Carlos Brailovsky

Effect of a community oriented problem based learning curriculum on quality of primary care delivered by graduates: historical cohort comparison study

Abstract Objective To assess whether the transition from a traditional curriculum to a community oriented problem based learning curriculum at Sherbrooke University is associated with the expected improvements in preventive care and continuity of care without a decline in diagnosis and management of disease. Design Historical cohort comparison study. Setting Sherbrooke University and three traditional medical schools in Quebec, Canada. Participants 751 doctors from four graduation cohorts (1988-91); three before the transition to community based problem based learning (n = 600) and one after the transition (n = 151). Outcome measures Annual performance in preventive care (mammography screening rate), continuity of care, diagnosis (difference in prescribing rates for specific diseases and relief of symptoms), and management (prescribing rate for contraindicated drugs) assessed using provincial health databases for the first 4-7 years of practice. Results After transition to a community oriented problem based learning curriculum, graduates of Sherbrooke University showed a statistically significant improvement in mammography screening rates (55 more women screened per 1000, 95% confidence interval 10.6 to 99.3) and continuity of care (3.3% more visits coordinated by the doctor, 0.9% to 5.8%) compared with graduates of a traditional medical curriculum. Indicators of diagnostic and management performance did not show the hypothesised decline. Sherbrooke graduates showed a significant fourfold increase in disease specific prescribing rates compared with prescribing for symptom relief after the transition. Conclusion Transition to a community oriented problem based learning curriculum was associated with significant improvements in preventive care and continuity of care and an improvement in indicators of diagnostic performance.

A large-scale multicenter objective structured clinical examination for licensure

No abstract available.

Construct validity of the québec licensing examination SP‐based OSCE

Background: A large‐scale standardized patients‐based objective structured clinical examination (OSCE) was introduced in Quebec in 1990 for licensing family physicians. Purpose: This article presents the results of a construct validity study conducted on the Spring, 1993 OSCE, using the validation by the extremes method. Methods: Three groups of participants (205 graduating residents, 21 graduating clerks, and 13 general practitioners) were submitted to the same exam. Differences in examination total scores, scores by cases, and scores by skills were analyzed using analysis of variance. Results: The reliability of the examination was 0.80. Clerks obtained significantly lower total results (M = 58.8, SD = 5.6) than residents (M = 70.9, SD = 5.64, p < 0.001); no difference was found between residents’ and family physicians’ total scores (M = 71.3, SD = 4.34, p ‐ 0.662). Cases that were difficult for one group were as difficult for the two other groups. Conclusions: The results support the construct validity...

When to recommend compulsory versus optional Cme programs? A study to establish criteria

When should remedial continuing medical education (CME) be compulsory for family physicians? When should it be optional? Should it be structured or not? In 1993-1994, the authors addressed this need for criteria by conducting a study that used reports on 14 physicians who had undergone a structured oral interview (SOI) at the College of Physicians of Quebec. (The SOI is a day-long encounter during which two specially trained physician-interviewers present a physician with standardized clinical cases that focus on ten specific aspects of a family physicians competence.) The 14 SOI reports were reviewed by 12 external physician-judges in an attempt to see how consistently they could link the ten aspects of competence, as shown in the reports, to five particular types of recommended remedial CME programs (the strictest being “compulsory program with suspended license” and the most lenient being “simple suggestions for improvement”). There was substantial agreement among the judges when choosing between compulsory and optional programs (kappa = 0.63, p < .05). The main criteria used when recommending an optional program were overall strengths and the quality of clinical reasoning. The same two criteria were also used for recommending a compulsory program, but the judges also considered three additional factors: the physicians ability to recognize his or her limits and how he or she handled referrals and prescribed medications. Many of the criteria used by the judges were based on unique information that came out of observations and interactions during the SOIs, such as quality of argumentation, sustaining a train of thought, sense for the case as a whole, or awareness of ones limits. Finally, the external judges corroborated the decisions previously made by the College of Physicians of Quebec concerning the appropriate CME programs for the 14 physicians.

French‐English, English‐French translation process of an objective structured clinical examination (OSCE) used for licensing family physicians in quebec

Medical examinations translated into two or more languages may discriminate against one or more of the linguistic groups involved if the quality of the translations is poor or if the “medical cultures”; of the different linguistic groups are not identical. The most striking aspect of a literature review of the subject is the paucity of published reports. Over the past 3 years, the authors have gained considerable experience in translating large‐scale objective structured clinical examinations into French and English. Analysis of the examination results is described and leads to the conclusion that the translation does not discriminate against either linguistic group. The translation process developed for these examinations is presented, and hypotheses to explain the scarcity of literature on the subject are developed.

Detection of Gender Differences in High-Stakes Performance SP-Based Examinations in Family Medicine

Female candidates have been shown to repeatedly outperform male candidates in examinations measuring their medical competence. This study explored differences in the results of both groups on the 1993, 1994 and 1995 Quebec licensing examinations which used two SP-based instruments and one paper and pencil instrument. ANOVA and ANCOVA analyses confirmed that female candidates obtained higher results on all instruments year after year, and that these results were not biased by the content of the examination.

The Quebec Licensing OSCE: Modifications and Improvements over 6 Years of Experience

The large scale standardized patient-based objective structured clinical examination used in Quebec licensing examination was held for the first time in 1990 and was the 1st OSCE in the world used for high-stakes purposes such as licensure. As of June 1996, 13 examination sessions have been implemented and more than 1500 candidates assessed. Major changes have been implemented through the years in order to improve the examination. The length of the cases has been progressively increased from 7 minutes duration to 7, 10, 14 or 20 minutes duration according to the complexity of the clinical situations. More weight has been given to the assessment of integrative problem solving skills such as diagnosis and treatment. A multiple key feature approach to weighting the assessment items in the cases is progressively used. Sophisticated psychometric analysis of the results, that confirmed the quality of the examination, have been implemented.

Implementing a Multiple Station Clinical Examination: An International Collaboration

This paper presents an experience of international collaboration that was implemented following the Sixth Ottawa Conference in Medical Education in 1994. Through collaboration between those responsible for the Quebec licensing examination for family physicians and members of the Catalan Society of Internal Medicine as well as members of the Institut d’Estudis de la Salut of Catalonia, a large scale standardized patient-based examination to assess clinical competence of internal medicine specialists in Catalonia was developed. The collaboration process included the participation to a workshop on the evaluation of clinical competence with a comprehensive OSCE examination, the observation of the Quebec licensing examination by Catalan colleagues, continuous work by the examination committee members and extensive revision of the evaluation instruments by the Quebec experts. This process of collaboration made possible the implementation of a pilot examination for internal medicine graduates in February 1996. This collaborative experience, from which major lessons can be drawn, was the basis for the development of a larger collaborative project on the evaluation of clinical competence of health professionals in Catalonia.