Development and validation of a geriatrics knowledge test for primary care residents

This study reports the development and preliminary validation of an instrument to measure geriatrics knowledge of primary care residents. A 23-item test was developed using questions selected from the American Geriatrics Society's Geriatrics Review Syllabus. Ninety-six internal medicine and family practice residents, 14 geriatrics fellows, and 11 geriatrics faculty members participated in the study. Findings support the reliability (Cronbach's alpha = 0.66) and validity (content and "known groups") of this short test. Predictive validity and sensitivity of the test to changes in knowledge will have to be further explored as residents progress through their training.     

Reliability of scores on the Stroke Rehabilitation Assessment of Movement (STREAM) measure

BACKGROUND AND PURPOSE: The Stroke Rehabilitation Assessment of Movement (STREAM) is a new clinical measurement tool for evaluating the recovery of voluntary movement and basic mobility following stroke. This article presents the results of 3 substudies examining the reliability (interrater and intrarater) and internal consistency of STREAM scores. SUBJECTS AND METHODS: A "direct-observation reliability study" was conducted on 20 patients who had strokes and were in a rehabilitation setting. Pairs of raters from a group of 6 participating therapists provided data to judge interrater agreement. A "videotaped assessments reliability study" was done to assess intrarater and interrater agreement on the scoring of videotaped performances using the STREAM measure and involved 4 videotaped assessments that were viewed and rated on 2 occasions by 20 physical therapists. The internal consistency of the STREAM scores was evaluated for 26 patients who had strokes and who demonstrated the full range of motor ability. RESULTS: The reliability of the STREAM scores was demonstrated by generalizability correlation coefficients of .99 for total scores and of .96 to .99 for subscale scores. The internal consistency of the STREAM scores was demonstrated by Cronbach alphas of greater than .98 on the subscales and overall. CONCLUSION AND DISCUSSION: These high levels of reliability support the use of the STREAM instrument for the measurement of motor recovery following stroke. Further work on the validity and responsiveness of the STREAM measure is in progress.     

Frequent hypomethylation in Wilms tumors of pericentromeric DNA in chromosomes 1 and 16

RATIONALE AND OBJECTIVES: The purpose of this study was to test the effectiveness of resident-prepared, independent learning cases in teaching residents chest radiology. MATERIALS AND METHODS: Three 2nd-year residents (one each from the University of Wisconsin, the Oregon Health Sciences University, and the University of Michigan) prepared four chest radiology teaching cases each (total, 12 cases). Radiology residents from each institution were randomly divided into control (n = 30) and experimental (n = 35) groups. Residents from both groups took a pretest of 36 multiple-choice questions covering the material from the 12 teaching cases. Residents in the experimental group reviewed these cases independently, and both groups took the same test (posttest) immediately after the teaching cases had been reviewed and again 3 months later (final test). RESULTS: Test scores were similar across institutions (P > .05) but differed across time and treatment groups (experimental vs control) (P < .0001). Mean differences in test scores between the experimental and control groups at pretest, posttest, and final test were -0.4, +9.0, +4.0, respectively, demonstrating increased performance at posttesting that was still present (though somewhat attenuated) 3 months later at final testing. CONCLUSION: Independent study of resident-prepared chest radiology teaching cases increases the resident's knowledge for as long as 3 months after instruction.     

Emergency department presentations of Lyme disease in children

BACKGROUND AND OBJECTIVES: Family physicians frequently encounter patients' family members in family meetings regarding health care. Although residents are expected to learn how to interview families, no quantitative studies have examined variables associated with building residents' confidence in their ability to lead family meetings. The current study sought to clarify the relationship between a number of training, participant, and situational components and resident confidence. METHODS: All family practice residents (n = 90) in a five-residency program system were sent a survey that examined their experience in and perceived competence to conduct family meetings. Responses were analyzed with a hierarchical regression analysis and an ex post facto univariate analysis. RESULTS: Residents with higher perceived confidence in their ability to run a family meeting were male, had specific training for leading family meetings, had participated in and initiated more family meetings, perceived stronger family physician faculty support, and had more family systems training than lower-confidence residents. CONCLUSIONS: The results highlight the experiential, curricular, and environmental variables that are associated with building resident confidence to lead family meetings. Residents may benefit from early exposure to the skills needed for family meetings and from reinforcement of these skills through observations of skilled practitioners, the expectation that they will initiate meetings, and the opportunity to debrief meetings with supportive faculty. Family meeting curricula should include conflict management skills and incorporate input from other specialists and hospital personnel who meet with families.     

Patient-caregiver functional unit scale: a new scale to assess the patient-caregiver dyad

BACKGROUND AND OBJECTIVES: This study evaluated the reliability and validity of the Patient-Caregiver Functional Unit Scale (PCFUS), a new instrument to assess the stability or endurance of patient-caregiver dyads. METHODS: Patient-caregiver dyads were recruited from a nursing home (NH) (n = 38), a comprehensive geriatric assessment program (CGA) (n = 20), and an ambulatory medical clinic (controls) (n = 85). Caregivers were eligible if they assisted, or were available to assist, the patient with personal and instrumental activities of daily living, without pay. Data were collected by interviewer-administered questionnaires. Inter-rater and test-retest reliability were evaluated among the CGA sample. Validity was assessed by comparing PCFUS scores among the NH, CGA, and control groups and by correlation of PCFUS scores with other standardized caregiver burden measures. RESULTS: The PCFUS had excellent inter-rater and test-retest reliability. Mean PCFUS scores were significantly lower (ie, less stable patient-caregiver dyad) in NH than CGA and control caregivers. PCFUS scores were significantly associated with Burden Interview, Perceived Stress Scale, and Geriatric Depression Scale scores and risk factors for caregiver stress (eg, patient's cognitive impairment, disruptive behaviors). CONCLUSIONS: The PCFUS is a short, easily administered measure with good reliability and validity and is applicable to clinical and research settings.     

Validation of an objective structured clinical examination in psychiatry

PURPOSE: To examine the validity of a psychiatry clerkship's objective structured clinical examination (OSCE). METHOD: In 1996, 33 clinical clerks and 17 psychiatry residents at the University of Toronto participated in an eight-station OSCE evaluated by psychiatrist-examiners using binary checklists and global ratings. Prior to the OSCE, communication course instructors were asked to rank the clerks on interviewing ability, and faculty supervisors were asked to identify the OSCE stations on which the clerks were likely to do well or poorly. RESULTS: Mean OSCE scores were significantly higher for the residents than for the clerks on global ratings but not on checklists. The communication instructors accurately predicted the clerks' rankings on the global scores but not their scores on the checklists. The faculty supervisors predicted with moderate accuracy the clerks' success on the OSCE stations as measured by the checklists but not by the global ratings. The residents rated the OSCE scenarios as highly realistic. CONCLUSIONS: The evidence of construct and concurrent validity together with high ratings of realism suggest that a psychiatry OSCE can be a valid assessment of clerks' clinical competence.     

Effects of time-in-clinic, clinic setting, and faculty supervision on the continuity clinic experience

STUDY OBJECTIVE: To evaluate the effects of setting, type of supervision, and time in clinic on the resident continuity clinic experience. DESIGN: Prospective cohort with preintervention and postintervention measures. SETTINGS: Pediatric residents selected one of three clinic settings for their continuity clinic experience. These included a traditional, university-based clinic, private practice offices, and publicly funded community-based clinics. SUBJECTS: All pediatric residents at the University of Utah Health Sciences Center, July 1985 through June 1991. INTERVENTIONS: Using varied clinic sites, matching residents one or two to one with preceptors for their continuity clinic, increasing continuity clinic from 1 to 2 half-days per week. MEASUREMENTS AND MAIN RESULTS: Residents in private offices had the most varied experience, seeing more patients, more acute care, and a broader age range of patients than residents at other sites. They were more likely both to be observed by their preceptors during patient visits and to observe their preceptors delivering care. Because the number of patients seen per session rose, increasing continuity clinic time from one to two half-days per week more than doubled the number of patients seen per week. Increased time away from hospital did not affect scores on the Pediatric In-Training Examination. While test scores were similar for incoming residents, those in private offices scored higher on the final Behavioral Pediatrics Examination (P < .05). CONCLUSIONS: Clinic setting, time in clinic, and faculty supervision affect the quality of the continuity clinic experience. Increased time in clinic resulted in a broader exposure to patients. Residents placed in private offices had a more varied patient mix, were more closely supervised, and seemed to gain primary care skills more rapidly than residents at other sites.     

The Teenage Inventory of Social Skills: Development, reliability, and validity.

Describes the development and the evaluation of reliability and convergent and discriminant validity of a newly designed self-report questionnaire for the assessment of adolescent social competence: the Teenage Inventory of Social Skills (TISS). Two-week test–retest reliabilities for positive and negative behavior scales were .90 and .72; internal consistencies were .88. Convergent validity was assessed by comparing TISS scales with self-monitoring data, ratings by peers, and sociometric data. Discriminant validity was examined by investigating correlations between scores on the TISS and social desirability, SES, and another paper-and-pencil self-report instrument (Conflict Behavior Questionnaire) thought not to be necessarily related to adolescent social behavior. Results provided adequate evidence for both the convergent and discriminant validity of the TISS scales. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Capabilities of Upper Extremity instrument: reliability and validity of a measure of functional limitation in tetraplegia

OBJECTIVE: To evaluate the reliability and validity of the Capabilities of Upper Extremity (CUE) instrument, designed to measure upper extremity functional limitations in individuals with tetraplegia. Functional limitations are actions such as reaching or grasping and are a link between the domains of impairment and disability. DESIGN: Survey of people with chronic spinal cord injury. SETTING: Regional spinal cord injury center. SUBJECTS: One hundred fifty-four individuals (140 male) with tetraplegia at least 1 year after injury and followed by the center. Mean age was 36.7 years (SD=11.1). Sixty-eight percent were motor complete. METHODS: The 32-item CUE was administered by telephone interview twice about 2 weeks apart. The motor portion of the Functional Independence Measure (FIM) was collected during the first interview. Upper extremity motor scores and motor levels were obtained from the most recent assessment in the outpatient chart. The instrument was evaluated for internal consistency, reliability, and validity. Exploratory factor analysis was performed to examine scale structure. RESULTS: Homogeneity of the scale was excellent. Cronbach's alpha was .96, and item-total correlations ranged from .49 to .78. Test-retest reliability was high (ICC=.94). All but three items had desired levels of agreement (K > .60). Analysis of variance indicated that the CUE distinguished between motor levels of tetraplegia more than one level apart. The CUE was correlated highly with both motor scores and FIM. Regression analysis indicated that the CUE was better than upper extremity motor scores for predicting FIM scores. The model containing the CUE explained 73% of the variance in FIM and was not enhanced by the addition of motor scores. Factor analysis suggested four potential subscales: arm function (bilateral), right hand function, left hand function, and reaching down. CONCLUSION: The CUE exhibits good homogeneity, reliability, and validity; further work is needed to determine its sensitivity to change in function.     

The pediatric cancer quality of life inventory-32 (PCQL-32): I. Reliability and validity

BACKGROUND: Multidimensional measurement of pediatric cancer patients' health-related quality of life (HRQOL) in Phase III randomized controlled clinical trials is being recognized increasingly as an essential component in evaluating the comprehensive health outcomes of modern antineoplastic treatment protocols. The Pediatric Cancer Quality of Life Inventory-32 (PCQL-32) is a standardized patient self-report and parent proxy-report assessment instrument designed to assess systematically pediatric cancer patients' HRQOL outcomes. METHODS: To validate a patient-report form and a parent-report form, the PCQL-32 was administered to 291 pediatric cancer patients and to their parents. Both forms yield a total score and five a priori multidimensional scales. Clinical validity was determined by the known-groups approach by comparing patients classified as either on or off treatment. To determine construct validity, a battery of standardized psychosocial measures was administered and a multitrait-multimethod matrix was constructed. RESULTS: For both patient and parent forms, internal consistency reliability of the PCQL-32 total scale was high (0.91 and 0.92, respectively). The internal consistency reliabilities of the five component scales for both patient and parent forms were in the acceptable range for group comparisons. With regard to clinical validity, the PCQL-32 total scale and the disease/treatment and physical functioning scales of the PCQL-32 distinguished between patients on and off treatment for both patient- and parent-report. The results of the multitrait-multimethod matrix approach were consistent with hypotheses and lent evidence for the construct validity of the patient and parent forms of the PCQL-32 total scale and the psychological functioning, social functioning, cognitive functioning, physical functioning, and disease/treatment scales. CONCLUSIONS: The PCQL-32 has demonstrated acceptable internal consistency reliability, clinical validity, and construct validity for both patient-report and parent-report forms. Further field testing of the PCQL-32 will determine its practicality and utility in multisite pediatric cancer randomized controlled clinical trials.     

Toward an integrated program design: Evaluating the status of diversity training in a graduate school curriculum.

Domain D of the American Psychological Association's (APA's) accreditation guidelines (APA, 1995) requires doctoral training programs in psychology to address diversity. Measurement of diversity integration is difficult and often addresses only faculty and student composition (E. M. Altmaier; see record 1993-31088-001). This study had 3 purposes: (1) the development of an instrument for rating diversity inclusion in courses, the Diversity Rating Form (DRF; S. A. Kuba, 1995); (2) the comparison of faculty diversity inclusion according to demographic characteristics; and (3) the application of the DRF to a graduate school program. The DRF was completed by 613 students and 37 faculty members. It demonstrated high reliability (alpha?=?.95)and construct validity (r?=?.88, p?p?p?     

Modifiers and Perceived Stress Scale.

Investigated the interrelations between perceived stress and its modifiers (anticipation of events, responsibility for events, and amount of social support from friends and family) and total or averaged scores on a modifiers and perceived stress (MAPS) scale and obtained data on reliability and validity of the MAPS. Factor analysis of total and average scores of 302 men (average age 52 yrs) for these areas identified 4 dimensions: Total and average anticipated and responsible scores loaded on 1 dimension, number of events and total perceived stress loaded on another, the 2 support scores loaded on a 3rd factor, and average perceived stress loaded independently on a factor. Two-week test–retest reliabilities for scores were in the moderate to high range. Independent assessments of stress by social workers correlated significantly with the total perceived stress score and with average perceived stress score. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Perceptions of Fair Interpersonal Treatment Scale: development and validation of a measure of interpersonal treatment in the workplace

The Perceptions of Fair Interpersonal Treatment (PFIT) scale was designed to assess employees' perceptions of the interpersonal treatment in their work environment. Analyses of the factor structure and reliability of this new instrument indicate that the PFIT scale is a reliable instrument composed of 2 factors: supervisor treatment and coworker treatment. It was hypothesized that the PFIT scale would be positively correlated with job satisfaction variables and negatively correlated with work withdrawal, job withdrawal, experiences of sexual harassment, and an organization's tolerance of sexual harassment. Results based on 509 employees in a private-sector organization and 217 female faculty and staff members at a large midwestern university supported these hypotheses. Arguments that common method variance and employees' dispositions are responsible for the significant correlations between the PFIT scale and other job-related variables were eliminated. The implications of these results are discussed.     

Average thresholds in the 8 to 20 kHz range in young adults

RATIONALE AND OBJECTIVES: The Comprehensive Clinical Assessment (CCA) examination at the University of Michigan Medical School is a series of test stations through which the mastery of clinical skills is evaluated. The purpose of this study was to determine whether student performance on the radiology station improved in years when radiology faculty presented case-of-the-week unknowns to the 3rd-year students. MATERIALS AND METHODS: The authors compared four separate classes of medical students in examination years 1993, 1994, 1995, and 1996 by using the total CCA examination score, the radiology station score, and radiology station pass/fail rates. Radiology case-of-the-week presentations were given by the radiology faculty only in academic years 1993-1994 and 1994-1995 (examination years 1994 and 1995). RESULTS: The means and standard deviations of the radiology station scores for the examination years when case-of-the-week presentations were not given, 1993 and 1996, were 78.92 +/- 13.62 and 79.76 +/- 13.62, respectively. In the years case-of-the-week presentations were given, 1994 and 1995, the radiology station scores averaged 90.83 +/- 8.58 and 89.97 +/- 9.66, respectively (P < .001, global alpha = .05). Total CCA percentage correct scores were similar for all years studied. In 1993 and 1996, 7.6% and 5.3% of students, respectively, failed the radiology station. In 1994 and 1995, 0.4% and 0% of students, respectively, failed (P < .0001). CONCLUSION: Case-of-the-week presentations by radiology faculty increased 3rd-year students' basic radiologic knowledge as evidenced by increased scores on the radiology station of the CCA examination.     

Comparison of continuity clinic experience by practice setting and postgraduate level

OBJECTIVE: To compare continuity clinic experiences by practice setting and postgraduate level. DESIGN: Mailed questionnaire. SETTING: Baylor College of Medicine pediatric residents selected 1 of 3 continuity practice settings, including community-based private offices (n = 35) and university-based clinics in a private (n = 71) and a public (n = 12) hospital. SUBJECTS: One hundred eighteen pediatric residents, May 1993. OUTCOME MEASURES: Patient volume, continuity of care, type of patient visit, and faculty supervision. RESULTS: The response rate was 77% (91/118). Pediatric residents in community-based private offices reported seeing more patients per session than those in the university-based private and public clinics (88%, 10%, and 0% residents in the respective practice settings reported > or = 4 patients per session), but were less likely to see patients repeatedly (6%, 68%, and 40% residents in the respective practice settings had seen more than half their patients > 2 times). Residents in private offices provided a smaller percentage of well child care (16%, 61%, and 90% residents in the respective practice settings reported > 50% patients were well) and more acute care (68%, 15% and 0% residents in the respective practice settings reported > 25% patients were acutely ill). Residents in private offices reported a higher percentage of time spent observing only (33%, 0%, and 0% residents in the respective practice settings observed > 25% of the time) and less time managing patients independently (93%, 59%, and 40% residents, respectively, managed < or = 25% of the time). No significant differences among postgraduate levels were found for these variables. CONCLUSIONS: Patient volume, continuity of care, type of patient visit, and faculty supervision were significantly different among continuity practice settings. Postgraduate level of training did not affect significantly these measures of continuity clinic experience. These differences need to be considered in curriculum development.     

Quality of life in osteoporosis: reliability, consistency, and validity of the Osteoporosis Assessment Questionnaire

OBJECTIVE: To determine the reliability, consistency, and clinical utility of the Osteoporosis Assessment Questionnaire (OPAQ), an AIMS2 based self-assessment questionnaire. METHODS: Reliability of individual questions, scales, and domains were evaluated in 40 subjects by test-retest and intraclass correlation coefficients and internal consistency by Cronbach's alpha. Construct validity was evaluated by disease state. The relationships between domains and scales were modeled by confirmatory factor analysis. RESULTS: Mean kappa (79 questions) and intraclass correlation (18 health scales) coefficients were 0.58+/-0.16 (mean+/-SD) and 0.82+/-0.07, respectively. Internal consistency was greater than 0.8 in all but 3 scales. Construct validity was confirmed. Patients with hip fracture recorded lower OPAQ scores than patients with vertebral fracture. Correlation and confirmatory factor analyses grouped the 18 health scales into 7 domains. CONCLUSION: These findings suggest that OPAQ is a reliable, consistent, and valid instrument capable of distinguishing hierarchy of functional loss in disease states in osteoporosis.     

Validity and reliability of a new questionnaire on patient satisfaction in rehabilitative therapy

BACKGROUND: The aim of this study was to examine some psychometric properties of a new questionnaire measuring patients' satisfaction with respect to the quality of care during stay in a rehabilitation unit. The instrument (called SAT-16) is composed of 16 four-level items and 2 open-ended questions. The construct validity of the 16-item section was already demonstrated in a previous study based on factorial analysis. In this study the concurrent validity, further aspects of the construct validity and test-retest reliability were analyzed. METHODS: The SAT-16 was administered to 339 inpatients, admitted consecutively to a Rehabilitation Center. RESULTS: 262 questionnaires (77%) were returned, of which 221 with all items filled in. The SAT-16 correlated well with two other measures of satisfaction (CSQ-8 and global satisfaction regarding the hospital stay). The answers to two open-ended questions came out to be consistent with those to the 16 closed-ended questions. The high values for the indices of test-retest reliability (ICC and kappa) are evidence of the stability of the scores in two repeated administrations. CONCLUSIONS: The SAT-16 was found to be provided with good psychometric characteristics. It can be proposed as a valid instrument for use in clinical practice for the continuous quality improvement of inpatient medical rehabilitation programmes.     

Teaching information mastery: evaluating information provided by pharmaceutical representatives

BACKGROUND: The pharmaceutical industry plays a large role in the lifelong learning of family physicians. Controversy exists over how to integrate this potential information source into residency curricula. METHODS: Based on a a faculty and resident needs assessment, a curriculum was designed to teach the evaluation of pharmaceutical representatives' (PRs) presentations. The Pharmaceutical Representative Evaluation Form is the keystone of the curriculum. This evaluation form guides discussion of pharmaceutical presentation to facilitate understanding of the sales process and help residents confirm or dispute the presentation's content, based on the sales methods used. A second goal of the evaluation program is to improve the content of the PRs' presentations. RESULTS: Residents rapidly acquire the ability to identify potential fallacies of logic and other misleading sales techniques in representatives' presentations. Compared with pretest results, residents' posttest scores demonstrate an understanding that PRs and the acceptance of promotional items can affect their prescribing behavior. Most PRs are pleased that their role is seen as educational. CONCLUSIONS: Physicians must function more as information managers than as information repositories, and it is important that residents be able to obtain useful information from PRs. Our curriculum has been effective in increasing residents' abilities to evaluate the pharmaceutical sales process and allowing them to separate the ?wheat from the chaff? contained in this ubiquitous source of information.     

The classification of child psychopathology: A review and analysis of empirical efforts.

Reviews empirically derived syndromes of child behavior problems, and identifies those having counterparts in 2 or more studies. A distinction between broad-band and narrow-band syndromes was made. Broad-band undercontrolled and overcontrolled syndromes and narrow-band aggressive, delinquent, hyperactive, schizoid, anxious, depressed, somatic, and withdrawn syndromes were found in diverse samples of disturbed children. Two other broad-band and 6 other narrow-band syndromes were found in a few studies. Test–retest reliabilities and stabilities of syndrome scores were more adequate than interrater reliabilities. Cross-instrument and cross-population consistencies corroborated some empirically derived syndromes but the lack of independent criteria for categorizing disturbed children made it difficult to establish criterion-referenced validity. Because categorization of children by syndromes has been limited primarily to the broad-band undercontrolled–overcontrolled dichotomy, it is suggested that more efforts are needed to translate syndromes into categories for use by practitioners and researchers. It is concluded that further work in this area should be systematically linked to the existing mental health system and to efforts at reforming this system. (98 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Career satisfaction of physical therapy faculty during their pretenure years

BACKGROUND AND PURPOSE: The purpose of this study was to compile information about and define variables that are influential in the career satisfaction of tenure-track, full-time, physical therapy faculty who have been employed in academia for 5 years or less but who do not yet have tenure. SUBJECTS AND METHODS: An investigator-developed instrument was used to collect the data. The self-report instrument contained 80 items in four categories: demographics, social supports, teaching, and scholarly activity. Questionnaires were sent to junior physical therapy faculty at the 127 physical therapist schools in the United States and Puerto Rico listed by the American Physical Therapy Association in 1993. There were 163 responses to the survey, representing an estimated 85% of the population of junior faculty as defined by this survey. RESULTS: Eighty-three percent of junior faculty surveyed were satisfied with having taken an academic position, despite feelings of loneliness, tenure anxiety, heavy work loads, and the desire for more guidance from colleagues. CONCLUSION AND DISCUSSION: Social and collegial supports such as relationship with senior faculty and experienced colleagues are key elements influencing faculty satisfaction. Information is given that could be utilized by directors and faculty who are planning to guide the professional development of new faculty.