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Abstract

This study examined thefeasibility of using outpatient consultation letters as a means of assessing the clinical performance of clerks and house staff in a large teaching hospital. A total of 222 assessments were obtained based on samples of consultation problems from two clinical services. The method involved a two-stage rating scale based on the performance areas of Data Base, Problem Formulation, Diagnostic Tests, Management and Overall Assessment. The technique was investigated in terms of the objectivity, reliability, validity and efficiency of the performance ratings. Product-moment coefficients were used to assess interand intrarater agreement in scoring the consultation letters. These analyses identified a consistent difficulty in assessing the category of Data Base. For the remainingperformance categories, interrater coefficients in the range .19-.76 and intrarater coefficients in the range .23-.96 were obtained Other preliminary findgs indicated good potentialfor a reliable and valid assessment. The method is technically feasible, and is based on a novel and reasonably unobtrusive approach to assessing trainee performance in a clinical setting.

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References

BENTSEN, B. G. (1976) "The accuracy of recording patient problems in family practice." J. of Medical Education 51: 311-316.

BIEHN, J. T. and J. E. MOLINEUX (1979) "Patient evaluation of physician performance." J. of Family Practice 8: 565-569.

BRUMBACK, G. B. and M. A. HOWELL (1972) "Rating the clinical effectiveness of employed physicians." J. of Applied Psychology 56: 241-244.

DIELMAN, T. E. , A. L. HULL and W. K. DAVIS (1980) "Psychometric properties of clinical performance ratings." Evaluation and the Health Professions 3 (1): 103-117.

EBEL, R. L. (1972) Essentials of Educational Measurement. Englewood Cliffs, NJ: Prentice-Hall.

FESSEL, W. J. and E. E. VAN BUNT (1972) "Assessing quality of care from the medical record." New England J. of Medicine 286: 134-138.

GOUGH, H. G and W. B. HALL (1975) "The prediction of academic and clinical performance in medical school." Research in Higher Education 3: 301-314.

KROEGER, H. H. , I. ALTMAN , D. A. CLARK , A. C. JOHNSON , and C. G. SHEPS (1965) "The office practice of internists: the feasibility of evaluating quality of care" J. of the Amer. Medical Assn. 193: 371-376.

LYONS, T. F. and B. C. PAYNE (1977) "Interdiagnoses relationships of physician performance measures in hospitals." Medical Care 15: 463-469.

10.

McSHERRY, C. K (1976) "Quality assurance: the cost of utilization review and the educational value of medical audit in a university hospital." Surgery 80: 122-129.

11.

MOLINEUX, J.E. , B. K. HENNEN , and I. R. McWHINNEY (1976) "In-training performance assessment in family practice." J. of Family Practice 3: 405-408.

12.

PAYNE, B.C. (1979) "The medical record as a basis for assessing physician competence." Annals of Internal Medicine 91: 623-629.

13.

RAMSDELL, M. D. and C. C. BERRY (1983) "Evaluation of general and traditional internal medicine residencies utilizing a medical records audit based on educational objectives." Medical Care 12: 1144-1152.

14.

SANAZARO, P. J. and R. M. WORTH (1978) "Concurrent quality assurance in hospital care: report of a study by private initiative in PSRO." New England J. of Medicine 298: 1171-1177.

15.

SCHUMAKER, C. F (1978) "Reliability, validity and standard setting," pp. 59-71 in J.P.Hubbard (ed.) Measuring Medical Education. Philadelphia: Lea & Febiger.

16.

SCOTT, H. M. and A. SNIDERMAN (1973) "Evaluation of clinical competence through a study of patient records." J. of Medical Education 48: 832-839.

17.

SIBLEY, J. C. , W. O. SPIZER , K. V. RUDNICK , J. D. BELL , R.D. BETHUNE , and D. L. SACKETT (1975) "Quality of care appraisal in primary care: a quantitative method." Annals of Internal Medicine 83: 46-52.

18.

SMITH, R. (1982) "Bar code labels branch out to testing." Educ. Testing Service Developments 28 (2): 2-2.

19.

STILLMAN, P. L. et al. (1986) "Assessing clinical skills of residents with standardized patients." Annals of Internal Medicine 105: 762-771.

20.

TEMPLETON, G. , V. F. ERVITTI , J. V. BUNCE , and F. D. BURG (1977) Medical Audit of Paediatric Resident Performance. Washington, DC: Department of Health, Education and Welfare.

21.

VOYTOVICH, A. E. , R. M. RIPPEY , and D. JUE (1986) "Diagnostic reasoning in the multiproblem patient: an interactive, microcomputer-based audit." Evaluation and the Health Professions 9 (1): 90-102.

Consultation Letters as a Method for Assessing in-Training Performance in a Department of Medicine

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