Variation in Aptitude of Trainees in Endoscopic Ultrasonography, Based on Cumulative Sum Analysis

BACKGROUND & AIMS

Studies have reported substantial variation in the competency of advanced endoscopy trainees, indicating a need for more supervised training in endoscopic ultrasound (EUS). We used a standardized, validated, data collection tool to evaluate learning curves and measure competency in EUS among trainees at multiple centers.

METHODS

In a prospective study performed at 15 centers, 17 trainees with no prior EUS experience were evaluated by experienced attending endosonographers at the 25th and then every 10th upper EUS examination, over a 12-month training period. A standardized data collection form was used (using a 5-point scoring system) to grade the EUS examination. Cumulative sum analysis was applied to produce a learning curve for each trainee; it tracked the overall performance based on median scores at different stations and also at each station. Competency was defined by a median score of 1, with acceptable and unacceptable failure rates of 10% and 20%, respectively.

RESULTS

Twelve trainees were included in the final analysis. Each of the trainees performed 265 to 540 EUS examinations (total, 4257 examinations). There was a large amount of variation in their learning curves: 2 trainees crossed the threshold for acceptable performance (at cases 225 and 245), 2 trainees had a trend toward acceptable performance (after 289 and 355 cases) but required continued observation, and 8 trainees needed additional training and observation. Similar results were observed at individual stations.

CONCLUSIONS

A specific case load does not ensure competency in EUS; 225 cases should be considered the minimum caseload for training because we found that no trainee achieved competency before this point. Ongoing training should be provided for trainees until competency is confirmed using objective measures.

Training in Informatics: Teaching Informatics in Surgical Pathology

This article presents an overview of the curriculum deemed essential for trainees in pathology, with mapping to the Milestones competency statements. The means by which these competencies desired for pathology graduates, and ultimately practitioners, can best be achieved is discussed. The value of case (problem)-based learning in this realm, in particular the kind of integrative experience associated with hands-on projects, to both cement knowledge gained in the lecture hall or online and to expand competency is emphasized.

Advanced life support (ALS) instructors experience of ALS education in Western Australia: a qualitative exploratory research study

BACKGROUND

When cardiac arrest occurs, timely competent advanced life support (ALS) interventions by nursing staff can influence patient outcomes. Ongoing ALS education influences maintenance of competency and avoids skill decay.

OBJECTIVES

To explore the methods of ALS education delivery for nurses in the workplace; describe the issues relating to maintaining ALS competency; explore ALS competency decay for nurses and develop recommendations for the provision of continuing ALS education.

DESIGN

A qualitative exploratory design was used to study ALS education provision in the workplace.

PARTICIPANTS

Data were collected from ALS nurse experts in Western Australia by face-to-face and phone interviews.

METHODS

Semi-structured interviews were conducted and organised around a set of predetermined questions.

RESULTS

Two major themes were identified; the first theme Demand and Supply describes the increasing demand for ALS education for nurses and the challenges with providing timely cost effective traditional face-to-face ALS education. The second theme, Choosing The Best Education Options describes new ways to provide ALS education using emerging technologies.

CONCLUSIONS

The study suggested that using e-learning methods would assist with educating the maximum amount of nurses in a timely manner and e-learning and teleconferencing offer opportunities to reach nurses in distant locations. Delivering ALS education more frequently than annually would increase skills maintenance and lessen skill decay. Further research is required to explore which blended e-learning model is best suited to ALS education.

Advancing the competency of infection preventionists

The Association of Professionals in Infection Control and Epidemiology (APIC) has identified advancing infection prevention competency as a core goal in their Strategic Plan 2020. To achieve this goal, APIC has published a self-assessment tool to help infection preventionists identify where they are on a predefined scale. This project trialed APIC's self-assessment tool along with an internally developed objective assessment. The objective was to determine if the tools help identify areas for improvement to advance overall group competency at BJC HealthCare, a large Midwestern health care system with nearly 30 infection preventionists.

The APGAR rubric for scoring online discussion boards

The World Health Organization has called for a dramatic increase in the number of midwives and supports the use of innovative programs to assist students in achieving midwifery competencies. Online discussion boards are excellent educational tools for stimulating in-depth student engagement. However, complex discussions can be difficult to grade without a well-constructed rubric. The 'discussion-board APGAR' provides clear scoring criteria for discussions of midwifery care. The discussion-board APGAR has 5 components: Application, Professionalism, Group work, Analysis, and Rationale and provides scoring criteria for unacceptable, marginal, and proficient performance. The discussion-board APGAR is based on the Core Competencies for Basic Midwifery Practice in the United States (US), consistent with the International Confederation of Midwives Essential Competencies for Basic Midwifery Practice, and can be adjusted to be congruent with other midwifery standards.

The impact of defendant ethnicity on the psycholegal opinions of forensic mental health evaluators

The impact of ethnicity on clinicians' decision making has received a great deal of attention and research. Several studies have documented that client ethnicity significantly influences diagnoses, testing and assessment protocols, recommendations for treatment, and expected outcomes. However, there is limited research examining the impact of a criminal defendant's ethnicity upon forensic mental health experts. To examine this issue, the authors reviewed 816 forensic reports on competency to stand trial submitted to the Hawaii judiciary between 2007 and 2008 and compared recommendation rates across categories of defendant ethnicity. Significant differences between ethnic groups were found in recommendations of competency to stand trial. Specifically, Asian misdemeanant populations were found to be incompetent to stand trial at higher rates than other ethnic groups. These findings highlight the potential impact that ethnicity may have on clinicians' decision making in certain forensic settings.

Academic training and clinical placement problems to achieve nursing competency

INTRODUCTION

High quality of care is one of the requirements of nursing which depends on the nursing competency. In this connection, the aim of this research was to determine the problems related to the academic training (nursing' educational program) and clinical practice to achieve competency from the viewpoint of nurses, faculty members, and nursing students.

METHODS

the study was an analytical cross-sectional one. The sample consisted of the academic staff, the third and the fourth year nursing students and nurses in practice. The instrument of the study was a two-part researcher-made questionnaire with 22 questions in the theoretical- clinical realm to assess  problems related to the theoretical and clinical teaching in nursing, and 23 questions to assess the clinical functions. The questionnaire was validated in terms of both face and content validity. Its reliability, using Cronbach's Alpha coefficient, was 0.72 in the theoretical-clinical and 0.73 in the clinical realm. Both descriptive and analytical statistics were used to analyze the data, using SPSS software.

RESULTS

The results of this study indicated that from the participants' viewpoints, the most important problems in the academic education for nursea to acquire competency were as follows: lack of academic research the clinical period (88.9%), no application of theoretical aspects of the nursing process in practice (85.6%), insufficient knowledgeable and professional educators (81.1%), the use of traditional routine-oriented methods on the wards (75.6%); also insufficient time for performance based on knowledge in relation to  the nurse's workload (86.5%), weakness and usefulness of scientific function encouragement systems in clinic (85.2%), and learnt theoretical subjects not coming into practice in clinical fields after graduation (75.6%).

CONCLUSION

Efforts to reduce the gap between the theoretical and practical (clinical function) knowledge in educational and work environment are required to improve the training of qualified nurses.

Food allergy competencies of dietitians in the United Kingdom, Australia and United States of America

BACKGROUND

A knowledgeable and competent dietitian is an integral part of the food allergy multidisciplinary team, contributing to effective diagnosis and management of food allergic disorders. Little is currently known about the food allergy training needs and preferences of dietitians. The purpose of this paper is to measure and compare self-reported food allergy competencies of dietitians based in the UK, Australia and USA.

METHODS

A survey of USA-based paediatric dietitians was developed to measure self-reported proficiency and educational needs in the area of food allergy. The survey was modified slightly and circulated online to paediatric and adult dietitians in the UK and Australia. Descriptive statistics and Pearson correlations are presented.

RESULTS

A total of 797 dietitians completed the questionnaire. Competency in "developing food challenge protocols" and "managing feeding problems" were rated the poorest overall across all three settings. A higher level of competency was significantly positively associated with length of practice as a dietitian, percentage of caseload composed of patients with food allergy and training in food allergy. The most popular topics for further training were food additives, pharmacological reactions and oral allergy syndrome.

CONCLUSIONS

There is a need amongst dietitians to increase their knowledge in different aspects of food allergy diagnosis and management, specifically the areas of developing food challenge protocols and management of feeding problems. This study provides valuable information for designing targeted food allergy education for dietitians.

CTAB-mediated, single-step preparation of competent Escherichia coli, Bifidobacterium sp. and Kluyveromyces lactis cells

An efficient and reproducible method for transformation depends on the competency of the organism. We have developed a simple method for the preparation of competent Escherichia coli, Kluyveromyces lactis, and Bifidobacterium sp. by using a buffer containing cetyl trimethyl ammonium bromide (CTAB) and permits efficient uptake of plasmid DNA and ligation-reaction products. Cells are harvested, washed, mixed with 1–10 μg/ml CTAB, incubated, and followed by a buffer wash. For long-term storage of competent cells, bacteria may be frozen in 10% glycerol without the addition of other components. The transformation process is very simple; plasmid DNA and the cells are mixed and incubated for 5–60 min at 4 °C; no heat pulse is required, and the duration of incubation at 4 °C is not crucial.

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We developed a simple and rapid procedure for the preparation of competent E. coli, Bifidobacterium sp., and K. lactis.

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CTAB permits efficient uptake of plasmid, as well as ligation reaction products.

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The equal transformation efficiencies were observed with cells harvested at late exponential and stationary phases.

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CTAB treated cells are used for transformation by heat shock, electroporation, etc.

Sustaining hope as a moral competency in the context of aggressive care

BACKGROUND

Nurses who provide aggressive care often experience the ethical challenge of needing to preserve the hope of seriously ill patients and their families without providing false hope.

RESEARCH OBJECTIVES

The purpose of this inquiry was to explore nurses' moral competence related to fostering hope in patients and their families within the context of aggressive technological care. A secondary purpose was to understand how this competence is shaped by the social-moral space of nurses' work in order to capture how competencies may reflect an adaptation to a less than ideal work environment.

RESEARCH DESIGN

A critical qualitative approach was used.

PARTICIPANTS

Fifteen graduate nursing students from various practice areas participated.

ETHICAL CONSIDERATIONS

After receiving ethics approval from the university, signed informed consent was obtained from participants before they were interviewed.

FINDINGS

One overarching theme 'Mediating the tension between providing false hope and destroying hope within biomedicine' along with three subthemes, including 'Reimagining hopeful possibilities', 'Exercising caution within the social-moral space of nursing' and 'Maintaining nurses' own hope', was identified, which represents specific aspects of this moral competency.

DISCUSSION

This competency represents a complex, nuanced and multi-layered set of skills in which nurses must be well attuned to the needs and emotions of their patients and families, have the foresight to imagine possible future hopes, be able to acknowledge death, have advanced interpersonal skills, maintain their own hope and ideally have the capacity to challenge those around them when the provision of aggressive care is a form of providing false hope.

CONCLUSION

The articulation of moral competencies may support the development of nursing ethics curricula to prepare future nurses in a way that is sensitive to the characteristics of actual practice settings.

Strong performance on the Progressive Evaluation of Competency fellowship final examination predicts American Board of Pathology Certification

INTRODUCTION

The Progressive Evaluation of Competency (PEC) program was developed to help cytopathology fellowship directors evaluate the progress of fellows before program completion. There are no data on how PEC examination results compare with American Board of Pathology (ABP) certification status.

MATERIALS AND METHODS

PEC final examination results from the 2011/2012 academic year were compared with performance on the ABP cytopathology examination. The total and section PEC scores were compared with ABP scaled written and practical scores, and individuals who failed the certification examination were analyzed in detail.

RESULTS

Of the 103 fellows who took the final PEC examination in spring of 2012, 88 took the ABP examination, and 79 became certified. The total and the fine-needle aspiration scores on the PEC exam were positively and significantly correlated with performance on both ABP exam sections. Every fellow who scored in the upper one-third on the PEC exam became certified. The failing candidates scored significantly lower in both total scores and the fine-needle aspiration section of the PEC exam.

CONCLUSIONS

The PEC final examination performance is positively correlated with ABP certification status, and fellows who score in the top one-third of the PEC examination become certified. These findings can help provide guidance to both fellowship directors and fellows on competency and readiness for board certification.

Improving the scalability of psychological treatments in developing countries: an evaluation of peer-led therapy quality assessment in Goa, India

Psychological treatments delivered by lay therapists, with little or no previous mental health training, have been shown to be effective in treating a range of mental health problems. In low resource settings, the dearth of available experts to assess therapy quality potentially leads to a bottleneck in scaling up lay therapist delivered psychological treatments. Peer-led supervision and the assessment of therapy quality may be one solution to address this barrier. The purpose of this study was two-fold: 1) to assess lay therapist quality ratings compared to expert supervisors in a multisite study where lay therapists delivered two locally developed, psychological treatments for harmful and dependent drinking and severe depression; 2) assess the acceptability and feasibility of peer-led supervision compared to expert-led supervision. We developed two scales, one for each treatment, to compare lay therapist and expert ratings on audio-taped treatment sessions (n = 189). Our findings confirmed our primary hypothesis of increased levels of agreement between peer and expert ratings over three consecutive time periods as demonstrated by a decrease in the differences in mean therapy quality rating scores. This study highlights that lay therapists can be trained to effectively assess each other's therapy sessions as well as experts, and that peer-led supervision is acceptable for lay therapists, thus, enhancing the scalability of psychological treatments in low-resource settings.

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Peer lay therapists can assess therapy quality as well as experts.

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Peer-led supervision is preferred to expert-led supervision by lay counsellors.

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Scalability of psychological treatments in low-resource settings can be enhanced by using peer-led supervision.

Prevention of meticillin-resistant Staphylococcus aureus bloodstream infections in European hospitals: moving beyond policies

BACKGROUND

There is evidence that meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia can be reduced with improved infection control and antibiotic stewardship.

AIM

To survey infection control and antibiotic stewardship practices within European hospitals and to identify initiatives that correlate with reduced MRSA prevalence.

METHODS

Online questionnaires were sent to European hospitals about their surveillance, hand hygiene, intravenous device management, admission screening, isolation, antibiotic prescribing, hospital demographics and MRSA blood culture isolates during 2010.

FINDINGS

In all, 269 replies were received from hospitals in 29 European countries. Lower MRSA prevalence showed significant association with presence of incidence surveillance, performance of root cause analysis, mandatory training requirements for hand hygiene, accountability measures for persistent non-compliance, and multi-stakeholder teamwork in antibiotic prescribing. Presence of policies on intravenous catheter insertion and management showed no variation between different MRSA prevalence groups. However, low-prevalence hospitals reported more competency assessment programmes in insertion and maintenance of peripheral and central venous catheters. Hospitals from the UK and Ireland reported the highest uptake of infection control and antibiotic stewardship practices that were significantly associated with low MRSA prevalence, whereas Southern European hospitals exhibited the lowest. In multiple regression analysis, isolation of high-risk patients, performance of root cause analysis, obligatory training for nurses in hand hygiene, and undertaking joint ward rounds including microbiologists and infectious disease physicians remained significantly associated with lower MRSA prevalence.

CONCLUSION

Proactive infection control and antibiotic stewardship initiatives that instilled accountability, ownership, teamwork, and validated competence among healthcare workers were associated with improved MRSA outcomes.

Communicative Competence for Individuals who require Augmentative and Alternative Communication: A New Definition for a New Era of Communication?

In 1989, Light defined communicative competence for individuals with complex communication needs who require augmentative and alternative communication (AAC) as a dynamic interpersonal construct based on functionality of communication; adequacy of communication; and sufficiency of knowledge, judgment, and skills. Specifically, Light argued that, in order to demonstrate communicative competence, individuals who required AAC had to develop and integrate knowledge, judgment, and skills in four interrelated domains: linguistic, operational, social, and strategic. In 2003, Light expanded this definition and argued that the attainment of communicative competence is influenced by not just linguistic, operational, social, and strategic competencies but also a variety of psychosocial factors (e.g., motivation, attitude, confidence, resilience) as well as barriers and supports in the environment. In the 25 years since this definition of communicative competence for individuals who use AAC was originally proposed, there have been significant changes in the AAC field. In this paper, we review the preliminary definition of communicative competence, consider the changes in the field, and then revisit the proposed definition to determine if it is still relevant and valid for this new era of communication.

"Portfolios" as a method of assessment in medical education

Portfolios are increasingly used in postgraduate medical education and in gastroenterology training as an assessment tool, as documentation of competence, a database of procedure experience (for example endoscopy experience) and for revalidation purposes. In this paper the educational theory behind their use is described and the evidence for their use is discussed.

The Papua New Guinea medical supply system - documenting opportunities and challenges to meet the Millennium Development Goals

Objectives

Limited human resources are widely recognised as an impediment to achieving the health-related Millennium Development Goals in Pacific Island Countries, with the availability of medical supplies and suitably trained health personnel crucial to ensuring a well-functioning medical supply chain. This paper presents our findings as we seek to answer the research question ‘What factors influence the availability of medical supplies within the health facilities of Papua New Guinea?’

Methods

We used a qualitative, triangulated strategy using semi-structured interviews, workplace observation and semi-structured focus groups. The parallel use of the interview tool and workplace observation tool allowed identification of ‘know-do’ gaps between what the interviewee said they did in their work practices, and the actual evidence of these practices. Focus groups provided further opportunities for raising and elaborating issues.

Results

During 2 weeks of data collection we conducted 17 interviews and 15 observational workplace surveys in 15 facilities. Sixteen health personnel participated in 3 focus groups across 2 provinces and one district. An array of medical supply issues across all levels of the medical supply chain were revealed, including standard operating procedures, facilities, transport, emergency medical kits, the cold chain and record keeping. The influence of health worker training and competency was found to be common across all of these issues.

Conclusion

The factors influencing the availability of medical supplies in PNG consist of a range of interrelating issues, consisting of both simple and complex problems involving the different levels and cadres of workers within the medical supply chain. Health systems sustainability theory suggests that a coordinated approach which addresses the inter-related nature of these issues, led by the PNG government and supported by suitable development partners, will be required for sustainable health systems change to occur. These changes are necessary for PNG to meet the health-related Millennium Development Goals.

Simulation as a methodology for assessing the performance of healthcare professionals working in the delivery room

Formal evaluation of healthcare professionals has been accomplished primarily through assessment of the ability to recall content knowledge despite the fact that cognitive, technical and behavioral skills are all important aspects of human performance in this domain. In addition human performance is also influenced by elements that are extrinsic to the human being including the systems and subsystems with which they must interact. Rigorous assessment of human and system performance in the actual healthcare environment is extremely challenging for a number of reasons. Simulation provides a methodology by which this performance can be objectively assessed, thereby facilitating the delivery of effective, safe and efficient patient care.

The development and implementation of a hospital based paediatric orthopaedic nursing transition program

Within Australia and the rest of the world paediatric orthopaedic nursing as a subspeciality nursing workforce faces challenges due to a lack of formal education programs that support the development of knowledge. Despite these challenges the need to ensure the availability of competent and knowledgeable nursing staff to positively contribute to health care outcomes remains unchanged. Thus a need has arisen to develop locally implemented education programs. A multi-tiered paediatric orthopaedic nursing transition program which incorporates work based learning processes combined, with formal assessment components, has been designed utilising Benner's "theory of novice to expert" to facilitate the growth of experts in the clinical setting driven by the requirements of individual clinical settings. The implementation of this program has led to increased confidence in the clinical setting for nursing staff which has positively influenced the care of children and their families in the orthopaedic service.

Informed consent in adult psychiatry

This article addresses some of the groundwork of informed consent in people with mental illness whose decision-making capacity has obviously been compromised. This article examines four crucial aspects in particular, namely: i) the main elements of informed consent; ii) difficulties pertaining to psychiatric illnesses; iii) the effect of psychiatric disorders on the patient's capability; iv) how to assess situations in which consents may not be required.

Dental Curriculum Revision in Iran: Dentists' Perspective on Achievement of Essential Competencies through National Curriculum

BACKGROUND

Based on the current emphasis on competency-based education, as a part of need assessment phase of dental curriculum revision in Iran, in the present study the dental graduates' perspective concerning the minimum competency requirements for an Iranian general dentist has been investigated.

METHODS

Based on the three available major competency documents in the literature a questionnaire was developed in which the participants were asked to indicate their opinion about the necessity of each of the 142 stated competencies for an Iranian general dentist (Yes/No), and to state the degree to which they believed the current curriculum covers each competency (Completely, Partially, Not at all). In an annual meeting in June 2008, the provincial chief dental managers were asked to distribute the questionnaires among general dentists in their province (10 questionnaires in each province). The managers posted back the completed questionnaires to the researchers.

RESULTS

Of 300 questionnaires distributed in the 30 provinces of the country, 250 questionnaires (83%) were returned. While most of the participants considered the competencies as necessary for an Iranian dentist, less than 40% of the respondents believed that the graduates acquire the most required competencies of the profession during the current educational program.

CONCLUSION

A necessity exists for curriculum revision. In addition to clinical skills, in this revision more emphasis also should be placed on the non-clinical part of the curriculum.

Physician's acquittal of responsibility in Iranian statutes

The physician's acquittal has obsessed Iranian legislator's mind to a large extent. This is exclusively observed in Iranian statuses and specifically in Shi'ite school of though. Muslim jurists' opinions play a very important role in enacting legal articles related to it. After reviewing the literature, the authors tried to pick and collect common features of physician's responsibilities and duties to introduce Iranian Acts with respect to the subject. Also, Iranian Acts are analyzed and the challenging medical topics such as emergency situations and infectious diseases are discussed.Iranian legislator didn't specify a kind of physician's acquittal which received from the patient knowingly and is based on his/her free will. There are also some medical and legal gaps. Patients are not often informed of all exact and scientific information and results of their treatments. Furthermore, the forms prepared to receive the patient's consent do not provide what Iranian legislator meant.

Effects on Nursing Students of Cognition-Behavior Integrated Breast Cancer Prevention Education Using an Interchangeable Nodule Model

PURPOSE

The study was done to examine the effects of cognition-behavior integrated breast cancer prevention education, in which a breast model with interchangeable nodules was utilized, on the self-competency of nursing students in performing breast cancer education.

METHODS

A nonequivalent control group non-synchronized design was used. A traditional lecture intervention was provided for 49 3rd year college of nursing students (control group) while the integrated breast cancer prevention education was given to 47 3rd year students in the same college one year later (experimental group). The integrated breast cancer prevention education was developed by the research team to strengthen the competency of cognitive and behavioral components in education on breast cancer.

RESULTS

Effects of the intervention were found to be significant through all study variables: knowledge about breast cancer (t=7.79, p <.001), breast cancer risk awareness (t=2.05, p <.05), self-competency of breast self-exam (t=8.27, p <.001), and intention to teach breast self-exam (t=3.87, p <.001).

CONCLUSION

The integrated breast cancer prevention education was useful to improve not only knowledge about breast cancer but competency in performing breast examination for nursing students who acquired technical skills from various simulation nodules. As the program helped the students to be prepared as confident educators, future application of the module is recommended for academic curricula.

The noncompliant patient in psychiatry: the case for and against covert/surreptitious medication

Nonadherence to treatment continues to be one of psychiatry's greatest challenges. To improve adherence and thus improve the care of patients, clinicians and patients' family members sometimes resort to hiding medication in food or drink, a practice referred to as covert/ surreptitious medication. The practice of covert drug administration in food and beverages is well known in the treatment of psychiatrically ill world-wide but no prevalence rates exist. Covert medication may seem like a minor matter, but it touches on legal and ethical issues of a patient's competence, autonomy, and insight. Medicating patients without their knowledge is not justifiable solely as a shortcut for institutions or families wishing to calm a troublesome patient and thus alleviate some of the burdens of care giving. The paramount principle is ensuring the well-being of a patient who lacks the competence to give informed consent. Ethically, covert/surreptitious administration can be seen as a breach of trust by the doctor or by family members who administer the drugs. Covert medication contravenes contemporary ethical practice. Legally, treatment without consent is permissible only where common law or statute provides such authority. The practice of covert administration of medication is not specifically covered in the mental health legislation in developing countries. Many of the current dilemmas in this area have come to public attention because of two important developments in medical ethics and the law - the increasing importance accorded to respect for autonomy and loss of the parens patriae jurisdiction of the courts [parens patriae means 'parent of the country'; it permitted a court to consent or refuse treatment on behalf of an 'incapacity', or alternatively to appoint a guardian with such powers].

A Model for Developing ACGME Competencies in an Academic Anesthesiology Department

In response to the American College of Graduate Medical Education's Outcomes Project and its mandate for a transition to a competency based curriculum, the Department of Anesthesiology at the Penn State Milton S. Hershey Medical Center executed a focused 18 month program which engaged the entire faculty and effected not only curricular, but cultural change in how anesthesiology residents are taught and evaluated. This article describes the process through which the department leadership educated, engaged, and focused the department's efforts and created an environment that sustained progress and provided incentives for performance. This process also resulted in the development of a novel web based evaluation tool tailored to meet the challenge of evaluating performance in the context of a competency based curriculum. This model, which proved effective for transition to a competency based curriculum, is one which can be applied to any large scale departmental education initiative.

Psychiatric evaluation of competency in cancer patients

This study was conducted to investigate the profile of patients referred for psychiatric evaluation of competency among patients with cancer. Among the 1721 referred cancer patients, 43 (2.5%) were referred for competency evaluation. The most common reason for competency evaluation was refusal of test or treatment, and the common psychiatric diagnoses were adjustment disorders, delirium and personality disorders. Cancer patients with personality disorders were more likely to be evaluated as competent, while patients with delirium and dementia were often incompetent; those with adjustment disorders, major depression and psychotic illness could be either competent or incompetent. While these findings were almost consistent with those reported from previous studies, some results may be unique to cancer patients.