Evaluations of competence to stand trial are evolving amid a national "competency crisis".

Across the United States, court orders for competence to stand trial (CST) evaluations and competence restoration services have been increasing much more rapidly than states can provide these services, prompting what has been called a national "competency crisis." The challenge in providing timely competence restoration services has, in several jurisdictions, prompted a change in competence evaluations. Evaluators are more often required to address broader clinical issues-such as recommending placement or addressing the urgency of hospitalization-rather than addressing only CST. This marks an evolving practice in forensic evaluation, which moves evaluators beyond the very narrow forensic question of competence and into more traditionally clinical recommendations. We describe several state examples of changing practice in order to highlight the initial barriers, and potential benefits, to addressing additional clinical issues in competence evaluations, amid a national competence crisis.

Evaluating competency in video-assisted thoracoscopic surgery (VATS) lobectomy performance using a novel assessment tool and virtual reality simulation.

BACKGROUND: Competency-based training has gained ground in surgical training and with it assessment tools to ensure that training objectives are met. Very few assessment tools are available for evaluating performance in thoracoscopic procedures. Video recordings would provide the possibility of blinded assessment and limited rater bias. This study aimed to provide validity evidence for a newly developed and dedicated tool for assessing competency in Video-Assisted Thoracoscopic Surgery (VATS) lobectomy. METHODS: Participants with varying experience with VATS lobectomy were included from different countries. Video recordings from participants' performance of a VATS right upper lobe lobectomy on a virtual reality simulator were rated by three raters using a modified version of a newly developed VATS lobectomy assessment tool (the VATSAT) and analyzed in relation to the unitary framework (content, response process, internal structure, relation to other variables, and consequences of testing). RESULTS: Fifty-three participants performed two consecutive simulated VATS lobectomies on the virtual reality simulator, leaving a total of 106 videos. Content established in previously published studies. Response process Standardized data collection was ensured by using an instructional element, uniform data collection, a special rating program, and automatic generation of the results to a database. Raters were carefully instructed in using the VATSAT, and tryout ratings were carried out. Internal structure Inter-rater reliability was calculated as intra-class correlation coefficients, to 0.91 for average measures (p < 0.001). Test/re-test reliability was calculated as Pearson's r of 0.70 (p < 0.001). G-coefficient was calculated to be 0.79 with two procedures and three raters. By performing D-theory was found that either three procedures rated by two raters or five procedures rated by one rater were enough to reach an acceptable G-coefficient of ≥ 0.8. Relation to other variables Significant differences between groups were found (p < 0.001). The participants' VATS lobectomy experience correlated significantly to their VATSAT score (p = 0.016). Consequences of testing The pass/fail score was found to be 14.9 points by the contrasting groups' method, leaving five false positive (29%) and six false negatives (43%). CONCLUSION: Validity evidence was provided for the VATSAT according to the unitary framework. The VATSAT provides supervisors and assessors with a procedure-specific assessment tool for evaluating VATS lobectomy performance and aids with the decision of when the trainee is ready for unsupervised performance.

Profiles of juveniles with sex offense charges referred for competence evaluations.

Juveniles referred for adjudicative competence evaluations make up a subset of youth involved in the juvenile justice system. Among those referred for adjudicative competence evaluations, a significant number involve youth with current or past charges for sexual offenses. This study examines the profiles of youth with sexual offense charges who have been referred for competence evaluations at a state psychiatric hospital for children and adolescents. Differences between the characteristics of youth with and without sexual offenses were explored, and predictors of competence opinions were examined among the subset of youth with current or prior sexual charges (juveniles with sexual offenses, or JSOs). Findings indicated that youth with sexual offenses have several demographic, cognitive, clinical, and legal differences from youth without sexual offenses. Although youth with sexual offenses were less likely to be opined competent, presence of a sexual offense was not a predictor of competence opinions after controlling for other factors. Predictors of competence among JSOs were found to be similar to those among youth referred for competence evaluations in general. Primary diagnosis of an autism-related disorder was a unique predictor of being opined not competent among the JSO subgroup, but not the overall sample. Implications for practice, policy, and research are discussed.

Teaching parasitology in a modular veterinary curriculum - The Vienna experience.

In a changing world with rapidly evolving new technologies, even in the "sheltered world" of teachers and lecturers at universities, we are challenged by new developments. As diversification is increasing in many aspects of our professional life, there is also a need to employ new ways of teaching, learning and assessments in veterinary curricula, taking into account the increasing numbers of students and limited teaching resources. The "classical" Austrian veterinary curriculum, with a series of consecutive lectures followed by practical courses in the different disciplines, separated from each other in the curricular time table and by annual examinations, has been a long-standing concept for teaching in the past. However, when veterinary practitioners and graduates where asked to judge the adequacy of undergraduate training for their professional skills and knowledge, several major shortcomings were revealed. The most commonly mentioned point was a lack of first-day competencies. As a consequence, the Vetmeduni Vienna developed a new veterinary curriculum implemented in 2014-2015. This curriculum covers 12 semesters and includes a "Diploma" (degree) thesis and several externships; graduates are eligible to practice in all branches of veterinary medicine. We abandoned the classical discipline-based teaching, established a modular, mostly organ-based system, and focus on student-centred and competency-based learning and teaching with defined learning outcomes and first-day skills. We also include training of scientific, managerial and communication skills in the curriculum. What does this mean for parasitology? We do not teach this subject in a closed lecture, but rather in a modular style, starting in the first year with the taxonomy and basic morphology of the animal kingdom, proceeding to parasite biology of the major groups in the second year, to the diagnostic and clinical training in practicals in the third year as well as joint lectures, seminars and conversatories in the organ- and species-based clinical training in years 3-6. Examinations are organised in different test formats, aligned to a list of skills and diseases. Quality assurance is a formal process and implemented at different levels. The ultimate aim of undergraduate teaching is to provide students with defined professional competencies and promoting life-long learning.

Path on the management of surgical graded and refined management based on information technology / 中华医院管理杂志

The authors attempted to use information technology in hierarchical management on clinician′s surgical authority. By means of a hierarchical surgery catalogue database, clinicians′ surgical authority is subject to by-level IT-based approval, and such authorities as clinician′s surgical medical advice, application for surgery, and approval of special surgeries are regulated. Thanks to multi-dimensional objective data, clinicians′surgical competence is subject to a dynamic evaluation, hierarchical authorization and reauthorization. These measures further standardize the behavior of the surgeons, and rule out unauthorized operations, thus improving fine management of surgeries and ensuring patient safety.

An empirical study on the criterion-related validity of the National Medical Licensing Exami-nation / 中华医学教育探索杂志

Objective The empirical validity of the National Medical Licensing Examination (NMLE) has rarely been studied. This is one of the first studies comparing NMLE and annual assess-ment scores. This study provided the criterion-related validity evidence for the NMLE. The NMLE can be used to test the abilities and skills of physicians. Method We evaluated the test 163 residents in 12 medical school-affiliated hospitals who had finished their first year of tralning and had taken the NMLE and an annual skills assessment. We used Pearson correlations to estimate the relationship be-tween NMLE scores and annual assessment scores. Results A total of 163 residents met inclusion requirements. Correlations between NMLE scores and annual assessment scores ranged from 0.300 to 0.843. Conclusions The criterion-related validity of NMLE was high, so it can be use to evaluate the residents clinical competence indeed.

Evaluación de la calidad del diagnóstico de la malaria por microscopía óptica en laboratorios provinciales de la República de Angola / Evaluation of the quality of malaria diagnosis by optical microscopy in provincial laboratories of the Republic of Angola

INTRODUCCIÓN: la malaria continúa siendo uno de los más importantes problemas de la salud pública a nivel mundial y afecta severamente al continente africano. OBJETIVO: evaluar el nivel de conocimientos teóricos y prácticos en el diagnóstico de la malaria de un grupo de técnicos dedicados a esta actividad. MÉTODOS: entre los años 2010 y 2012, se realizó un estudio cuasi experimental de evaluación en la red de salud, en 14 laboratorios provinciales de las 18 provincias de la República Angola, donde se entrenaron 243 técnicos que realizan habitualmente el diagnóstico de la malaria. Se hicieron entrenamientos de 10 días (70 horas) cumplimentando un programa que incluyó clases prácticas y teóricas, y sus respectivas evaluaciones inicial y final. RESULTADOS: después de los entrenamientos en cada una de las 14 provincias evaluadas la frecuencia de los técnicos desaprobados en la evaluaciones teóricas y prácticas disminuyó significativamente, (p<0,01). CONCLUSIONES: este es el primer trabajo realizado en Angola donde se demuestra una mejoría cualitativa y cuantitativa tanto en los conocimientos teóricos y habilidades prácticas de los técnicos después de un entrenamiento y readiestramiento, y constituye el primer paso de un esfuerzo encaminado para mejorar el diagnóstico de la malaria en el país(AU)

INTRODUCTION: malaria continues to be one of the main public health problems worldwide, severely affecting the African continent. OBJECTIVE: evaluate the level of theoretical and practical competence in the diagnosis of malaria achieved by a group of technicians engaged in this activity. METHODS: an evaluative quasi-experimental study was conducted from 2010 to 2012 in 14 provincial laboratories from the 18 provinces of the Republic of Angola, where 243 technicians received training in the field of malaria diagnosis. Training extended for 10 days (70 hours) based on a syllabus which included theoretical and practical lessons as well as an initial and a final evaluation. RESULTS: a post-training evaluation conducted in 14 provinces showed a significant decrease in the number of technicians failing their theoretical and practical tests (p<0.01). CONCLUSIONS: this is the first evaluation carried out in Angola in which qualitative and quantitative improvement is observed both in the theoretical knowledge and the practical skills of technicians after receiving training or retraining. It is also a first step in an effort to improve the quality of malaria diagnosis in the country(AU)

Construction of clinical thinking competence evaluation index system of undergraduate nursing students / 中国实用护理杂志

Objective To construct clinical thinking competence index system for undergraduate nursing students.Methods The study established the Clinical Thinking Competence Evaluation Index System through Delphi method.Results The evaluation index system included 5 level-1 dimensions and 28 level-2 Index connotations.Conclusions Through quantitative research methods,Clinical Thinking Competence evaluation index system is established for undergraduate nursing students,which provides an objective standard for cultivation and evaluation of undergraduate nursing students.