Assessing Competency: A Tale of Two Professions

Trunkey, Donald D.; Botney, Richard

doi:10.1016/s1072-7515(01)00770-0

Cited by 80 publications

(62 citation statements)

References 3 publications

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“…ways of expressing drug dosage), medication cabinets, trolleys or trays and the use of information technologies [31] could be explored. With regard to operators, methods for improving arithmetic skills could be tested [20], and professionals could be licensed and relicensed [32] to carry out specific tasks within the medication process. This would help implement the principle of equivalent operators, one of the pillars of safe systems as put forward by Amalberti et al [33].…”

Section: Discussionmentioning

confidence: 99%

Measuring human-error probabilities in drug preparation: a pilot simulation study

Garnerin

Pellet-Meier

Chopard

et al. 2007

Eur J Clin Pharmacol

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Objectives Designing a safe medication process requires the ability to model its reliability using methods such as probabilistic risk assessment (PRA). However, lack of data, especially on human-error probabilities (HEPs), limits its use. To assess whether small-scale simulations could help generate HEP data, a pilot study was conducted among nurses and anaesthetists. It focused on two core activities, namely, the manual preparation of medications and the arithmetic necessary to prepare drugs. Its specific objectives were to evaluate whether HEPs could be high enough to be measurable and to determine whether these HEPs could be sensitive to individuals and task details. These would give some insight into the level of detail required by PRA analysis. Methods Thirty nurse and 28 anaesthetist volunteers were involved in the experiment. Nurses and anaesthetists had to prepare medications for 20 patients and 22 syringes of various drugs, respectively. Both groups had to perform 22 calculations relating to the preparation of drugs. HEPs, distribution of HEPs and dependency of HEPs on individuals and task details were assessed. ResultsIn the preparation tasks, overall HEP was 3.0% for nurses and 6.5% for anaesthetists. In the arithmetic tasks, overall HEP was 23.8% for nurses and 8.9% for anaesthetists. A statistically significant difference was noted between the two groups. In both preparation and arithmetic tasks, HEPs were dependent on individual nurses but not on individual anaesthetists. In every instance, HEPs were dependent on task details. Conclusion Our study illustrates that small-scale simulations represent an interesting way of generating HEPs. HEPs are, indeed, in the range of 10 −2 and 10 −1 . But in most cases, HEPs depend heavily on operators and task details. This dependency means that the influence of these parameters must be determined before advanced PRA analysis. There is therefore an urgent need to develop experimental research into assessing this influence by means of randomised controlled trials.

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Section: Discussionmentioning

confidence: 99%

Measuring human-error probabilities in drug preparation: a pilot simulation study

Garnerin

Pellet-Meier

Chopard

et al. 2007

Eur J Clin Pharmacol

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“…First to go is strength, then eyesight, then dexterity, and finally cognition [10,18,19]. Knowledge, experience, and reputation can compensate for a long time.…”

Section: Only Wine and Cheese Improve With Agementioning

confidence: 99%

“…Trunkey and Botney [19] have developed a series of tests, together named the ''MicroCog,'' designed to detect ''impaired competence occurring late in a physician's career.'' The tests measure ''reactivity, attention, numeric recall, verbal memory, visiospatial facility, reasoning, and mental calculation'' [19].…”

Section: Cognitive Declinementioning

confidence: 99%

“…The tests measure ''reactivity, attention, numeric recall, verbal memory, visiospatial facility, reasoning, and mental calculation'' [19]. According to the overall MicroCog scores, at all ages, physicians (not necessarily surgeons) perform better than nonphysicians, but even physicians by age 75 lose 25% of their starting score.…”

Section: Cognitive Declinementioning

confidence: 99%

“…Trunkey and Botney [19] assert that the MicroCog has been validated, but they are no more than partly correct. The subtests of the MicroCog arguably should measure surgeon competency and skills.…”

Section: Cognitive Declinementioning

confidence: 99%

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The Problem of the Aging Surgeon: When Surgeon Age Becomes a Surgical Risk Factor

Blasier¹

2009

Clinical Orthopaedics &Amp; Related Research

101

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The question of when a surgeon should retire has been the subject of debate for decades. Both anecdotal evidence and objective testing of surgeons suggest age causes deterioration in physical and cognitive performance. Medical education, residency and fellowship training, and technology evolve at a rapid pace, and the older a surgeon is, the more likely it is he or she is remote from his or her initial education in his or her specialty. Research also shows surgeons are reluctant to plan for retirement. Although there is no federally mandated retirement age for surgeons in the United States, surgeons must realize their skills will decline, a properly planned retirement can be satisfying, and the retired surgeon has much to offer the medical and teaching community.

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The Aging Physician and the Medical Profession

2017

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As physicians age, a required cognitive evaluation combined with a confidential, anonymous feedback evaluation by peers and coworkers regarding wellness and competence would be beneficial both to physicians and their patients. While it is unlikely that this will become a national standard soon, individual health care organizations could develop policies similar to those present at a few US institutions. In addition, large professional organizations should identify a range of acceptable policies to address the aging physician while leaving institutions flexibility to customize the approach. Absent robust professional initiatives in this area, regulators and legislators may impose more draconian measures.

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Assessing Competency: A Tale of Two Professions

Cited by 80 publications

References 3 publications

Measuring human-error probabilities in drug preparation: a pilot simulation study

Measuring human-error probabilities in drug preparation: a pilot simulation study

The Problem of the Aging Surgeon: When Surgeon Age Becomes a Surgical Risk Factor

The Aging Physician and the Medical Profession

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