Karen E. Hauer

Bio: Karen E. Hauer is an academic researcher from University of California, San Francisco. The author has contributed to research in topics: Competence (human resources) & Clinical clerkship. The author has an hindex of 38, co-authored 174 publications receiving 5525 citations. Previous affiliations of Karen E. Hauer include University of California, Berkeley & Yale University.

Tools for Direct Observation and Assessment of Clinical Skills of Medical Trainees: A Systematic Review

Abstract: Context Direct observation of medical trainees with actual patients is important for performance-based clinical skills assessment. Multiple tools for direct observation are available, but their characteristics and outcomes have not been compared systematically. Objectives To identify observation tools used to assess medical trainees' clinical skills with actual patients and to summarize the evidence of their validity and outcomes. Data Sources Electronic literature search of PubMed, ERIC, CINAHL, and Web of Science for English-language articles published between 1965 and March 2009 and review of references from article bibliographies. Study Selection Included studies described a tool designed for direct observation of medical trainees' clinical skills with actual patients by educational supervisors. Tools used only in simulated settings or assessing surgical/procedural skills were excluded. Of 10 672 citations, 199 articles were reviewed and 85 met inclusion criteria. Data Extraction Two authors independently abstracted studies using a modified Best Evidence Medical Education coding form to inform judgment of key psychometric characteristics. Differences were reconciled by consensus. Results A total of 55 tools were identified. Twenty-one tools were studied with students and 32 with residents or fellows. Two were used across the educational continuum. Most (n = 32) were developed for formative assessment. Rater training was described for 26 tools. Only 11 tools had validity evidence based on internal structure and relationship to other variables. Trainee or observer attitudes about the tool were the most commonly measured outcomes. Self-assessed changes in trainee knowledge, skills, or attitudes (n = 9) or objectively measured change in knowledge or skills (n = 5) were infrequently reported. The strongest validity evidence has been established for the Mini Clinical Evaluation Exercise (Mini-CEX). Conclusion Although many tools are available for the direct observation of clinical skills, validity evidence and description of educational outcomes are scarce.

Tools for Direct Observation and Assessment of Clinical Skills of Medical Trainees

Abstract: CONTEXT Direct observation of medical trainees with actual patients is important for performance-based clinical skills assessment. Multiple tools for direct observation are available, but their characteristics and outcomes have not been compared systematically. OBJECTIVES To identify observation tools used to assess medical trainees' clinical skills with actual patients and to summarize the evidence of their validity and outcomes. DATA SOURCES Electronic literature search of PubMed, ERIC, CINAHL, and Web of Science for English-language articles published between 1965 and March 2009 and review of references from article bibliographies. STUDY SELECTION Included studies described a tool designed for direct observation of medical trainees' clinical skills with actual patients by educational supervisors. Tools used only in simulated settings or assessing surgical/procedural skills were excluded. Of 10 672 citations, 199 articles were reviewed and 85 met inclusion criteria. DATA EXTRACTION Two authors independently abstracted studies using a modified Best Evidence Medical Education coding form to inform judgment of key psychometric characteristics. Differences were reconciled by consensus. RESULTS A total of 55 tools were identified. Twenty-one tools were studied with students and 32 with residents or fellows. Two were used across the educational continuum. Most (n = 32) were developed for formative assessment. Rater training was described for 26 tools. Only 11 tools had validity evidence based on internal structure and relationship to other variables. Trainee or observer attitudes about the tool were the most commonly measured outcomes. Self-assessed changes in trainee knowledge, skills, or attitudes (n = 9) or objectively measured change in knowledge or skills (n = 5) were infrequently reported. The strongest validity evidence has been established for the Mini Clinical Evaluation Exercise (Mini-CEX). CONCLUSION Although many tools are available for the direct observation of clinical skills, validity evidence and description of educational outcomes are scarce.

Factors associated with medical students' career choices regarding internal medicine.

Abstract: Context Shortfalls in the US physician workforce are anticipated as the population ages and medical students' interest in careers in internal medicine (IM) has declined (particularly general IM, the primary specialty serving older adults). The factors influencing current students' career choices regarding IM are unclear. Objectives To describe medical students' career decision making regarding IM and to identify modifiable factors related to this decision making. Design, Setting, and Participants Web-based cross-sectional survey of 1177 fourth-year medical students (82% response rate) at 11 US medical schools in spring 2007. Main Outcome Measures Demographics, debt, educational experiences, and number who chose or considered IM careers were measured. Factor analysis was performed to assess influences on career chosen. Logistic regression analysis was conducted to assess independent association of variables with IM career choice. Results Of 1177 respondents, 274 (23.2%) planned careers in IM, including 24 (2.0%) in general IM. Only 228 (19.4%) responded that their core IM clerkship made a career in general IM seem more attractive, whereas 574 (48.8%) responded that it made a career in subspecialty IM more attractive. Three factors influenced career choice regarding IM: educational experiences in IM, the nature of patient care in IM, and lifestyle. Students were more likely to pursue careers in IM if they were male (odds ratio [OR] 1.75; 95% confidence interval [CI], 1.20-2.56), were attending a private school (OR, 1.88; 95% CI, 1.26-2.83), were favorably impressed with their educational experience in IM (OR, 4.57; 95% CI, 3.01-6.93), reported favorable feelings about caring for IM patients (OR, 8.72; 95% CI, 6.03-12.62), or reported a favorable impression of internists' lifestyle (OR, 2.00; 95% CI, 1.39-2.87). Conclusions Medical students valued the teaching during IM clerkships but expressed serious reservations about IM as a career. Students who reported more favorable impressions of the patients cared for by internists, the IM practice environment, and internists' lifestyle were more likely to pursue a career in IM.

Remediation of the Deficiencies of Physicians Across the Continuum From Medical School to Practice: A Thematic Review of the Literature

Abstract: Despite widespread endorsement of competency-based assessment of medical trainees and practicing physicians, methods for identifying those who are not competent and strategies for remediation of their deficits are not standardized. This literature review describes the published studies of deficit remediation at the undergraduate, graduate, and continuing medical education levels. Thirteen studies primarily describe small, single-institution efforts to remediate deficient knowledge or clinical skills of trainees or belowstandard-practice performance of practicing physicians. Working from these studies and research from the learning sciences, the authors propose a model that includes multiple assessment tools for identifying deficiencies, individualized instruction, deliberate practice followed by feedback and reflection, and reassessment. The findings of the study reveal a paucity of evidence to guide best practices of remediation in medical education at all levels. There is an urgent need for multiinstitutional, outcomes-based research on strategies for remediation of less than fully competent trainees and physicians with the use of long-term follow-up to determine the impact on future performance. Acad Med. 2009; 84:1822–1832. Medical educators and accrediting organizations have shifted their emphasis from what is taught in the curriculum to what a medical student, resident, or practicing physician can perform. Whereas most trainees and practicing physicians can demonstrate competence in clinical and communication skills, a minority fail to meet the expected standard and require remediation. Despite widespread endorsement of the expectation that physicians-in-training and practicing physicians be assessed for their competence, it remains challenging to identify accurately and reliably those trainees and physicians who are incompetent or less than fully competent and to remediate their deficiencies effectively. Less than fully competent physicians or trainees fail to maintain acceptable standards in one or more areas of professional physician practice, whereas incompetent physicians lack the abilities (cognitive, noncognitive, and communicative) and qualities needed to

Understanding trust as an essential element of trainee supervision and learning in the workplace

Abstract: Clinical supervision requires that supervisors make decisions about how much independence to allow their trainees for patient care tasks. The simultaneous goals of ensuring quality patient care and affording trainees appropriate and progressively greater responsibility require that the supervising physician trusts the trainee. Trust allows the trainee to experience increasing levels of participation and responsibility in the workplace in a way that builds competence for future practice. The factors influencing a supervisor’s trust in a trainee are related to the supervisor, trainee, the supervisor–trainee relationship, task, and context. This literature-based overview of these five factors informs design principles for clinical education that support the granting of entrustment. Entrustable professional activities offer promise as an example of a novel supervision and assessment strategy based on trust. Informed by the design principles offered here, entrustment can support supervisors’ accountability for the outcomes of training by maintaining focus on future patient care outcomes.

Standards for educational and psychological testing

Abstract: Pedagosko i psiholosko testiranje i procjenjivanje spadaju među najvažnije doprinose znanosti o ponasanju nasem drustvu i pružaju temeljna i znacajna poboljsanja u odnosu na ranije postupke. Iako se ne može ustvrditi da su svi testovi dovoljno usavrseni niti da su sva testiranja razborita i korisna, postoji velika kolicina informacija koje ukazuju na ucinkovitost kvalitetnih instrumenata u onim situacijama u kojima je njihovo koristenje potkrijepljeno validacijskim podacima. Pravilna upotreba testova može dovesti do boljih odluka o pojedincima i programima nego sto bi to bio slucaj bez njihovog koristenja, a također i ukazati na put za siri i pravedniji pristup obrazovanju i zaposljavanju. Međutim, losa upotreba testova može dovesti do zamjetne stete nanesene ispitanicima i drugim sudionicima u procesu donosenja odluka na temelju testovnih podataka. Cilj Standarda je promoviranje kvalitetne i eticne upotrebe testova te uspostavljanje osnovice za ocjenu kvalitete postupaka testiranja. Svrha objavljivanja Standarda je uspostavljanje kriterija za evaluaciju testova, provedbe testiranja i posljedica upotrebe testova. Iako bi evaluacija prikladnosti testa ili njegove primjene trebala ovisiti prvenstveno o strucnim misljenjima, Standardi pružaju okvir koji osigurava obuhvacanje svih relevantnih pitanja. Bilo bi poželjno da svi autori, sponzori, nakladnici i korisnici profesionalnih testova usvoje Standarde te da poticu druge da ih također prihvate.

Shared Decision Making: A Model for Clinical Practice

Abstract: The principles of shared decision making are well documented but there is a lack of guidance about how to accomplish the approach in routine clinical practice. Our aim here is to translate existing conceptual descriptions into a three-step model that is practical, easy to remember, and can act as a guide to skill development. Achieving shared decision making depends on building a good relationship in the clinical encounter so that information is shared and patients are supported to deliberate and express their preferences and views during the decision making process. To accomplish these tasks, we propose a model of how to do shared decision making that is based on choice, option and decision talk. The model has three steps: a) introducing choice, b) describing options, often by integrating the use of patient decision support, and c) helping patients explore preferences and make decisions. This model rests on supporting a process of deliberation, and on understanding that decisions should be influenced by exploring and respecting “what matters most” to patients as individuals, and that this exploration in turn depends on them developing informed preferences.