Philip G. Bashook

Best practices for assessing competence and performance of the behavioral health workforce.

The need for mechanisms to assess the competence and performance of the behavioral health workforce has received increasing attention. This article reviews strategies used in general medicine and other disciplines for assessing trainees and practitioners. The possibilities and limitations of various approaches are reviewed, and the implications for behavioral health are addressed. A conceptual model of competence is presented, and practical applications of this model are reviewed. Finally, guidelines are proposed for building competency assessment protocols for behavioral health.

A conceptual framework for measuring clinical problem-solving.

Most attempts to measure clinical competence start by modeling the clinicians problem-solving process. The conflicting data from studies built around this approach suggest the need for rethinking the underlying concepts. Presented is a conceptual framework for clinical competence which is a natural expansion of earlier approaches. The framework is based upon defining the domain in which the clinician functions as the starting point for measuring clinical competence. There are three dimensions to the framework-problem-solving process, clinical discipline, and context of care. The intersection of the dimensions defines the clinical practice domain to be measured. For each domain specific problems can be identified and clinicians asked to demonstrate competence in resolving them.

PerioSim: Haptic virtual reality simulator for sensorimotor skill acquisition in dentistry

This paper describes a haptic simulator that has been developed as an aid for the sensorimotor skill acquisition in dentistry. An important feature of the simulator is the ability to generate templates of position and force trajectories for the students to follow. Furthermore, the simulator has a mechanism, haptic playback, to help the students follow and learn these templates. Using this feature, the teacher can perform a procedure in the haptic simulator and record her actions. The trainee is then able to observe the recorded procedure and follow the correct trajectory in the position and force. Several haptic playback techniques are reviewed and the procedure implemented in the simulator is described in detail. We also describe hardware and software components of the simulator and their functionality.We conclude by describing the results of a preliminary classroom evaluation of the simulator.

Relationship between candidate communication ability and oral certification examination scores

Context  Structured case‐based oral examinations are widely used in medical certifying examinations in the USA. These orals assess the candidate’s decision‐making skills using real or realistic patient cases. Frequently mentioned but not empirically evaluated is the potential bias introduced by the candidate’s communication ability.

Orthopaedic Graduate Medical Education: A Changing Paradigm

Orthopaedic surgeons traditionally have been trained with use of an apprenticeship model, with experience being measured on the basis of case log documentation and with competency being determined by senior mentors. Over the past decade, medical education has undergone a major paradigm shift, with increasing emphasis on teaching toward competence as a specialist, including operative skills, essential knowledge for practice, professionalism, and the use of evaluation methods thought to be credible, accurate, reproducible, and transparent. The primary use of an apprenticeship model may result in graduates never having performed some procedures or never having managed patients with certain diagnoses. Alternatively, the competency model may result in graduates performing well on certain standard procedures but perhaps not demonstrating competency on relatively rare entities. While the provision and assessment of medical education have become more complex in proportion to advanced technologies and novel procedures, delivering excellence in education itself has become increasingly difficult as a result of duty-hour restrictions, …

Teaching problem-oriented recording: a systematic approach.

Medical students and practitioners usually learn how to use problem-oriented medical records (POMR) by haphazard means. In attempting to put system into the teaching of POMR, the authors devised teaching case material and two instructional formats: self-instruction and workshop. The results of a controlled study with second-year medical students to determine the relative effectiveness of instructional formats and case materials are presented. At the end of instruction POMR performance was measured by assessing the students ability to convert a case to POMR format. The results suggest that all student groups attained an acceptable performance level no matter which format they experienced.

Format Review: Evaluating Implementation of the Problem-Oriented Medical Record

As interest in the problem-oriented medical record (POMR) develops, and more medical settings begin to implement the system, many observers are expressing a desire to know how well the system is being used and accepted. Moreover, settings currently using the POMR system have a need to document the effectiveness of their POMR program as a means of insuring continued progress and for addressing difficulties and obstacles affecting its use. Format review is a technique for reviewing patient records and describing patterns of POMR use. Patient records of an institution are reviewed concurrent to the patients contact with the institution. Data collected from each record is summarized to provide an overview on patterns of POMR use and to identify areas of difficulty. These findings can serve as the basis for educational and administrative intervention to improve use of POMR. The format review technique is explained and examples of its application are given. The technique has been used at Michael Reese Hospital and Medical Center over the past two years, and has proven to be a useful tool in describing the implementation progress of POMR.