La culture de l’annulation : exploration des conséquences involontaires du retrait de l’examen clinique pour l’octroi de la licence au Canada

Assessment drives learning. However, when it comes to high-stakes examinations (e.g., for licensure or certification), these assessments of learning may be seen as unnecessary hurdles by some. Licensing clinical skills assessment in particular have come under fire over the years. Recently, assessments such as the Medical Council of Canada Qualifying Examination Part II, a clinical skills objective structured clinical examination, have been permanently cancelled. The authors explore potential consequences of this cancellation including those that are inadvertent and undesirable. Future next steps for clinical skills assessment are explored.L’évaluation est le moteur de l’apprentissage. Cependant, lorsqu’il s’agit d’examens à enjeux élevés (par exemple, pour l’obtention du titre de licencié ou la certification), ces évaluations de l’apprentissage peuvent être perçues comme inutiles par certains. L’évaluation des compétences cliniques pour l’obtention du titre de licencié, en particulier, a été critiquée au fil des ans. Récemment, des évaluations comme l’examen d’aptitude du Conseil médical du Canada, partie II, un examen clinique objectif structuré permettant d’évaluer les compétences cliniques, ont été définitivement retirées. Les auteurs explorent les conséquences potentielles de l’annulation de ces évaluations incluant celles non intentionnelles et indésirables, ainsi que des perspectives sur l’évaluation des habiletés cliniques.

Calida del diligenciamiento de fichas epidemiológicas de enfermedades transmitidas por vectores (ETV) caso: dengue, chikungunya y malaria del Sivigila, Santa Marta, 2015-2016

La vigilancia en salud pública de las enfermedades transmitidas por vectores (ETV) tiene trascendencia económica, social, comunitaria y sanitaria por lo que conocer su incidencia y su prevalencia en forma asertiva, generará toma de decisiones oportunas y adecuadas para reducir esos impactos. El objetivo es determinar la calidad del diligenciamiento de fichas epidemiológicas de enfermedades transmitidas por vectores (ETV) para casos dengue, chikungunya y malaria reportadas al SIVIGILA en el ente territorial de Santa Marta, 2015-2016. Se trabajó mediante un Estudio observacional descriptivo transversal. La variable dependiente es la calidad del dato. Las independientes principales son el tipo, nivel de complejidad y ámbito de atención de las UPGD y las independientes secundarias los demás ítem que componen las fichas. La segunda fuente de información es la cargada en el SIVIGILA a fin de estimar correlación y calidad del dato. Se hizo análisis descriptivo, para los datos cuantitativos, usando medidas de tendencia central y de dispersión, y para los datos cualitativos, medidas de distribución de frecuencias; en el análisis bivariado se utilizó la prueba X2 y regresión lineal; y para el análisis multivariante se utilizó regresión logística. El intervalo de confianza del 95% (IC 95%) y el grado de significación (p). Se considerarán significativos todos aquellos valores de p<0,05. Los resultados mostraron que La media de la calidad del diligenciamiento en los datos básicos de las fichas epidemiológicas para Dengue, Malaria y Chikungunya, es 85.85. Para las caras A en Chikungunya es 88,0, Dengue 89,2, Dengue grave 90,4 y Malaria 61,8. La calidad en los datos específicos (cara B) de las fichas epidemiológicas para Dengue fue 61,5. Dengue grave 50 y Malaria 28,6. El estudio demostró asociación de interés entre la calidad del diligenciamiento y el tipo de UPGD (privadas o públicas) en los tres modelos diseñados. En el modelo 1, con OR

Direct observation of clinical skills feedback scale:development and validity evidence

Construct: This article describes the development and validity evidence behind a new rating scale to assess feedback quality in the clinical workplace.Background: Competency-based medical education has mandated a shift to learner-centeredness, authentic observation, and frequent formative assessments with a focus on the delivery of effective feedback. Because feedback has been shown to be of variable quality and effectiveness, an assessment of feedback quality in the workplace is important to ensure we are providing trainees with optimal learning opportunities. The purposes of this project were to develop a rating scale for the quality of verbal feedback in the workplace (the Direct Observation of Clinical Skills Feedback Scale [DOCS-FBS]) and to gather validity evidence for its use.Approach: Two panels of experts (local and national) took part in a nominal group technique to identify features of high-quality feedback. Through multiple iterations and review, 9 features were developed into the DOCS-FBS. Four rater types (residents n = 21, medical students n = 8, faculty n = 12, and educators n = 12) used the DOCS-FBS to rate videotaped feedback encounters of variable quality. The psychometric properties of the scale were determined using a generalizability analysis. Participants also completed a survey to gather data on a 5-point Likert scale to inform the ease of use, clarity, knowledge acquisition, and acceptability of the scale.Results: Mean video ratings ranged from 1.38 to 2.96 out of 3 and followed the intended pattern suggesting that the tool allowed raters to distinguish between examples of higher and lower quality feedback. There were no significant differences between rater type (range = 2.36-2.49), suggesting that all groups of raters used the tool in the same way. The generalizability coefficients for the scale ranged from 0.97 to 0.99. Item-total correlations were all above 0.80, suggesting some redundancy in items. Participants found the scale easy to use (M = 4.31/5) and clear (M = 4.23/5), and most would recommend its use (M = 4.15/5). Use of DOCS-FBS was acceptable to both trainees (M = 4.34/5) and supervisors (M = 4.22/5).Conclusions: The DOCS-FBS can reliably differentiate between feedback encounters of higher and lower quality. The scale has been shown to have excellent internal consistency. We foresee the DOCS-FBS being used as a means to provide objective evidence that faculty development efforts aimed at improving feedback skills can yield results through formal assessment of feedback quality.</p