Remco Feskens

Collecting Data among Ethnic Minorities in an International Perspective

This article examines strategies to reduce nonresponse rates among ethnic minorities. The authors review nonresponse rates and data collection strategies among ethnic minorities with respect to response rates and response bias in six European countries. The national statistical institutes of these six countries use different definitions of ethnic minorities. This is why the definitions of ethnic minorities and their impact on the number of members of ethnic minorities in the six countries are compared. Nonresponse rates are usually higher among ethnic minorities than among the native population. Dissecting the nonresponse phenomenon shows that contact rates among ethnic minorities are lower, nonresponse due to an inability to produce the required information is higher, and cooperation rates are higher among ethnic minorities than among the native population. Increasing the response rates among ethnic minorities should focus on enhancing the contact rate and reducing the number of nonrespondents who are unable to produce the required information.

Evaluation and feedback for effective clinical teaching in postgraduate medical education: Validation of an assessment instrument incorporating the CanMEDS roles

Background: Providing clinical teachers in postgraduate medical education with feedback about their teaching skills is a powerful tool to improve clinical teaching. A systematic review showed that available instruments do not comprehensively cover all domains of clinical teaching. We developed and empirically test a comprehensive instrument for assessing clinical teachers in the setting of workplace learning and linked to the CanMEDS roles. Methods: In a Delphi study, the content validity of a preliminary instrument with 88 items was studied, leading to the construction of the EFFECT (evaluation and feedback for effective clinical teaching) instrument. The response process was explored in a pilot test and focus group research with 18 residents of 6 different disciplines. A confirmatory factor analyses (CFA) and reliability analyses were performed on 407 evaluations of 117 supervisors, collected in 3 medical disciplines (paediatrics, pulmonary diseases and surgery) of 6 departments in 4 different hospitals. Results: CFA yielded an 11 factor model with a good to excellent fit and internal consistencies ranged from 0.740 to 0.940 per domain; 7 items could be deleted. Conclusion: The model of workplace learning showed to be a useful framework for developing EFFECT, which incorporates the CanMEDS competencies and proved to be valid and reliable.

Precision of individual and composite performance scores: the ideal number of indicators in an indicator set.

Background:In many countries, quality indicators are used to assess the quality of care of family practice. Such assessments need to have an adequate precision, so that the results can be interpreted correctly. However, a small sample size per practitioner can lead to inadequate precision. A possible solution could be to create composite performance scores. Objectives:To evaluate the relationship between sample size and precision. We examine whether a composite performance score has an increased precision and how many indicators are needed minimally to achieve this level of precision. Research Design:We performed a descriptive statistical study on data from the medical records of 455 Dutch practices. We included 3 different conditions: diabetes (12 indicators), chronic obstructive pulmonary disease (4 indicators), and Cardiovascular Disease and Risk Management (9 indicators). Results:For individual quality indicators, patient samples close to 100 are required to achieve even moderate precision (10 percentage points) on the performance scores. This number decreases substantially when a composite score is used. A composite derived from combining 5 to 7 indicators can provide much the same precision of measurement as one made up from a much larger number of indicators. Conclusions:The added value of a composite score depends on the a priori reasons for measuring quality. Our results indicate that especially for formative quality improvement a small number of carefully selected indicators can provide a sufficiently precise composite measure.

Influence of symptom expectancies on stair-climbing performance in chronic fatigue syndrome: effect of study context

BackgroundIn patients with chronic fatigue syndrome (CFS), performance of physical activities may be affected by an anticipated increase in symptoms after these activities. Nijs et al. previously studied the influence of symptom expectancies and related psychological processes on the performance of an isolated physical activity [Nijs J, Meeus M, Heins M, Knoop H, Moorkens G, Bleijenberg G. Kinesiophobia, catastrophizing and anticipated symptoms before stair climbing in chronic fatigue syndrome: an experimental study. Disabil Rehabil 2012. doi:10.3109/09638288.2011.641661.].PurposeWe aimed to validate the previous findings in a larger group of patients in a different setting. We also extended the possible underlying psychological processes studied.MethodIn 49 CFS patients, we measured performance (duration and increase in heart rate) during self-paced climbing and descending of two floors of stairs. Before this task, patients rated experienced fatigue and anticipated fatigue after stair climbing. In addition, kinesiophobia, catastrophising and focusing on bodily symptoms were measured. Using correlational and regression analyses, we tested whether performance during stair climbing could be explained by experienced and anticipated fatigue and psychological factors.ResultsLonger duration of stair climbing correlated with higher anticipated fatigue, independently of sex, age, body mass index and fatigue before stair climbing. Focusing on bodily symptoms and fatigue-related catastrophising were related to anticipated fatigue.ConclusionSymptom expectations affect the performance of physical activity in CFS patients, possibly through focusing on bodily symptoms and catastrophising. These findings partially contradict the findings of the previous study, which stresses the importance of study context in conducting this type of experiments (i.e., patient characteristics, instructions).

Understanding resident ratings of teaching in the workplace: a multi-centre study

Abstract Providing clinical teachers with feedback about their teaching skills is a powerful tool to improve teaching. Evaluations are mostly based on questionnaires completed by residents. We investigated to what extent characteristics of residents, clinical teachers, and the clinical environment influenced these evaluations, and the relation between residents’ scores and their teachers’ self-scores. The evaluation and feedback for effective clinical teaching questionnaire (EFFECT) was used to (self)assess clinical teachers from 12 disciplines (15 departments, four hospitals). Items were scored on a five-point Likert scale. Main outcome measures were residents’ mean overall scores (MOSs), specific scale scores (MSSs), and clinical teachers’ self-evaluation scores. Multilevel regression analysis was used to identify predictors. Residents’ scores and self-evaluations were compared. Residents filled in 1,013 questionnaires, evaluating 230 clinical teachers. We received 160 self-evaluations. ‘Planning Teaching’ and ‘Personal Support’ (4.52, SD .61 and 4.53, SD .59) were rated highest, ‘Feedback Content’ (CanMEDS related) (4.12, SD .71) was rated lowest. Teachers in affiliated hospitals showed highest MOS and MSS. Medical specialty did not influence MOS. Female clinical teachers were rated higher for most MSS, achieving statistical significance. Residents in year 1–2 were most positive about their teachers. Residents’ gender did not affect the mean scores, except for role modeling. At group level, self-evaluations and residents’ ratings correlated highly (Kendall’s τ 0.859). Resident evaluations of clinical teachers are influenced by teacher’s gender, year of residency training, type of hospital, and to a lesser extent teachers’ gender. Clinical teachers and residents agree on strong and weak points of clinical teaching.