Application of a community needs assessment survey to decategorization of child welfare services

Decategorization is a process of restructuring funding sources and services to encourage interagency collaboration, out-of-home placement prevention, and innovative programming driven by needs of families as opposed to bureaucratic contingencies. In this study a community needs assessment survey was used as one of the first steps in decategorization program planning. The survey assessed the most serious problems, the priorities for tax dollar support, and the service needs in a county beginning decategorization of child welfare services. Methods, results, and implications are discussed and compared to other types of data available about needs of the residents of the county as a model for other communities that may be undertaking decategorization projects or other large-scale planning efforts.     

Health needs assessment and determinants of health-seeking behaviour among elderly Nigerians: a house-hold survey

BACKGROUND: In the last decade the number of elderly citizens in Nigeria has increased and their health needs are becoming popularly recognized. A number of factors have also been recognized to determine health care seeking behaviour in these elderly. METHODS: The sample consisted of 756 households that had at least one resident who was aged 60 years and above (35% of 2160 households). Multistage and proportionate sampling techniques were employed to select the study subjects. Structured interview were conducted to elicit information on health needs and determinants of health care seeking behaviour of household members aged 60 years and above. RESULTS: The most frequently reported illnesses were body pain (89.5%), joint pain (86.4%), generalized body weakness and fatigue (81.5%), poor sight (78.2%), fever (71.3%), irritability, anger, and nervous tension (70%), listlessness, depression, and headaches (60%),and decreased mobility (65.8%). More than two-thirds (68.8%) of respondents had never visited health facilities in the last one year even for ordinary medical check-up. Family care/Family consultation was the first choice (44.6%) of treatment for the most frequently reported illnesses irrespective of age group and sex. Less than one-third (28.7%) of the subjects were aware of their health needs. Receiving treatment when sick was the health needs mentioned by the majority (89.4%) of the elderly. Poverty emerged as a major (50.3%) determinant of health care seeking behaviour followed by nature of illness (28.5%). The odds ratio that elderly from poor households will seek health care from unqualified health care practitioners was 0.7 (95% confidence interval (CI) = 0.38-0.67); while the odds ratio that elderly from poor households will seek health care from qualified health care practitioners was 0.8 (95% CI = 0.57-0.89). Self treatment had odds ratio of 1.7 (95% CI = 0.38-0.67). After controlling the household's poverty status, there was still a significance difference (P < 0.05) in age group and gender in terms of health care seeking behaviour. CONCLUSION: Socio-economic indicators and nature of illness were the most pervasive determinants of health care seeking behaviour among the elderly, overriding age and sex, and in terms of health-care expenditure, the nature of illness and quality of service provided ranked the major determinants.     

Clinical skills assessment.

BACKGROUND: From September 1996, all GP registrars completing vocational training in the United Kingdom must demonstrate competence by means of a four-part assessment procedure. AIM: To look at the accuracy of one of the components of vocational training: the trainer's report. METHOD: Seventy-five registrars completing their general practice training at the end of July 1997 were invited to take part in a practical skills workshop. Eight stations were designed to test practical skills and diagnostic interpretations that were included in the trainer's report, and a clinical vignette accompanied each task. The marking schedule used was developed from the minimum standards required in the trainer's report. Twenty-nine registrars (38%) took part in the workshop. RESULTS: Only one registrar passed all eight stations. The maximum number of stations failed by any one individual was five and this doctor was the only one of the sample to ultimately fail summative assessment. The majority of registrars failed by being unable to interpret clinical findings. Twenty-five registrars (86%) responded to the follow-up questionnaire. Of these, only six felt that the stations were unrealistic. All but two registrars had spent at least six months in their hospital training doing obstetrics and gynaecology but, in spite of this, only 31% of registrars were above minimum competence for vaginal and speculum examination. CONCLUSION: With one exception, registrars passed all aspects of the trainer's report. Discrepancy was found between the trainer's report and the doctor's ability to carry out clinical procedures. There is an assumption that many of these clinical skills are being taught and assessed at undergraduate level and during the hospital component, but this cannot be taken for granted. Doubt must also be cast on whether the trainers are using the trainer's report appropriately, and whether this is a valid and reliable tool to identify skills deficient in registrars for summative assessment.     

Inhaler use and education characteristics among English and non-English speaking patients: A pilot needs assessment survey

Objective

Identify inhaler use characteristics among English (ESP) and non-English speaking patients (NSP) to develop quality improvement efforts.

Unmet needs and unused skills: physicians' reflections on their liberal arts education

Physicians who graduated from 1955 to 1982 from three liberal arts colleges in southeastern Pennsylvania were asked about the ways that their undergraduate education had prepared or failed to prepare them for careers in medicine and about changes that they would, in retrospect, have made in their courses of undergraduate study. For many, college had failed to meet their perceived need, as physicians, for skill in dealing with people, but had provided skills in the form of basic science knowledge and willingness to be different that exceeded the demands of their careers. They wished that in college they had taken more courses in the humanities--especially art, history, music, and English literature--and less chemistry, mathematics, physics, and biology. Would-be physicians should be encouraged to take full advantage of the humanizing opportunities of a liberal arts education with confidence that it will contribute to their future professional and personal lives.     

The resident-as-teacher educational challenge: a needs assessment survey at the National Autonomous University of Mexico Faculty of Medicine

Background  

The role of residents as educators is increasingly recognized, since it impacts residents, interns, medical students and other healthcare professionals. A widespread implementation of resident-as-teacher courses in developed countries' medical schools has occurred, with variable results. There is a dearth of information about this theme in developing countries. The National Autonomous University of Mexico (UNAM) Faculty of Medicine has more than 50% of the residency programs' physician population in Mexico. This report describes a needs assessment survey for a resident as teacher program at our institution.     

Assessing the need for a needs assessment.

Needs assessments are conducted with the expectation that the information obtained will be used to make rational decisions. However, appropriate planning and service delivery decisions do not always flow from needs assessment information. Assessment of the anticipated utilization of needs assessment data, and evaluation of the appropriateness of these uses prior to conducting a needs assessment may prevent inefficient use of resources. The present study evaluated the willingness and ability of community mental health leaders to use needs assessment data. A structured interview was developed which tapped into several dimensions relevant to the evaluation of the need for a needs assessment. The most striking result was that when asked how they would use future needs assessment data, all respondents indicated that the results would not influence service delivery patterns. Strategies to facilitate the constructive use of information gained from needs assessments are discussed.     

A survey of basic technical skills of medical students.

PURPOSE: In 1998, the Medical Schools Objectives Project (MSOP) Report listed the minimum routine technical procedures that graduating medical students should be proficient to perform. The authors conducted a survey to determine to what extent basic technical skills are being taught formally and how student competence in these skills is being evaluated in U.S. medical schools. METHOD: A questionnaire of five items, designed to supplement existing information in CurrMIT, the national curriculum database for medical schools, was transmitted electronically via the AAMC listserv to associate deans for academic affairs. RESULTS: Sixty-two of the 126 medical schools (52%) responded to the survey. Most agreed that graduating medical students should be proficient to perform basic technical skills. Fifty-five percent of the respondents required students to keep logs of procedures performed. A majority responded that their students were proficient to perform venipuncture, IV placement, suturing lacerations, Foley catheter placement, and arterial puncture. The responding schools stated that few students are proficient in thoracentesis and intubation of children and neonates. CONCLUSIONS: It is likely that half of the medical schools are not attaining the MSOP objective of rigorously teaching and evaluating technical procedures. Currently, more measures and more sophisticated measures of physicians' performance are being implemented in medical practice. The authors' findings call attention to this educational need and act as a stimulus to improve this aspect of medical education.     

Developing an institution-based assessment of resident communication and interpersonal skills.

PURPOSE: The authors describe the development and validation of an institution-wide, cross-specialty assessment of residents' communication and interpersonal skills, including related components of patient care and professionalism. METHOD: Residency program faculty, the department of medical education, and the Clinical Performance Center at the University of Illinois at Chicago College of Medicine collaborated to develop six standardized patient-based clinical simulations. The standardized patients rated the residents' performance. The assessment was piloted in 2003 for internal medicine and family medicine and was subsequently adapted for other specialties, including surgery, pediatrics, obstetrics-gynecology, and neurology. We present validity evidence based on the content, internal structure, relationship to other variables, feasibility, acceptability, and impact of the 2003 assessment. RESULTS: Seventy-nine internal medicine and family medicine residents participated in the initial administration of the assessment. A factor analysis of the 18 communication scale items resulted in two factors interpretable as "communication" and "interpersonal skills." Median internal consistency of the scale (coefficient alpha) was 0.91. Generalizability of the assessment ranged from 0.57 to 0.82 across specialties. Case-specific items provided information about group-level deficiencies. Cost of the assessment was about $250 per resident. Once the initial cases had been developed and piloted, they could be adapted for other specialties with minimal additional effort, at a cost saving of about $1,000 per program. CONCLUSION: Centrally developed, institution-wide competency assessment uses resources efficiently to relieve individual programs of the need to "reinvent the wheel" and provides program directors and residents with useful information for individual and programmatic review.     

Sequential testing in the assessment of clinical skills.

PURPOSE: Educators who use standardized-patient-based (SP-based) tests may save resources by using sequential testing. In this approach, students take a short screening test; only those who fail take a second test. This study investigated whether sequential testing increases efficiency with only a minor decrease of validity. METHOD: In 1994-95, first- through fourth-year (Group 1) and sixth-year (Group 2) medical students at the University of Maastricht took SP-based tests. Each test took two days. In a simulation experiment based on the data from those tests, the authors considered the first day as the screening test and the second day as the second test. They investigated efficiency and validity as a function of the cutoff score of the screening test. They developed and evaluated a new method to determine the optimum cutoff score of the screening test, a method based on minimization of the loss represented by the (weighted) numbers of false positives and negatives in the screening test. RESULTS: The negative predictive value (probability that a student would fail the complete test if he or she had failed the screening test) was low (<60%), while the positive predictive value was high (>96%). Accordingly, stringent pass/fail cutoff scores in the screening test (75% for Group 1 and 80% for Group 2) produced optimum results. Using those cutoff values, only 26% and 11% of 'the students would have had to take the complete test to get a "true" score, while only 0.2% and 0.0% of the students who passed the screening test went on to fail the complete test (false positives). CONCLUSIONS: In a sequential SP-based test, the pass/fail cutoff score of the screening test should be stringent. This can considerably reduce testing time (30% to 40%), while keeping the percentage of false positives at an acceptably low level of less than 0.2%. As an alternative to receiver operator characteristic analysis, minimization of the loss function was found to be an appropriate method to determine the optimum cutoff value of the screening test.     

An interactive computer tutorial to teach pain assessment

Under-treated pain is a significant problem. Health care institutions are under increasing pressure from patients and accreditation bodies to improve staff training in pain management. Pain assessment, a necessary pre-cursor to good pain management, is a complex multi-step process requiring sophisticated understanding and superior communication skills. This article describes the development and usability testing of an interactive, Internet-deliverable, multimedia tutorial to teach best practice pain assessment. The software platform allowed non-programmers to create multimedia tutorials and included the capability to simulate role-plays. The tutorial was designed to actively engage and respond to the learner and to include skills practice. Twenty-five nurses took the tutorial and rated it positively on a usability questionnaire in terms of ease-of-use and learning method.     

Facilitation of nutritional assessment by computer dietary analysis

Dietary nutritional analysis, an important component of nutritional assessment, has been greatly advanced by computers. Computers save time and money and allow more analyses to be performed. A Nutrient Data Bank is being developed by the U.S. Department of Agriculture, the Food and Drug Administration and others. Computers calculate many useful statistical relationships and can interact with users to perform interviews. New uses include field surveys and dental and medical practice with dietitians who are Consulting Nutritionists. Possible home computer uses are suggested.