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Guest B, Donaldson-Perrott A, Hickman B, Louis C, Ritsema T, Roberts K. Increasing Knowledge in the Requesting of Clinical Investigations. J Physician Assist Educ 2023; 34:303-308. [PMID: 37698945 DOI: 10.1097/jpa.0000000000000546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
PURPOSE Overtesting, ordering diagnostic investigations that do not help diagnose or manage a patient, is well-recognized as a problem across multiple healthcare settings in developed countries. One of the reasons often cited for overtesting is a lack of confidence or knowledge, so this article addresses our attempt to reduce overtesting through an investigation-specific course for a physician associate (PA) program based in the United Kingdom. We found no evidence of pedagogical literature that focused on clinical diagnostics teaching and assessment for PAs, so we aim to be the first to provide this research. METHODS To assess student confidence, student feedback was collected through open-ended focus groups and qualitative surveys. The effectiveness of the course was evaluated through students' scores on investigation single best answer assessments. RESULTS Overall, qualitative feedback from students showed an increase in knowledge in accurate investigation requests and interpretation. Students' assessment scores show a marked improvement after the implementation of the course. CONCLUSION This approach to an investigation-specific course, with a focus on limiting overinvestigating, demonstrates improved student performance on investigation assessments at the university level.
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Affiliation(s)
- Brogan Guest
- Brogan Guest, PA-C, is a reader, St George's, University of London, London, United Kingdom
- Amy Donaldson-Perrott, PA-R, is a senior lecturer, St George's, University of London, London, United Kingdom
- Beck Hickman, PA-C/R, is a lecturer,St George's, University of London, London, United Kingdom
- Chandran Louis, PA-R, is a senior lecturer, St George's, University of London, London, United Kingdom
- Tamara Ritsema, PA-C, is an associate professor, George Washington School of Medicine and Health Sciences, Washington, DC
- Karen Roberts, PA-C/R, is a reader, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Amy Donaldson-Perrott
- Brogan Guest, PA-C, is a reader, St George's, University of London, London, United Kingdom
- Amy Donaldson-Perrott, PA-R, is a senior lecturer, St George's, University of London, London, United Kingdom
- Beck Hickman, PA-C/R, is a lecturer,St George's, University of London, London, United Kingdom
- Chandran Louis, PA-R, is a senior lecturer, St George's, University of London, London, United Kingdom
- Tamara Ritsema, PA-C, is an associate professor, George Washington School of Medicine and Health Sciences, Washington, DC
- Karen Roberts, PA-C/R, is a reader, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Beck Hickman
- Brogan Guest, PA-C, is a reader, St George's, University of London, London, United Kingdom
- Amy Donaldson-Perrott, PA-R, is a senior lecturer, St George's, University of London, London, United Kingdom
- Beck Hickman, PA-C/R, is a lecturer,St George's, University of London, London, United Kingdom
- Chandran Louis, PA-R, is a senior lecturer, St George's, University of London, London, United Kingdom
- Tamara Ritsema, PA-C, is an associate professor, George Washington School of Medicine and Health Sciences, Washington, DC
- Karen Roberts, PA-C/R, is a reader, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Chandran Louis
- Brogan Guest, PA-C, is a reader, St George's, University of London, London, United Kingdom
- Amy Donaldson-Perrott, PA-R, is a senior lecturer, St George's, University of London, London, United Kingdom
- Beck Hickman, PA-C/R, is a lecturer,St George's, University of London, London, United Kingdom
- Chandran Louis, PA-R, is a senior lecturer, St George's, University of London, London, United Kingdom
- Tamara Ritsema, PA-C, is an associate professor, George Washington School of Medicine and Health Sciences, Washington, DC
- Karen Roberts, PA-C/R, is a reader, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Tamara Ritsema
- Brogan Guest, PA-C, is a reader, St George's, University of London, London, United Kingdom
- Amy Donaldson-Perrott, PA-R, is a senior lecturer, St George's, University of London, London, United Kingdom
- Beck Hickman, PA-C/R, is a lecturer,St George's, University of London, London, United Kingdom
- Chandran Louis, PA-R, is a senior lecturer, St George's, University of London, London, United Kingdom
- Tamara Ritsema, PA-C, is an associate professor, George Washington School of Medicine and Health Sciences, Washington, DC
- Karen Roberts, PA-C/R, is a reader, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Karen Roberts
- Brogan Guest, PA-C, is a reader, St George's, University of London, London, United Kingdom
- Amy Donaldson-Perrott, PA-R, is a senior lecturer, St George's, University of London, London, United Kingdom
- Beck Hickman, PA-C/R, is a lecturer,St George's, University of London, London, United Kingdom
- Chandran Louis, PA-R, is a senior lecturer, St George's, University of London, London, United Kingdom
- Tamara Ritsema, PA-C, is an associate professor, George Washington School of Medicine and Health Sciences, Washington, DC
- Karen Roberts, PA-C/R, is a reader, Brighton and Sussex Medical School, Brighton, United Kingdom
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Edwards TC, Guest B, Garner A, Logishetty K, Liddle AD, Cobb JP. The metabolic equivalent of task score : a useful metric for comparing high-functioning hip arthroplasty patients. Bone Joint Res 2022; 11:317-326. [PMID: 35604337 PMCID: PMC9130675 DOI: 10.1302/2046-3758.115.bjr-2021-0445.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIMS This study investigates the use of the metabolic equivalent of task (MET) score in a young hip arthroplasty population, and its ability to capture additional benefit beyond the ceiling effect of conventional patient-reported outcome measures. METHODS From our electronic database of 751 hip arthroplasty procedures, 221 patients were included. Patients were excluded if they had revision surgery, an alternative hip procedure, or incomplete data either preoperatively or at one-year follow-up. Included patients had a mean age of 59.4 years (SD 11.3) and 54.3% were male, incorporating 117 primary total hip and 104 hip resurfacing arthroplasty operations. Oxford Hip Score (OHS), EuroQol five-dimension questionnaire (EQ-5D), and the MET were recorded preoperatively and at one-year follow-up. The distribution was examined reporting the presence of ceiling and floor effects. Validity was assessed correlating the MET with the other scores using Spearman's rank correlation coefficient and determining responsiveness. A subgroup of 93 patients scoring 48/48 on the OHS were analyzed by age, sex, BMI, and preoperative MET using the other metrics to determine if differences could be established despite scoring identically on the OHS. RESULTS Postoperatively the OHS and EQ-5D demonstrate considerable negatively skewed distributions with ceiling effects of 41.6% and 53.8%, respectively. The MET was normally distributed postoperatively with no relevant ceiling effect. Weak-to-moderate significant correlations were found between the MET and the other two metrics. In the 48/48 subgroup, no differences were found comparing groups with the EQ-5D, however significantly higher mean MET scores were demonstrated for patients aged < 60 years (12.7 (SD 4.7) vs 10.6 (SD 2.4), p = 0.008), male patients (12.5 (SD 4.5) vs 10.8 (SD 2.8), p = 0.024), and those with preoperative MET scores > 6 (12.6 (SD 4.2) vs 11.0 (SD 3.3), p = 0.040). CONCLUSION The MET is normally distributed in patients following hip arthroplasty, recording levels of activity which are undetectable using the OHS. Cite this article: Bone Joint Res 2022;11(5):317-326.
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Affiliation(s)
- Thomas C Edwards
- MSk Lab, Imperial College London, Sir Michael Uren Biomedical Engineering Research Hub, London, UK
| | - Brogan Guest
- MSk Lab, Imperial College London, Sir Michael Uren Biomedical Engineering Research Hub, London, UK
| | - Amy Garner
- MSk Lab, Imperial College London, Sir Michael Uren Biomedical Engineering Research Hub, London, UK
| | - Kartik Logishetty
- MSk Lab, Imperial College London, Sir Michael Uren Biomedical Engineering Research Hub, London, UK
| | - Alexander D Liddle
- MSk Lab, Imperial College London, Sir Michael Uren Biomedical Engineering Research Hub, London, UK
| | - Justin P Cobb
- MSk Lab, Imperial College London, Sir Michael Uren Biomedical Engineering Research Hub, London, UK
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