Browsing by Subject "Direct observation"

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    ItemOpen Access
    Creating a win-win for the health system and health Profession's education: a direct observation clinical experience with feedback iN real-time (DOCENT) for low acuity patients in the emergency department.
    (BMC medical education, 2022-01-27) Clay, Alison S; Leiman, Erin R; Theiling, Brent Jason; Song, Yao; Padilla, Blanca Blanca Iris; Hudak, Nicholas M; Hartman, Ann Michelle; Hoder, Jeffrey M; Waite, Kathleen A; Lee, Hui-Jie; Buckley, Edward G

    Background

    Clinical education across the professions is challenged by a lack of recognition for faculty and pressure for patient throughput and revenue generation. These pressures may reduce direct observation of patient care provided by students, a requirement for both billing student-involved services and assessing competence. These same pressures may also limit opportunities for interprofessional education and collaboration.

    Methods

    An interprofessional group of faculty collaborated in a sequential quality improvement project to identify the best patients and physical location for a student teaching clinic. Patient chief complaint, use of resources, length of stay, estimated severity of illness and student participation and evaluation of the clinic was tracked.

    Results

    Clinic Optimization and Patient Care: Five hundred and thirty-two emergency department (ED) patients were seen in the first 19 months of the clinic. A clinic located near the ED allowed for patients with higher emergency severity index and greater utilization of imaging. Patients had similar or lower lengths of stay and higher satisfaction than patients who remained in the ED (p < 0.0001). In the second clinic location, from October 2016-June 2019, 644 patients were seen with a total of 667 concerns; the most common concern was musculoskeletal (50.1%). Student Interprofessional Experience: A total of 991 students participated in the clinic: 68.3% (n = 677) medical students, 10.1% (n = 100) physician assistant students, 9.7% (n = 96) undergraduate nursing students, 9.1% (n = 90) physical therapy students, and 2.8% (n = 28) nurse practitioner students. The majority (74.5%, n = 738) of student participants worked with students from other professions. More than 90% of students reported that faculty set a positive learning environment respectful of students. However, 20% of students reported that faculty could improve provision of constructive feedback. Direct Observation: Direct observation of core entrustable professional activities for medical students was possible. Senior medical students were more likely to be observed generating a differential diagnosis or management plan than first year medical students.

    Conclusions

    Creation of a DOCENT clinic in the emergency department provided opportunities for interprofessional education and observation of student clinical skills, enriching student experience without compromising patient care.
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    ItemOpen Access
    Validity of a Medical Record in Measuring the Quality of Obstetric Services in Rural Clinics in Greater Masaka District, Uganda
    (2019) Kim, Min Kyung

    Introduction

    Despite improvements in health service coverage, quality of care (QoC) is often poor in low- and middle-income countries. To improve QoC, accurate measurements of healthcare processes are needed. The aim of this study was to estimate the validity of QoC data from patient medical records for childbirth deliveries by comparing them with direct clinical observation.

    Methods

    My study was part of a larger parent study of the effects of a healthcare QoC training program at six health facilities in Masaka district, Uganda. My study data were collected in two phases: 1) validation paired data of 321 observations plus the corresponding medical records collected; 2) evaluation data of 1,146 medical records of deliveries while the training intervention was being implemented. Sensitivity, specificity, positive predictive values, and negative predictive values were estimated as the bias parameters. Quantitative bias analysis was conducted by assigning these bias parameters. Prevalence ratio and odds ratio measured the parent study’s program efficacy.

    Results

    Medical records overestimated providers’ performance on quality indicators. The odds ratio of seven out of eleven indicators changed significantly; while the prevalence ratio of only one indicator varied.

    Conclusion

    The medical records for childbirth deliveries in Uganda demonstrated poor validity in measuring QoC compared with direct observation. Studies measuring QoC that rely on medical record data should be interpreted carefully, especially for obstetric and neonatal services. Meanwhile, poor record data showed a mixed result on the efficacy of the quality improvement program. Studies using the record data to evaluate the program efficacy should be done carefully, especially in low-resource settings.