Academic medicine : journal of the Association of American Medical Colleges
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Given the shortage of palliative care specialists in the United States, to ensure quality of care for patients with serious, life-threatening illness, generalist-level palliative care competencies need to be defined and taught. The purpose of this study was to define essential competencies for medical students and internal medicine and family medicine (IM/FM) residents through a national survey of palliative care experts. ⋯ This national survey of palliative care experts defines comprehensive and essential palliative care competencies for medical students and IM/FM residents that are specific, measurable, and can be used to report educational outcomes; provide a sequence for palliative care curricula in undergraduate and graduate medical education; and highlight the importance of educating medical trainees in communication and pain management. Next steps include seeking input and endorsement from stakeholders in the broader medical education community.
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The process of developing checklists to rate clinical performance is essential for ensuring their quality; thus, the authors applied an integrative approach for designing checklists that evaluate clinical performance. ⋯ This approach integrates published evidence and the knowledge of domain experts. A robust development process is a necessary prerequisite of valid performance checklists. Establishing a widely recognized standard for developing evaluation checklists will likely support the design of appropriate measurement tools and move the field of performance assessment in health care forward.
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High-quality checklists are essential to performance test score validity. Prior research found that physical exam checklists of items that clinically discriminated between competing diagnoses provided more generalizable scores than all-encompassing thoroughness checklists. The purpose of this study was to compare validity evidence for clinically discriminating versus thoroughness checklists, hypothesizing that evidence would favor the former. ⋯ Limiting checklist items to those affecting diagnostic decisions resulted in better accuracy and psychometric indices. Thoroughness items performed without thinking do not reflect clinical reasoning ability and contribute construct-irrelevant variance to scores.
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Patients frequently do not receive recommended therapies because performance expectations are often unclear. Clinical guidelines provide exhaustive details and recommendations, but this information is not formatted in a way that supports decision making or bedside translation of therapies. When performance expectations are unclear, it is difficult for clinicians to assess their own or others' competence. ⋯ Fourth, checklists provide an opportunity to evaluate and improve an individual's performance concurrently with the context in which it is delivered. A tighter connection between education and training activities and process improvement strategies will accelerate improvements in safety and quality. Schmutz and colleagues have provided advancements in performance evaluation that will help health care achieve higher-quality and safer care.
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Evaluating educators using a novel toolbox: applying rigorous criteria flexibly across institutions.
Valuing faculty as educators is essential for medical schools to fulfill their unique mission of educating physicians. The 2006 Consensus Conference on Educational Scholarship, sponsored by the Association of American Medical Colleges (AAMC) Group on Educational Affairs, provided educators seeking academic promotion with a portfolio-based format for documenting activities in five domains, using evidence of quantity, quality, a scholarly approach, and educational scholarship. Yet, the lack of a rigorous, widely accepted system to assess educator portfolio submissions during the promotion and tenure process continues to impede the ability to fully value educators and educational scholars. ⋯ Adoption of such criteria is now the rate-limiting step in using a fair process to recognize educators through academic promotion. To inform institutional review and implementation of these criteria, this article describes the iterative, evidence- and stakeholder-based process to establish the criteria. The authors advocate institutional adoption of these criteria so that faculty seeking academic promotion as educators, like their researcher colleagues, can be judged and valued using established standards for the assessment of their work.