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91.
92.
Kevin W. Eva Georges Bordage Craig Campbell Robert Galbraith Shiphra Ginsburg Eric Holmboe Glenn Regehr 《Advances in health sciences education : theory and practice》2016,21(4):897-913
Despite multifaceted attempts to “protect the public,” including the implementation of various assessment practices designed to identify individuals at all stages of training and practice who underperform, profound deficiencies in quality and safety continue to plague the healthcare system. The purpose of this reflections paper is to cast a critical lens on current assessment practices and to offer insights into ways in which they might be adapted to ensure alignment with modern conceptions of health professional education for the ultimate goal of improved healthcare. Three dominant themes will be addressed: (1) The need to redress unintended consequences of competency-based assessment; (2) The potential to design assessment systems that facilitate performance improvement; and (3) The importance of ensuring authentic linkage between assessment and practice. Several principles cut across each of these themes and represent the foundational goals we would put forward as signposts for decision making about the continued evolution of assessment practices in the health professions: (1) Increasing opportunities to promote learning rather than simply measuring performance; (2) Enabling integration across stages of training and practice; and (3) Reinforcing point-in-time assessments with continuous professional development in a way that enhances shared responsibility and accountability between practitioners, educational programs, and testing organizations. Many of the ideas generated represent suggestions for strategies to pilot test, for infrastructure to build, and for harmonization across groups to be enabled. These include novel strategies for OSCE station development, formative (diagnostic) assessment protocols tailored to shed light on the practices of individual clinicians, the use of continuous workplace-based assessment, and broadening the focus of high-stakes decision making beyond determining who passes and who fails. We conclude with reflections on systemic (i.e., cultural) barriers that may need to be overcome to move towards a more integrated, efficient, and effective system of assessment. 相似文献
93.
Reed DA West CP Holmboe ES Halvorsen AJ Lipner RS Jacobs C McDonald FS 《Journal of general internal medicine》2012,27(8):917-923
BACKGROUND
Maintenance of certification examination performance is associated with quality of care. We aimed to examine relationships between electronic medical knowledge resource use, practice characteristics and examination scores among physicians recertifying in internal medicine.METHODS
We conducted a cross-sectional study of 3,958 United States physicians who took the Internal Medicine Maintenance of Certification Examination (IM?CMOCE) between January 1, 2006 and December 31, 2008, and who held individual licenses to one or both of two large electronic knowledge resource programs. We examined associations between physicians?? IM?CMOCE scores and their days of electronic resource use, practice type (private practice, residency teaching clinic, inpatient, nursing home), practice model (single or multi-specialty), sex, age, and medical school location.RESULTS
In the 365?days prior to the IM?CMOCE, physicians used electronic resources on a mean (SD, range) of 20.3 (36.5, 0?C265) days. In multivariate analyses, the number of days of resource use was independently associated with increased IM?CMOCE scores (0.07-point increase per day of use, p?=?0.02). Increased age was associated with decreased IM?CMOCE scores (1.8-point decrease per year of age, p?0.001). Relative to physicians working in private practice settings, physicians working in residency teaching clinics and hospital inpatient practices had higher IM?CMOCE scores by 29.1 and 20.0 points, respectively (both p?0.001).CONCLUSIONS
Frequent use of electronic resources was associated with modestly enhanced IM?CMOCE performance. Physicians involved in residency education clinics and hospital inpatient practices had higher IM?CMOCE scores than physicians working in private practice settings. 相似文献94.
To ensure that medical residents will be prepared to deliver consistently high-quality care, they should be trained in settings that provide such care. Residents in internal medicine, particularly, need to learn good care habits in order to meet the needs of patients with diabetes and other common chronic and high-impact illnesses. To assess the strength of such training, we compared the quality of medical care provided in sixty-seven US internal medicine residency ambulatory clinics with the quality of care provided by 703 practicing general internists. We found significant quality gaps in process, intermediate outcome, and patient-experience measures. These inadequacies in ambulatory training for internal medicine residents must be addressed by policy makers and educators-for example, by accelerating the movement toward new residency curricula that emphasize competency-based training. 相似文献
95.
为了评估美国内科委员会(American Board of Internal Medicine,ABIM)开展的实践改善单元(Practice Improvement Module,PIM)教育活动的效果,以及参与心脏疾病预防PIM教育活动的专科医师临床实践改善的表现,美国内科委员会进行了一项以自我指导为基础的观察研究. 相似文献
96.
Fiellin David A. O'Connor Patrick G. Holmboe Eric S. Horwitz Ralph I. 《Substance Abuse》2002,23(2):83-94
To determine the characteristics associated with an increased risk for delirium tremens (DT) we performed a case-control study at the detoxification units of two hospitals. Cases met DSM-IV criteria for DT. For each case (n = 15), 3 controls (n = 45) were chosen. Eligibility criteria were applied equally to cases and controls. Cases were more likely than controls to report a prior complicated withdrawal (DT or alcohol withdrawal seizure) (53 vs. 27%, OR 3.1, 95% CI 0.94–10.55), have a systolic blood pressure greater than 145 mm Hg on admission (60 vs. 27%, OR 4.1, 95% CI 1.21–14.06), and have comorbidity scores of at least 1 (60 vs. 18%, OR 6.9, 95% CI 1.92–25.08). Zero cases (0%) and 15 (33%) controls had no prior complicated withdrawals and no adverse clinical features (systolic blood pressure >145 or comorbidity score >1). Compared to this group, the odds of being a case and having both prior complicated withdrawal and at least 1 adverse clinical feature was 44.8 (95% CI 4.36–460). Elevated blood pressure, prior complicated alcohol withdrawal and medical comorbidity, alone and in combination, are associated with an increased risk of delirium tremens. 相似文献
97.
Eric S Holmboe Stephen Huot Jeff Chung John Norcini Richard E Hawkins 《Academic medicine》2003,78(8):826-830
98.
Henneberg Holmboe C Thorlacius-Ussing O Teglbjaerg PS Vinter-Jensen L 《Scandinavian journal of gastroenterology》2003,38(2):225-227
We describe a case of Meckel's diverticulum containing ectopic gastric epithelium being the leading point in an ileoileal intussusception. This is usually an acute or subacute condition, but in this case the course was protracted and the case was misdiagnosed and treated as Crohn disease. 相似文献
99.
100.