Although the case presentation is a frequent activity, little is known about the attributes that ... more Although the case presentation is a frequent activity, little is known about the attributes that faculty members use when assessing case presentation ability. Define the dimensions used by faculty when assessing students' case presentation abilities. Eleven internal medicine faculty members independently assessed the same 17 videotaped student case presentations. Raters used an evaluation form assembled with 4 descriptors of content and 6 attributes of communication style. For each evaluator, correlation analyses were used to examine associations among the individual descriptors and a student's overall evaluation. Despite efforts toward uniform scoring, faculty evaluators varied in their application of rating criteria. The majority of raters had significant (p < .01) correlation between 4 of the 10 dimensions and the overall score. These 4 were history of present illness and three communication skills: economy, fluency, and precision of language. Faculty members' assessment of case presentations is based on both the facts presented and communication style. These identified performance dimensions can facilitate teaching students to present cases and allow more informative feedback on their abilities.
Management strategies for suspected temporal arteritis range from bilateral temporal artery biops... more Management strategies for suspected temporal arteritis range from bilateral temporal artery biopsy to empiric corticosteroid therapy. A decision analysis of the clinical situation was constructed, and a sensitivity analysis for varying prevalences of temporal arteritis was used to calculate costs for different management strategies. Conclusions suggested by the analysis include the following: (1) due to the high cost of blindness, suspicion of disease must be low (less than 1.4%) not to biopsy; (2) at high suspicion of disease (greater than 30%), empiric steroids are the cheapest management; (3) when diagnostic procedures are indicated, bilateral biopsy is the cheapest initial diagnostic procedure; and (4) if unilateral biopsy is negative, a second biopsy is always cost effective.
To evaluate the implementation of a quarterly group objective structured clinical examination (GO... more To evaluate the implementation of a quarterly group objective structured clinical examination (GOSCE) to assess the patient-evaluation abilities of a medical school class. The study subjects were 94 first-year students participating in the Principles of Clinical Medicine course at the Oregon Health Sciences University School of Medicine in 1992-93. To create the GOSCE, the authors modified the format of the quarterly objective structured clinical examination by making each standardized-patient station the site of an interaction between a standardized patient and a group of four or five students. The GOSCE's reliability, content and face validity, and expense were evaluated. Student feedback was obtained using a structured questionnaire. Performances varied both among the five stations of the GOSCE and among the 23 student groups: the mean percentage of items performed correctly per station was 83%, with a range of 73-97%. The reliability of the GOSCE's stations was low, with intraclass correlations during the three consecutive quarters of .29, .05, and .12. Despite no prior experience with this type of testing, the students' mean rating of the GOSCE's appropriateness was 3.8 (on a Likert scale of 1, poor, to 5, excellent), compared with 2.5 for the appropriateness of the written examination also used for quarterly assessment. The expense of the GOSCE was much less than the costs reported for the OSCE format. The use of the quarterly GOSCE favorably influenced the students, faculty, and curriculum. The GOSCE format made possible the assessment of a large number of students' abilities, without the time and expense needed to evaluate students individually.
Mrs. R. had delayed finding a new physician for almost a year. Finally, she could not refill her ... more Mrs. R. had delayed finding a new physician for almost a year. Finally, she could not refill her medications without a physician’s prescription and made an appointment. She had heard good things about this individual, but a visit with a new physician made her anxious. She wondered what it would be like.
tervention group had significantly higher bone mineral density in the spine and trochanter region... more tervention group had significantly higher bone mineral density in the spine and trochanter regions during the first study year, which was maintained during the sec- ond study year. The naltrexone biomarker demon- stratedagreaterrelativedecreaseintheinterventiongroup compared with the control group, with nonsignificant changes in osteocalcin consistent with more bone build- ing in the intervention group. Participants in the inter- vention group reported
Although the case presentation is a frequent activity, little is known about the attributes that ... more Although the case presentation is a frequent activity, little is known about the attributes that faculty members use when assessing case presentation ability. Define the dimensions used by faculty when assessing students' case presentation abilities. Eleven internal medicine faculty members independently assessed the same 17 videotaped student case presentations. Raters used an evaluation form assembled with 4 descriptors of content and 6 attributes of communication style. For each evaluator, correlation analyses were used to examine associations among the individual descriptors and a student's overall evaluation. Despite efforts toward uniform scoring, faculty evaluators varied in their application of rating criteria. The majority of raters had significant (p < .01) correlation between 4 of the 10 dimensions and the overall score. These 4 were history of present illness and three communication skills: economy, fluency, and precision of language. Faculty members' assessment of case presentations is based on both the facts presented and communication style. These identified performance dimensions can facilitate teaching students to present cases and allow more informative feedback on their abilities.
Management strategies for suspected temporal arteritis range from bilateral temporal artery biops... more Management strategies for suspected temporal arteritis range from bilateral temporal artery biopsy to empiric corticosteroid therapy. A decision analysis of the clinical situation was constructed, and a sensitivity analysis for varying prevalences of temporal arteritis was used to calculate costs for different management strategies. Conclusions suggested by the analysis include the following: (1) due to the high cost of blindness, suspicion of disease must be low (less than 1.4%) not to biopsy; (2) at high suspicion of disease (greater than 30%), empiric steroids are the cheapest management; (3) when diagnostic procedures are indicated, bilateral biopsy is the cheapest initial diagnostic procedure; and (4) if unilateral biopsy is negative, a second biopsy is always cost effective.
To evaluate the implementation of a quarterly group objective structured clinical examination (GO... more To evaluate the implementation of a quarterly group objective structured clinical examination (GOSCE) to assess the patient-evaluation abilities of a medical school class. The study subjects were 94 first-year students participating in the Principles of Clinical Medicine course at the Oregon Health Sciences University School of Medicine in 1992-93. To create the GOSCE, the authors modified the format of the quarterly objective structured clinical examination by making each standardized-patient station the site of an interaction between a standardized patient and a group of four or five students. The GOSCE's reliability, content and face validity, and expense were evaluated. Student feedback was obtained using a structured questionnaire. Performances varied both among the five stations of the GOSCE and among the 23 student groups: the mean percentage of items performed correctly per station was 83%, with a range of 73-97%. The reliability of the GOSCE's stations was low, with intraclass correlations during the three consecutive quarters of .29, .05, and .12. Despite no prior experience with this type of testing, the students' mean rating of the GOSCE's appropriateness was 3.8 (on a Likert scale of 1, poor, to 5, excellent), compared with 2.5 for the appropriateness of the written examination also used for quarterly assessment. The expense of the GOSCE was much less than the costs reported for the OSCE format. The use of the quarterly GOSCE favorably influenced the students, faculty, and curriculum. The GOSCE format made possible the assessment of a large number of students' abilities, without the time and expense needed to evaluate students individually.
Mrs. R. had delayed finding a new physician for almost a year. Finally, she could not refill her ... more Mrs. R. had delayed finding a new physician for almost a year. Finally, she could not refill her medications without a physician’s prescription and made an appointment. She had heard good things about this individual, but a visit with a new physician made her anxious. She wondered what it would be like.
tervention group had significantly higher bone mineral density in the spine and trochanter region... more tervention group had significantly higher bone mineral density in the spine and trochanter regions during the first study year, which was maintained during the sec- ond study year. The naltrexone biomarker demon- stratedagreaterrelativedecreaseintheinterventiongroup compared with the control group, with nonsignificant changes in osteocalcin consistent with more bone build- ing in the intervention group. Participants in the inter- vention group reported
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