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Author: Brian S McGowan, PhD

ABSTRACT: Recertification: what do specialists think about skill assessment?

BACKGROUND:
Continuing medical education and objective performance assessment remain the key components of recertification. Objective skills assessment in routine practice remains challenging due to extensive variations in case selection and treatments. This study explores expert opinions regarding objective skills assessment for specialists within the framework of recertification.
METHODS:
We used a qualitative, semi-structured interview-based approach to obtain information and suggestions about key issues and recommendations relating to specialists’ skills assessment. Twenty-two face-to-face interviews were conducted. Interviews were transcribed and analysed by two reviewers.
RESULTS:
The information from the interviews was categorized under the headings of: (1) the components of specialist-level skills, (2) the methods for assessing specialist skills, (3) the types of tools and procedures used during observational assessment, (4) the unsuccessful specialists, and (5) the selection and training of assessors for specialist assessment.
CONCLUSIONS:
Outcome-based assessment of performance followed by observation of practice, were recommended as effective modes of evaluation of performance.

via Recertification: what do specialists think about ski… [Surgeon. 2013] – PubMed – NCBI.

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ABSTRACT: The long-term impact of a performance improvement continuing medical education intervention on osteoporosis screening.

INTRODUCTION:
The purpose of this study is to determine whether a performance improvement continuing medical education (PI CME) initiative that utilizes quality improvement (QI) principles is effective in producing sustainable change in practice to improve the screening of patients at risk for osteoporosis.
METHODOLOGY:
A health care center participated in a PI CME program designed to increase appropriate osteoporosis screening. There were eight 1-hour educational sessions for this activity over a 9-month period. Thirteen providers completed all 3 stages of the PI CME program. A variety of other clinicians, in addition to the 13 providers, participated in the educational sessions. Data were collected at the beginning and end of the PI CME activity and at three intervals during the 5 years after the completion of the activity.
RESULTS:
The percentage of tests for osteoporosis ordered and performed increased significantly from Stage A to Stage C of the PI CME activity and continued to increase after the completion of the PI CME activity. Follow-up data at 4 and 40 months (for ordering and performing osteoporosis screening) and 49 months (for performing the screening only) reflect the impact of the PI CME activity plus the continuing QI interventions. The percentage of BMD tests ordered continued to increase substantially over the post-PI CME periods: 4 and 40 months (F(3,46) = 4.04, p < .05). Similarly, the percentage of BMD tests performed continued to increase at 4, 40, and 49 months after the conclusion of the PI CME activity (F(4,55) = 12.55, p < .0001).
DISCUSSION:
The data indicate that PI CME utilizing QI principles can be effective in producing sustainable change in practice to improve the screening of patients at risk for osteoporosis. Further research is needed to determine the extent to which such changes can be directly attributed to this type of intervention.

via The long-term impact of a performa… [J Contin Educ Health Prof. 2013] – PubMed – NCBI.

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ABSTRACT: Enhancing quality improvements in cancer care through CME activities at a nationally recognized cancer center

Changing healthcare policy will undoubtedly affect the healthcare environment in which providers function. The current Fee for Service reimbursement model will be replaced by Value-Based Purchasing, where higher quality and more efficient care will be emphasized. Because of this, large healthcare organizations and individual providers must adapt to incorporate performance outcomes into patient care. Here, we present a Continuing Medical Education (CME)-based initiative at the City of Hope National Cancer Center that we believe can serve as a model for using CME as a value added component to achieving such a goal.

via Enhancing quality improvements in cancer care … [J Cancer Educ. 2013] – PubMed – NCBI.

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ABSTRACT: The Teamwork Mini-Clinical Evaluation Exercise (T-MEX): A Workplace-Based Assessment Focusing on Collaborative Competencies in Health Care

Purpose: Teamwork is an important and challenging area of learning during the transition from medical graduate to intern. This preliminary investigation examined the psychometric and logistic properties of the Teamwork Mini-Clinical Evaluation Exercise (T-MEX) for the workplace-based assessment of key competencies in working with health care teams.

Method: The authors designed the T-MEX for direct observation and assessment of six collaborative behaviors in seven clinical situations important for teamwork, feedback, and reflection. In 2010, they tested it on University of New South Wales senior medical students during their last six-week clinical term to investigate its overall utility, including validity and reliability. Assessors rated students in different situations on the extent to which they met expectations for interns for each collaborative behavior. Both assessors and students rated the tool’s usefulness and feasibility.

Results: Assessment forms for 88 observed encounters were submitted by 25 students. The T-MEX was suited to a broad range of collaborative clinical practice situations, as evidenced by the encounter types and the behaviors assessed by health care team members. The internal structure of the behavior ratings indicated construct validity. A generalizability study found that eight encounters were adequate for high-stakes measurement purposes. The mean times for observation and feedback and the participants’ perceptions suggested usefulness for feedback and feasibility in busy clinical settings.

Conclusions: Findings suggest that the T-MEX has good utility for assessing trainee competence in working with health care teams. It fills a gap within the suite of existing tools for workplace-based assessment of professional attributes.

via The Teamwork Mini-Clinical Evaluation Exercise (T-MEX): A W… : Academic Medicine.

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ABSTRACT: Nationwide online social networking for cardiovascular care in Korea using Facebook

To examine the use of online social networking for cardiovascular care using Facebook. All posts and comments in a Facebook group between June 2011 and May 2012 were reviewed, and a survey was conducted. A total of 298 members participated. Of the 277 wall posts, 26.7% were question posts requesting rapid replies, and 50.5% were interesting cases shared with other members. The median response time for the question posts was 16 min (IQR 8-47), which tended to decrease as more members joined the group. Many members (37.4%) accessed the group more than once a day, and more than half (64%) monitored the group posts in real time with automatic notifications of new posts. Most members expressed confidence in the content posted. Facebook enables online social networking between physicians in near-real time and appears to be a useful tool for physicians to share clinical experience and request assistance in decision-making

via Nationwide online social netwo… [J Am Med Inform Assoc. 2014 Jan-Feb] – PubMed – NCBI.

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ABSTRACT: Practice improvement, part II: update on patient communication technologies

Patient portals (ie, secure web-based services for patient health record access) and secure messaging to health care professionals are gaining popularity slowly. Advantages of web portals include timely communication and instruction, access to appointments and other services, and high patient satisfaction. Limitations include inappropriate use, security considerations, organizational costs, and exclusion of patients who are uncomfortable with or unable to use computers. Attention to the organization’s strategic plan and office policies, patient and staff expectations, workflow and communication integration, training, marketing, and enrollment can facilitate optimal use of this technology. Other communication technologies that can enhance patient care include automated voice or text reminders and brief electronic communications. Social media provide another method of patient outreach, but privacy and access are concerns. Incorporating telehealthcare (health care provided via telephone or Internet), providing health coaching, and using interactive health communication applications can improve patient knowledge and clinical outcomes and provide social support.

via Practice improvement, part II: update on patient c… [FP Essent. 2013] – PubMed – NCBI.

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ABSTRACT: Social media’s role in otolaryngology-head and neck surgery: informing clinicians, empowering patients

With the increasing availability of the Internet in the United States, patients are more frequently seeking medical information online. Oftentimes, the medical information that patients find on traditional websites is unreliable. It is a physician’s duty to ensure that patients are being educated properly. Providing sound medical information through social media websites is one way in which physicians may accomplish this goal, while also improving clinic reputation, patient volume, and doctor-patient communication.

via Social media’s role in otolaryngo… [Otolaryngol Head Neck Surg. 2013] – PubMed – NCBI.

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ABSTRACT: Social media in health care: benefits, concerns, and guidelines for use

The use of social media and other electronic communication has exploded as the number of social media outlets and applications continue to increase. These are exciting and valuable tools when used wisely, but pose risks when inappropriately used. The purpose of this article is to consider what comprises social media, its benefits and concerns, and guidelines for use that protect patients, employees, and organizations.

via Social media in health care: benefits, concerns, … [Creat Nurs. 2013] – PubMed – NCBI.

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ABSTRACT: Health Literacy, Cognitive Ability, and Functional Health Status among Older Adults

OBJECTIVE:
To investigate whether previously noted associations between health literacy and functional health status might be explained by cognitive function.
DATA SOURCES/STUDY SETTING:
Health Literacy and Cognition in Older Adults (“LitCog,” prospective study funded by National Institute on Aging). Data presented are from interviews conducted among 784 adults, ages 55-74 years receiving care at an academic general medicine clinic or one of four federally qualified health centers in Chicago from 2008 to 2010.
STUDY DESIGN:
Study participants completed structured, in-person interviews administered by trained research assistants.
DATA COLLECTION:
Health literacy was measured using the Test of Functional Health Literacy in Adults, Rapid Estimate of Adult Literacy in Medicine, and Newest Vital Sign. Cognitive function was assessed using measures of long-term and working memory, processing speed, reasoning, and verbal ability. Functional health was assessed with SF-36 physical health summary scale and Patient Reported Outcomes Measurement Information System short form subscales for depression and anxiety.
PRINCIPAL FINDINGS:
All health literacy measures were significantly correlated with all cognitive domains. In multivariable analyses, inadequate health literacy was associated with worse physical health and more depressive symptoms. After adjusting for cognitive abilities, associations between health literacy, physical health, and depressive symptoms were attenuated and no longer significant.
CONCLUSIONS:
Cognitive function explains a significant proportion of the associations between health literacy, physical health, and depression among older adults. Interventions to reduce literacy disparities in health care should minimize the cognitive burden in behaviors patients must adopt to manage personal health.

via Health Literacy, Cognitive Ability, and Func… [Health Serv Res. 2014] – PubMed – NCBI.

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ABSTRACT: How to identify, assess and utilise mobile medical applications in clinical practice

BACKGROUND:
There are thousands of medical applications for mobile devices targeting use by healthcare professionals. However, several factors related to the structure of the existing market for medical applications create significant barriers preventing practitioners from effectively identifying mobile medical applications for individual professional use.
AIMS:
To define existing market factors relevant to selection of medical applications and describe a framework to empower clinicians to identify, assess and utilise mobile medical applications in their own practice.
MATERIALS AND METHODS:
Resources available on the Internet regarding mobile medical applications, guidelines and published research on mobile medical applications.
RESULTS:
Mobile application stores (e.g. iTunes, Google Play) are not effective means of identifying mobile medical applications. Users of mobile devices that desire to implement mobile medical applications into practice need to carefully assess individual applications prior to utilisation.
DISCUSSION:
Searching and identifying mobile medical applications requires clinicians to utilise multiple references to determine what application is best for their individual practice methods. This can be done with a cursory exploration of mobile application stores and then moving onto other available resources published in the literature or through Internet resources (e.g. blogs, medical websites, social media). Clinicians must also take steps to ensure that an identified mobile application can be integrated into practice after carefully reviewing it themselves.
CONCLUSION:
Clinicians seeking to identify mobile medical application for use in their individual practice should use a combination of app stores, published literature, web-based resources, and personal review to ensure safe and appropriate use.

via How to identify, assess and utilise mobile … [Int J Clin Pract. 2014] – PubMed – NCBI.

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