Paul Ram

Assessment in general practice: the predictive value of written-knowledge tests and a multiple-station examination for actual medical performance in daily practice.

This study compares the predictive values of written‐knowledge tests and a standardized multiple‐station examination for the actual medical performance of general practitioners (GPs) in order to select effective assessment methods to be used in quality‐improvement activities.

Much variety and little evidence: a description of guidelines for doctor-patient communication

Aim  To explore the quality of the content of communication skills training programmes, we analysed and assessed guidelines for doctor–patient communication used in communication programmes for general practitioner (GP) trainees.

Setting a standard for performance assessment of doctor-patient communication in general practice

Context  Continuing professional development (CPD) of general practitioners.

Reliability of consultation skills assessments using standardised versus real patients.

Medical Education 2011; 45: 578–584

Quality assessment in general practice trainers

General practice trainers hold a key position in general practice training, especially through their provision of a role model. Their own competence in general practice care is important in this regard. The purpose of the study was to evaluate whether a quality assessment programme could identify the strengths and weaknesses of GP trainers in four main domains of general practice care.

Een sturende werking

SamenvattingIn een serie artikelen neemt In de praktijk een kijkje in de wereld van toetsing in de huisartsopleiding. Vijf W-vragen (wat toetst men, waartoe, waarmee, wanneer en (met) wie?) passeren de revue. In de vorige bijdragen is stilgestaan bij de kernbegrippen zoals meten, waarderen en beslissen, waarbij het leerproces van de haios Peter en Petra op de voet werd gevolgd. In deze bijdrage valt de beslissing: krijgen Peter en Petra na de eerste tien maanden van hun opleiding een go, een go, mits of een no go? En zijn de toetsen een stimulans voor hun leerproces?

Should we assess clinical performance in single patient encounters or consistent behaviors of clinical performance over a series of encounters? A qualitative exploration of narrative trainee profiles

Abstract Background: A variety of tools have been developed to assess performance which typically use a single clinical encounter as a source for making competency inferences. This strategy may miss consistent behaviors. We therefore explored experienced clinical supervisors’ perceptions of behavioral patterns that potentially exist in postgraduate general practice trainees expressed as narrative profiles to aid the grading of clinical performance. Methods: We conducted semistructured interviews with clinical supervisors who had frequently observed clinical performance in trainees. Supervisors were asked to describe which behavioral patterns they had discerned in excellent and underperforming trainees, during different stages of training, in their careers as clinical supervisor. We analyzed the interviews using a grounded theory approach. Results: The analysis resulted in a conceptual framework that distinguishes between desirable and undesirable narrative profiles. The framework consists of two dimensions: doctor–patient interaction and medical expertise. Personal values appear to be a moderating factor. Conclusions: According to experienced clinical supervisors, consistent behaviors do exist in GP trainees when observing clinical performance over time. The conceptual framework has to be validated by further observational studies to assess its potential for making robust and fair assessments of clinical performance and monitor the development of consultation performance over time.

Development and testing of the KERNset: an instrument to assess the quality of telephone triage in out-of-hours primary care services

BackgroundTelephone triage is a core but vulnerable part of the care process at out-of-hours general practitioner (GP) cooperatives. In the Netherlands, different instruments have been used for assessing the quality of telephone triage. These instruments focussed mainly on communicational aspects, and less on the medical quality of triage decisions. Our aim was to develop and test a minimum set of items to assess the quality of telephone triage.MethodsA national survey among all GP cooperatives in the Netherlands was performed to examine the most important aspects of telephone triage. Next, corresponding items from existing instruments were searched on these topics. Subsequently, an expert panel judged these items on importance, completeness and formulation. The concept KERNset consisted of 24 items about the telephone conversation: 13 medical, ten communicational and one regarding both types. It was pilot tested on measurement characteristics, reliability, validity and variation between triagists. In this pilot study, 114 anonymous calls from four GP cooperatives spread across the Netherlands were judged by three out of eight raters, both internal and external raters.ResultsCronbach’s alpha was .94 for the medical items and .75 for the communicational items. Inter-rater reliability: complete agreement between the external raters was 45% and reasonable agreement 73% (difference of maximally one point on the five-point scale). Intra-rater reliability: complete agreement within raters was 55% and reasonable agreement 84%. There were hardly any differences between internal and external raters, but there were differences in strictness between individual raters. The construct validity was confirmed by the high correlation between the general impression of the call and the items of the KERNset. Of the differences within items 19% could be explained by differences between triage nurses, which means the KERNset is able to demonstrate differences between triage nurses.ConclusionsThe KERNset can be used to assess the quality of telephone triage. The validity is good and differences between calls and between triage nurses can be measured. A more intensive training for raters could improve the reliability.

Het ‘lunapark’ van Marck Eyck

SamenvattingIn een serie gaat In de praktijk in op het perspectief van de huisarts die toe is aan een nieuwe stap in zijn carrière.

Besluitvorming tussen huisarts en patiënt

SamenvattingIn deze serie over de communicatie tussen huisarts en patiënt volgt In de praktijk aan de hand van casuïstiek (het hoesten van Loeka) de logische ordening van een consult: informatie verzamelen, informatie geven en gemeenschappelijke besluitvorming. Eerdere afleveringen behandelden algemene aspecten van de communicatie en de eerste twee consultfases: effectieve en efficiënte informatieverzameling over het probleem en de hulpvraag, en het geven van informatie. Deze aflevering neemt de derde consultfase onder de loep: de beleidsfase en de gemeenschappelijke besluitvorming tussen huisarts en patiënt.