Short- and Long-Term Evaluation of General Practitioners' Competences After a Training in Melanoma Diagnosis: Refresher Training Sessions May Be Needed.

General practitioners (GPs) are first-line clinicians in melanoma diagnosis. It is, therefore, important to ensure that they maintain their melanoma diagnostic accuracy over time. The objective of this study was to assess the short- and long-term competences of GPs after a training session in naked-eye melanoma diagnosis. An interventional prospective study was conducted whereby, over a 6-month period, GPs attended a 1-h melanoma diagnostic training session. To assess their acquired competences, GPs were asked to fill in a questionnaire on basic melanoma knowledge and to evaluate 10 clinical images of pigmented skin lesions prior to training, immediately after and 1 year later. In total, 89 GPs completed the questionnaire prior and immediately after training. As expected, the number of GPs who appropriately managed [Formula: see text] 50% of the melanoma cases increased after training (P < 0.001). One year after training, only 27 (30%) of the 89 GPs completed the questionnaire. This number of participants was too low to obtain significant figures but the GPs' mean overall score of appropriately managed clinical cases was much lower than in the immediate post-test. In conclusion, although this short training improved the GPs' diagnostic accuracy and management of melanoma in the short-term, participating GPs do not seem to have maintained these competences in the long-term. Further studies are needed to assess whether refresher training sessions are able to sustain acquired diagnostic and management skills.

In Brief: Validity of Case Summaries in Written Examinations of Clinical Reasoning.

Construct: The purpose of this study was to provide initial evidence of the validity of written case summaries as assessments of clinical problem representation in a classroom setting. BACKGROUND: To solve clinical problems, clinicians must gain a clear representation of the issues. In the clinical setting, oral case presentations-or summaries-are used to assess learners' ability to gather, synthesize, and "translate" pertinent case information. This ability can be assessed in Objective Structured Clinical Examination and Virtual Patient settings using oral or written case summaries. Evidence of their validity in these settings includes adequate interrater agreement and moderate correlation with other assessments of clinical reasoning. We examined the use of written case summaries in a classroom setting as part of an examination designed to assess clinical reasoning. APPROACH: We developed and implemented written examinations for 2 preclerkship general practice courses in Years 4 and 5 of a 7-year curriculum. Examinations included 8 case summary questions in Year 4 and 5 in Year 5. Seven hundred students participated. Cases were scored using 3 criteria: extraction of pertinent findings, semantic quality, and global ratings. We examined the item parameters (using classical test theory) and generalizability of case summary items. We computed correlations between case summary scores and scores on other questions within the examination. RESULTS: Item parameters were acceptable (average item difficulty = 0.49-0.73 and 0.59-0.68 in Years 4 and 5; average point-biserials = 0.21-0.24 and 0.18-0.21). Scores were moderately generalizable (G coefficients = 0.40-0.50), with case-specificity a substantial source of measurement error (10.2%-19.5% of variance). Scoring and rater had small effects. Correlations with related constructs were low to moderate. CONCLUSIONS: There is good evidence regarding the scoring and generalizability of written case summaries for assessment of clinical problem representation. Further evidence regarding the extrapolation and implications of these assessments is warranted.

Perceptions of medical advisers on ICF core-sets' use for evaluating work incapacity related to back pain in French-speaking Belgium.

BACKGROUND: There is willingness in Europe to implement the use of a biopsychosocial model such as the International Classification of Functioning, Disability and Health (ICF) for assessing work incapacity. OBJECTIVE: A preliminary study was conducted to investigate the perceptions of medical advisers on the value of structuring clients' biopsychosocial information in an ICF-based report. METHOD: A sample (n = 101) received a perception questionnaire after watching two comparative videos based on a clinical case. Questions relating to work incapacity were also asked. The data was analysed using quantitative methods. Comments were also collected. RESULTS: Before knowing the ICF-based report, 61.96% of the respondents believed a return to work seems possible by providing adapted work or a different job. There is an increase of 8.69 pp (p-value: 0.077) after reading the report. Opening up the initial sample to more insurance physicians (n = 119), the difference is more significant (p-value: 0.012). Also, 71.9% of respondents believe they have a better view of the client's biopsychosocial situation after reading the report. Respondents recognise the clinical and diagnostic relevance of ICF but say it cannot be used at the moment for various reasons, such as the time required or the need for a multidisciplinary team and effective coordination. Older respondents are less enthusiastic about the appropriateness of using ICF. CONCLUSION: The respondents identify an added value in having a biopsychosocial based-report. After learning about the report, more physicians see opportunities for professional re-integration than before. The medical advisers and their team must be strengthened and receive a clear role in order to empower them.

The perception of the clinical relevance of the MDS-Home Care(C) tool by trainers in general practice in Belgium.

BACKGROUND: comprehensive geriatric assessment has been advocated as an effective way to first identify multidimensional needs and second to establish priorities for organizing an individual health care plan for community-dwelling elderly. This paper reports on the perception of an internationally evaluated assessment system for use in community care programmes, the Minimal Data Set-Home Care (MDS-HC), by a group of experienced GP trainers. OBJECTIVE: the primary study aim was to determine the perception of a standardized home care assessment system (MDS-HC) by GP trainers in terms of acceptability, perceived clinical relevance, care planning empowerment and valorization of the GP. METHODS: sixty-five first-year GP trainees were educated about the MDS-HC and the use of a first version of an electronic interface. Each trainee included two elderly patients, based on strict inclusion criteria. Prior to the assessment, GP trainers and trainees were invited to complete together a basic medical record on the basis of their knowledge of the included patients. Next, the collected data, covering the multiple domains by MDS-HC, were introduced in the electronic interface by the trainee. Based on the collected data for each patient, a series of clinical assessment protocols (CAP's) were generated. Afterwards, these CAP's were critically discussed with the trainer. To investigate how the application of the MDS-HC was perceived, a 21 Likert-type item scale was drawn up based on four dimensions regarding the tool. RESULTS: the perception questionnaire had a good internal consistency (Cronbach's alpha 0.93). The first version of the electronic interface was considered not 'user-friendly' enough and the introduction of data time-consuming. The perception of the GP's about the overall clinical relevance of the MDS-HC was found to have little added value for the GP in the establishment of a personal management plan. CONCLUSIONS: many developments in health care result in an increasing demand for a standardized home care assessment system. In Belgium, the federal public health service advised to promote the MDS-HC for use in the community setting. In this study, it appears that its added value was not perceived by this sample of 37 experienced GP trainers as an empowering tool in term of management of the patient and valorization of the role of GP.

A novel assessment of an evidence-based practice course using an authentic assignment.

BACKGROUND: Evidence-based practice (EBP) is now a component of most medical curricula. Summative assessment instruments are often of debatable quality, do not cover the full spectrum of EBP or lack authenticity. AIM: To develop and evaluate the quality of an authentic assessment instrument for use in summative assessment of general practice trainees. METHODS: An assignment was designed based on the ask, acquire, appraise and apply steps of EBP. Content validity was evaluated by external EBP experts. Concurrent validity was tested with the Fresno test. Inter-rater agreement and internal consistency were measured. Acceptability and feasibility were also assessed. RESULTS: EBP experts agreed that the instrument had good content validity. Concurrent validity was good (disattenuated intraclass correlation coefficient 0.75). Inter-rater agreement varied from 0.70 to 0.83. Internal consistency was high (Cronbach's alpha 0.70-0.86). The procedure was feasible but only moderately acceptable to students. CONCLUSION: Our authentic assignment provided a valid, reliable and feasible procedure to assess our students. Acceptability was moderate, probably due to teething problems in instructions given and unfamiliarity with the format. Consequential validity data are lacking and would be of value. Our instrument could be an interesting alternative to other validated tests that may be less authentic.