http://science.sciencemag.org/content/sci/201/4359/899.2.full.pdf

Phenomenology of perception.

ContextCurrent assessment formats for physicians and trainees reliably test
core knowledge and basic skills. However, they may underemphasize some important
domains of professional medical practice, including interpersonal skills,
lifelong learning, professionalism, and integration of core knowledge into
clinical practice.ObjectivesTo propose a definition of professional competence, to review current
means for assessing it, and to suggest new approaches to assessment.Data SourcesWe searched the MEDLINE database from 1966 to 2001 and reference lists
of relevant articles for English-language studies of reliability or validity
of measures of competence of physicians, medical students, and residents.Study SelectionWe excluded articles of a purely descriptive nature, duplicate reports,
reviews, and opinions and position statements, which yielded 195 relevant
citations.Data ExtractionData were abstracted by 1 of us (R.M.E.). Quality criteria for inclusion
were broad, given the heterogeneity of interventions, complexity of outcome
measures, and paucity of randomized or longitudinal study designs.Data SynthesisWe generated an inclusive definition of competence: the habitual and
judicious use of communication, knowledge, technical skills, clinical reasoning,
emotions, values, and reflection in daily practice for the benefit of the
individual and the community being served. Aside from protecting the public
and limiting access to advanced training, assessments should foster habits
of learning and self-reflection and drive institutional change. Subjective,
multiple-choice, and standardized patient assessments, although reliable,
underemphasize important domains of professional competence: integration of
knowledge and skills, context of care, information management, teamwork, health
systems, and patient-physician relationships. Few assessments observe trainees
in real-life situations, incorporate the perspectives of peers and patients,
or use measures that predict clinical outcomes.ConclusionsIn addition to assessments of basic skills, new formats that assess
clinical reasoning, expert judgment, management of ambiguity, professionalism,
time management, learning strategies, and teamwork promise a multidimensional
assessment while maintaining adequate reliability and validity. Institutional
support, reflection, and mentoring must accompany the development of assessment
programs.

/pdf/defining-and-assessing-professional-competence-1sy606vpxu.pdf

Defining and Assessing Professional Competence

The politics of life itself Biomedicine, power, and subjectivity in the twenty-first century

Epidemiologist Nick Black has argued that a finding or a result is more likely to be accepted as a fact if it is quantified (expressed in numbers) than if it is not1 There is little or no scientific evidence, for example, to support the well known “facts” that one couple in 10 is infertile, or that one man in 10 is homosexual Yet, observes Black, most of us are happy to accept uncritically such simplified, reductionist, and blatantly incorrect statements so long as they contain at least one number

Researchers who use qualitative methods seek a deeper truth They aim to “study things in their natural setting, attempting to make sense of, or interpret, phenomena in terms of the meanings people bring to them,”2 and they use “a holistic perspective which preserves the complexities of human behaviour”1

#### Summary points

Qualitative methods aim to make sense of, or interpret, phenomena in terms of the meanings people bring to them

Qualitative research may define preliminary questions which can then be addressed in quantitative studies

A good qualitative study will address a clinical problem through a clearly formulated question and using more than one research method (triangulation)

Analysis of qualitative data can and should be done using explicit, systematic, and reproducible methods

Questions such as “How many parents would consult their general practitioner when their child has a mild temperature?” or “What proportion of smokers have tried to give up?” clearly need answering through quantitative methods But questions like “Why do parents worry so much about their children's temperature?” and “What stops people giving up smoking?” cannot and should not be answered by leaping in and measuring the first aspect of the problem that we (the outsiders) think might be important Rather, we need to listen to what people have to say, …

/pdf/how-to-read-a-paper-papers-that-go-beyond-numbers-h7kek25un5.pdf

How to read a paper: Papers that go beyond numbers (qualitative research)

WHO reported that adherence among patients with chronic diseases averages only 50% in developed countries. This is recognized as a significant public health issue, since medication nonadherence leads to poor health outcomes and increased healthcare costs. Improving medication adherence is, therefore, crucial and revealed on many studies, suggesting interventions can improve medication adherence. One significant aspect of the strategies to improve medication adherence is to understand its magnitude. However, there is a lack of general guidance for researchers and healthcare professionals to choose the appropriate tools that can explore the extent of medication adherence and the reasons behind this problem in order to orchestrate subsequent interventions. This paper reviews both subjective and objective medication adherence measures, including direct measures, those involving secondary database analysis, electronic medication packaging (EMP) devices, pill count, and clinician assessments and self-report. Subjective measures generally provide explanations for patient's nonadherence whereas objective measures contribute to a more precise record of patient's medication-taking behavior. While choosing a suitable approach, researchers and healthcare professionals should balance the reliability and practicality, especially cost effectiveness, for their purpose. Meanwhile, because a perfect measure does not exist, a multimeasure approach seems to be the best solution currently.

/pdf/medication-adherence-measures-an-overview-pu6x2kch5o.pdf

Medication Adherence Measures: An Overview

There is now a context for teaching humanities in undergraduate medical education via special study modules (SSMs). This paper discusses the instrumental and non-instrumental role of the humanities in the education of doctors. Three courses are then described and compared. The most successful of the three is a SSM which had the following characteristics: it was voluntary, it was an integral part of the curriculum, and it was examinable.

https://mh.bmj.com/content/medhum/26/1/23.full.pdf

The humanities in medical education: context, outcomes and structures

Purpose – This review article seeks to draw on experience in the UK to describe the different forms that arts in health activity can take and to examine the challenges for research in this field.Design/methodology/approach – A case study is used to describe the kind of arts in health project that intends to enhance the social capital of its community and to show how difficult it is to measure the effects of this work using conventional measures of health improvement. However, those who are responsible for providing funding for arts in health are increasingly demanding results that indicate a measurable health gain from the projects.Findings – A literature review of the evaluation of arts in health projects in the UK has shown that few aim at direct health improvement but rather at intermediate indicators of health gain, such as raising awareness of health issues and social activity and participation. This suggests that artists instinctively locate their work as having value within a social model of health...

Researching the benefits of arts in health

Chapter 1: Judgement and Science Chapter 2: Judgement in the clinic Chapter 3: Humane Judgement Chapter 4: Judgement in public health Chapter 5: Judgement and resource management Chapter6: Educating judgement: the humanities Conclusion: Clinical Judgement References

Clinical Judgement : Evidence in Practice

Purpose: Measuring professional behavior is problematic not least because the concept of professionalism is difficult to define. The authors describe a measurement tool that does not rely on qualitative judgments from respondents but, nonetheless, clearly correlates with individuals' subjective views about what constitutes professional behavior.

Method: The authors devised the Conscientiousness Index (CI) of medical students' performance in years 1 (n = 116) and 2 (n = 108) in 2006-2007. The CI scores were based on a range of objective measures of conscientiousness, including attendance and submission of required information (such as immunization status or summative assessments) by a deadline. The validity of this instrument was tested against (1) staff views of the professional behavior of individual students and (2) critical incident reports.

Results: The trait of conscientiousness, as measured by the CI, showed good correlation with the construct of professionalism as perceived by staff views of individual students' professional behavior. There was also a relationship with the frequency of critical incident reporting. Together, these observations support the validity of the approach. Reliability and practicality were also acceptable.

Conclusions: The results suggest that the CI measures a scalar objective trait that corresponds well with professional behavior as perceived by staff members in an undergraduate medical school. The individual decisions making up the CI are objective and easy to collect, making it a relatively simple and uncontroversial method for exploring students' professionalism.

Jane Macnaughton

Papers

The humanities in medical education: context, outcomes and structures

Researching the benefits of arts in health

Clinical Judgement : Evidence in Practice

The conscientiousness index: a novel tool to explore students' professionalism.

The dangerous practice of empathy