A comparison of objective and subjective measures of clinical competence

The purpose of this study was to determine if objective performance measures from a simulated patient practical examination were related to faculty subjective assessments of surgery students' performance. Another purpose was to determine if those students performing well on a simulated patient practical examination were the same students awarded honor ratings by faculty. Faculty ratings of students (n = 72) on history taking ability, physical exam skills, problem identification, use of investigations, problem integration, patient management, and patient relations skills were correlated with objective measures on these same criteria achieved on a practical exam employing three simulated patient cases. Correlations were also calculated to study the relationship between practical exam scores and honor rating recipients. Results indicated significant relationships between faculty subjective ratings and practical exam outcomes on all practical examination skills except physical exam skills and patient management skills. Findings also indicated the performance of honor students on the practical examination was significantly better than non-honor students on two skills: history-taking and patient relations. The implications of these research findings are discussed.     

As Good as it Gets? A Life Course Perspective on Marital Quality

Marital relationships, like individuals, follow a developmental trajectory over time with ups and downs and gains and losses. We work from a life course perspective and use growth curve analysis to look at trajectories of change in marital quality over time. Although the tendency is for marital quality to decline over time, some groups begin with much higher levels of marital quality than others. Moreover, a number of life course and contextual factors can accelerate or slow this path of change. Our findings point to the importance of considering the multi-dimensionality of time (e.g., age, marital duration, the passage of years) as well as family transitions (e.g., having children, emptying or refilling the nest) in creating the meanings and experiences of marriage over time.     

The Cost-Effectiveness of Alternative Advance Mailings in a Telephone Survey

Advance letters are being used increasingly to combat the declinein response rates, but their effectiveness depends partly ontheir being read. In the face of the post-9/11 anthrax mailingscare, the Office for Survey Research (OSR) converted to usingadvance postcards rather than advance letters. Subsequently,the OSR conducted an experiment to test the effectiveness ofsending letters, postcards, or nothing to directory-listed numbersselected in a large random digit dial (RDD) telephone survey.In terms of response rates, the results clearly indicate thatsending advance letters is more effective than sending postcards,which, in turn, is more effective than sending nothing. A detailedcost-effectiveness evaluation indicates that sending lettersactually saves money, despite the increased costs associatedwith the mailings, compared to sending postcards; sending postcardsis also more cost-effective than not sending anything.     

Predictors of retention in an alcohol, tobacco, and other drug prevention study

This article explored retention patterns, as well as factors that predicted these patterns, in the evaluation of a relationship-based substance abuse prevention intervention study that targeted inner-city African American youth. A total of 851 contacts were made to retain 82% (n = 104) of the baseline sample (N = 127) in the evaluation. Results from multinomial regression analyses indicated that participants who were retained in the evaluation were more likely to perceive alcohol, tobacco, and other drug use as less risky and were more likely to report higher levels of family supervision than were evaluation attrits. Those who were easy to retain reported lower family conflict and fewer family relocations during the past year than those who were difficult to retain. Implications of these findings for developing retention strategies, as well as future research, are discussed.     

Generalists or specialists--who does it better?

Managed care companies encourage primary care physicians to limit referrals to specialists and provide as much of the needed services themselves. As a result, generalist and specialist physicians are now in direct competition with one another. Is the care provided by generalist and specialist physicians different in terms of quality and cost? The authors reviewed the literature over the past five years and found 21 articles comparing the care between specialists and generalists. They realized asking who does it better, the generalists or the specialists, is the wrong question to explore. Physicians must come together to design systems of care that maximize the long-term health of patients and deliver care in a coordinated and efficient manner. The emphasis should be on creating value for the consumer across the continuum of providers and through time. Competition between generalists and specialists in a fragmented system only serves to further weaken the position of physicians in the health care industry.