trunk skinfolds relative to limb skinfolds and the ratio of the subscapular to triceps skinfold. Further, the ratio of the subscapular to supraspinale skinfold was used as an indicator of lower body fat patterning. The 85th percentiles of the NHANES III were used as cutoff values for overweight, overfatness and a centripetal fat patterning. RESULTS: At ages 7 and 8 years, mean BMI was statistically significantly higher in males compared to females (P < 0.05). The log transformed supraspinale skinfold thickness was larger in females compared to males at ages 4-7 years; the log transformed subscapular skinfold was larger in girls compared to boys aged 7-10 years. Less clear patterns were found for the extremity skinfolds and the skinfold ratios. Very few children (0-2.5% in males and 0-4.3% in females) had BMI values above the NHANES III 85th percentiles, indicating a very low prevalence of overweight children in the area. About 15% of the males showed overfatness at ages 3-4 years, while low prevalence was found at older ages. CONCLUSION: Few Ellisras rural children had above normal values for BMI, indicating a low prevalence of obesity in this population. In the 3- and 4-year-old group more subjects were found to have excessive fat, as indicated by the sum of the triceps and subscapular skinfold thicknesses.     

Prevalence of urinary schistosomiasis and HIV in females living in a rural community of Zimbabwe: does age matter?

A cross-sectional study was conducted on 544 women living in Mupfure rural area of Zimbabwe to determine whether infection with urinary schistosomiasis is associated with HIV infection. Schistosoma haematobium infection was examined in urine samples and HIV infection was determined in sera. The prevalence of S. haematobium infection was highest (60%) in women below 20 years of age and declined to 29% in the oldest age group (test for trends, P<0.001). Overall, women infected with urinary schistosomiasis had an HIV prevalence of 33.3%, whilst women without urinary schistosomiasis had an HIV prevalence of 25.6% (chi(2), P=0.053). Women above the age of 35 years and infected with urinary schistosomiasis had a significantly higher HIV prevalence (37.5%) than those without urinary schistosomiasis (16.8%; chi(2), P<0.001).     

Watching television: how does it influence the dietary quality of children?

The prevalence of obesity is increasing and continues to be a concern, particularly in children, where the condition may lead to chronic health problems typically seen only in adults. This has prompted researchers to look at the relationships between sedentary behaviours, such as television viewing, diet and obesity in children. Epidemiological studies have shown repeatedly that rates of obesity are associated with both increased media use and poor diet quality in children and adults. Such studies have also shown that hours of television watched are associated with an increased intake of nutrient‐poor, energy dense foods and greater overall energy intake. In children, intervention studies that have imposed reductions in television viewing time have shown that reducing the time spent watching television may decrease energy intake and improve overall diet quality. However, these studies are confounded by the use of self‐reported measures for television viewing time and dietary intake. Despite these limitations, the results are promising and more research could lead to a greater understanding of these relationships. Ultimately, clear and concise public health messages for children and their parents regarding the benefits of television time reduction would assist in the fight against obesity.     

Why do junior doctors not want to work in a rural location,and what would induce them to do so?

Objective: Identify the most important factors associated with choosing rural medical practice. Design: Cross‐sectional design using a web survey to collect quantitative and qualitative data. Participants: One hundred and ninety junior doctors – 91 interns, 99 PGY2. Main outcome measures: Choice of practice location (urban/rural), reason for choosing location, enticement to a rural location. Results: Twenty‐seven per cent of junior doctors preferred a rural practice location. Preference to practice in a rural area was associated with medical placement bonding schemes, rural background, rural placement experience and being older. High levels of professional expectations and prestige were associated with a preference for an urban location. The most important reasons for choosing a practice location included consideration of partner, family and friends (35.3%), preference for a location (20.5%), lifestyle goals (19.5%) and career opportunities, specialty requirements and infrastructure (17.9%). Those who preferred an urban compared with a rural location gave more importance to factors concerning partner, family and friends. The factors that would entice a doctor to a rural location included partner and family considerations (27.0%), professional support (20.3%), and career opportunities, specialty requirements and infrastructure (16.3%). Women gave more importance to partner and family factors than men. Conclusions: Our findings support the continuation of policies that are known to encourage choice of rural practice, but highlight the need for additional strategies that consider the personal and professional needs of this generation of doctors.     

The Clinton plan: how does it play for governors and states?

Many of the nation's governors are moving from short-term cost cures of the 1980s to sweeping health reform laws. States' ability to remain flexible in how they undertake reform remains a critical concern to governors as they size up the Clinton health plan, especially its call for a national budget.     

Readiness, action, and resolve for change: do health care leaders have what it takes?

Careful assessment and planning are not enough to lead organizational change. Success depends on deliberate action by leaders and the resolve to stay the course.     

Uncovering strengths within community dwelling older adults: What does it mean for health care practice?

The aim of this paper is to present the psychological strengths we identified from interviews with community dwelling older adults. Data for this paper is drawn from participants in a community dwelling older adult study. The latter involved qualitative in‐depth interviews with the participants exploring their well‐being. All participants were community dwelling and living in a region in the North Island of New Zealand. Interviews took place between March 2017 to September 2017. Thirty‐seven older adults between the ages of 66–99 took part in semi‐structured interviews and all interviews were audio‐recorded. Interviews ranged from 1 to 3 hr. Analysis was informed by the Values in Action Character strengths framework. We were able to identify strengths within the VIA conceptual framework comprising; cognitive strengths, emotional strengths, social and community strengths, protective strengths and transcendental strengths. Throughout this study we found that participants experienced difficulties in identifying and talking about their strengths. In many ways this may reflect participants' strength of humility, demonstrating modesty in talking about themselves. This study has highlighted the challenges older adults experienced in identifying their own strengths. However, the study has demonstrated how narratives can be one way of uncovering psychological strengths with older adults. In particular, these findings highlight the range of strengths, for example, bravery, gratitude, hope, humour, kindness, perseverance, spirituality, that older adults have and give a voice in highlighting these. However, more practical ways of making strength‐based practices workable in daily practice, for example, in clinical assessment and health promotion programs are required.     

The use of high-selenium yeast to raise selenium status: how does it measure up?

Selenium-enriched yeast (Se-yeast) is a common form of Se used to supplement the dietary intake of this important trace mineral. However, its availability within the European Union is under threat, owing to concerns expressed by the European Community (EC) Scientific Committee on Food that Se-yeast supplements are poorly characterised and could potentially cause the build up of Se in tissues to toxic levels. The present review examines the validity of these concerns. Diagrams of the biosynthesis and metabolism of Se compounds show which species can be expected to occur in Se-yeast preparations. Se-yeast manufacture is described together with quality-control measures applied by reputable manufacturers. The way in which speciation of Se-yeast is achieved is explained and results on amounts of Se species in various commercial products are tabulated. In all cases described, selenomethionine is the largest single species, accounting for 54-74 % of total Se. Se-yeast is capable of increasing the activity of the selenoenzymes and its bioavailability has been found to be higher than that of inorganic Se sources in all but one study. Intervention studies with Se-yeast have shown the benefit of this form in cancer prevention, on the immune response and on HIV infection. Of about one dozen supplementation studies, none has shown evidence of toxicity even up to an intake level of 800 microg Se/d over a period of years. It is concluded that Se-yeast from reputable manufacturers is adequately characterised, of reproducible quality, and that there is no evidence of toxicity even at levels far above the EC tolerable upper intake level of 300 microg/d.