Effectiveness of a simulated clinical examination in the assessment of the clinical competencies of entry-level trainees in a family medicine residency programme

Clinical competence is a multidimensional concept and encompasses a variety of skills including procedural, problem-solving and clinical judgement. The initial stages of postgraduate medical training are believed to be a particularly important time for the development of clinical skill competencies. This study reports on an evaluation of a Simulated Clinical Examination (SCE) method as a means of assessing the clinical skill competencies of entry-level family medicine residents. Two entering cohorts of PGY1 family medicine residents (N = 35) participated in a SCE encompassing realistic clinical encounters with standardised patients (SPs). Residents were asked to complete pre- and post-evaluation surveys, and both faculty and residents were invited to participate in separate focus groups. The SCE was perceived as a useful method during the early phases of postgraduate training for assessing clinical skill competencies, providing constructive feedback to residents and enhancing self-awareness and confidence. The SCE also appeared to be useful in fostering confidence in interviewing and diagnostic reasoning, however self-reported confidence in the ability to perform clinical skill tasks related to history taking, physical examination and differential diagnosis was not associated with observed performance in these areas. The SCE was an effective technique for benchmarking skill performance, however further research is required to evaluate the effect of this on the self-assessment abilities of trainees over the course of postgraduate medical education.     

The role of future work goal motives in adolescent identity development: A longitudinal mixed-methods investigation

Theories of adolescent identity development often emphasize the importance of adolescents’ future work goals, yet these theories rarely distinguish the self-oriented motives (enjoying or being a good fit for one’s work) from the beyond-the-self-oriented motives (having a positive impact on the world beyond the self) that underlie them. The present article explored the impact and development of both types of motives. Using longitudinal, mixed-methods data from middle school and high school students (N = 99), the present article found that: (1) adolescents generated both self-oriented and beyond-the-self-oriented motives for their future work goals, often simultaneously; (2) adolescents who held both self-oriented and beyond-the-self-oriented motives for their work goals were more likely to experience higher levels of purpose and meaning over a 2-year period than those who held neither; (3) school assignments that asked students to reflect on their work goals were positively related only to the development of self-oriented motives for work goals among middle school students; and (4) support from friends was positively related only to the development of self-oriented motives for work goals among high school students.     

Organizational Discourse and the Appraisal of Occupational Hazards: Interpretive Repertoires,Heedful Interrelating,and Identity at Work

Scholars and practitioners have often conceptualized hazards as external to discursive processes, focusing instead on the role of strategic communication in representing pre-organized vulnerabilities to stakeholders rather than on the capacity of mundane discourse practices to shape how hazards emerge. In this study of risk discourse in one high reliability organization, a municipal fire department, we demonstrate how hazard appraisals emerged as intersubjective products of organizational discourse. Specifically, we explore how the interpretive repertoires firefighters used to make sense of hazards were medium and outcome of discursive identity formations. Firefighters employed preferred identity terms to amplify identity-enhancing dangers and attenuate vulnerabilities that were threatening to a preferred sense of self.     

A Communicative Analysis of a Sexual Health Screening Intervention Conducted in a Low-Income Housing Complex

Providing free HIV screening within public housing sites offers the potential for increased participation of at-risk populations. Residential-based screening, however, raises concerns about privacy because of the stigma attached to HIV/AIDS and even to the testing for HIV. This study examined the effectiveness of offering HIV screening within a public housing high-rise in upstate New York. Through interviews with both women who obtained testing and those who did not, this study explored the tension between convenience and privacy concerns. The findings suggest that offering HIV screening where people live could encourage participation in the screenings, as well as lead to a destigmatization of HIV testing over time. Some women chose to eschew the convenience of on-site testing in favor of a more private venue for screening, whereas some women responded positively to the accessibility of on-site testing, using communicative strategies to manage privacy concerns.     

The forum

VALIDITY AND RHETORIC IN PHILOSOPHICAL ARGUMENT: AN OUTLOOK IN TRANSITION. By Henry W. Johnstone, Jr. University Park, Pennsylvania: The Dialogue Press of Man &; World, Publishers, 1978; pp. 155. $4.95.

POLITICAL PHILOSOPHY AND RHETORIC: A STUDY OF THE ORIGINS OF AMERICAN PARTY POLITICS. By John Zvesper. New York: Cambridge University Press, 1977; pp. vii+237. $19.50.

THE EDUCATION OF A PUBLIC MAN: MY LIFE AND POLITICS. By Hubert H. Humphrey. Ed. by Norman Sherman. Garden City, N.Y.: Doubleday &; Co., 1976; pp. xiii+495. $5.95 (paper).

GOD, CHURCH, AND FLAG: SENATOR JOSEPH R. MCCARTHY AND THE CATHOLIC CHURCH, 1950–57. By Donald F. Crosby. Chapel Hill: The University of North Carolina Press, 1978; pp. xv+307. $16.95.

CHAMBER THEATRE. By Robert S. Breen. Englewood Cliffs, N.J.: Prentice‐Hall, 1978; pp. 124. $5.95 (paper).

PERSPECTIVES ON CROSS‐CULTURAL COMMUNICATION. By Carley H. Dodd. Dubuque, Iowa: Kendall/Hunt Publishing Co., 1977; pp. 109. $4.95 (paper).

INTERCULTURAL COMMUNICATION. By L. E. Sarbaugh. Rochelle Park, N.J.: Hayden Book Co., 1979; pp. 148. $6.95 (paper).

INTERCULTURAL AND INTERNATIONAL COMMUNICATION. Edited by Fred L. Casmir. Washington, D.C.: University Press of America, Inc., 1978; pp. xx+814. $21.50.

FOUNDATIONS FOR CONVERSATION: ITS ART AND TECHNIQUES. By George P. Rice. North Quincy, Ma.: Christopher Publishing House, 1979; pp. 161. $6.95.     

Preliminary development of a measure of sibling relational maintenance behaviors: Scale development and initial findings

Two studies were conducted to examine the use of relational maintenance behaviors in the sibling relationship. In the first study, the specific relational maintenance behaviors used by siblings were identified. A principal components factor analysis of 70 previously generated behaviors used by 363 participants revealed six factors: confirmation, humor, social support, family visits, escape, and verbal aggression. In the second study, the link between the six relational maintenance behaviors used by siblings and the relational outcomes of liking, commitment, and trust was explored. Results indicate the confirmation, humor, social support, and family visits relational maintenance behaviors are correlated positively with liking, commitment, and trust, but the verbal aggression relational maintenance behavior failed to correlate with liking, commitment, or trust.     

The hypothetical: a new training resource for adult educators

The “hypothetical”, a panel game developed and popularised by Geoffrey Robertson on Granada Television in the U.K. and on Channel 9 (initially) and ABC Television (finally) in Australia, has proved to be readily adaptable into a technique for the training of adult educators.

In the television version, participants play themselves in an imaginary scenario invoked by a compere whose role is to provoke them into making decisions about key social dilemmas of contemporary public concern, such as drug trafficking, marriage breakdown, AIDS, police corruption.

In the training adaptation described here, the dilemmas are constructed around issues of concern in daily professional practice. The primary goal changes to the professional development of participants and (if present) of an audience who are also professionals, rather than the goal of mass entertainment or general audience edification as in the television version.

This paper describes the adaptation of this popular 1980's television production into a training tool of considerable power, and gives an account of how it has been developed and used in one institution. It argues that, whereas the hypothetical is clearly a close relative of a number of familiar experiential training techniques, it makes its own unique contribution to the catalogue of training strategies available.     

How do we know research and development projects in vocational education and training are cost‐effective?

This article reviews a recent U.K. study which sought to identify the steps that have to be taken to improve the efficacy of research and development (R&D) projects in Vocational Education and Training (VET). The review is facilitated by making reference to the approach and findings of a parallel study in Switzerland.

The review seeks to highlight the importance of more rigorously establishing what really happens to the results of R&D projects after they are completed. In particular, it seeks to identify what is necessary to ensure that each R&D project has a positive impact on practice. It does this in order to ensure that the now substantial investment in R&D for VET is cost effective. On the basis of the review the article proposes an agenda for an effective and coordinated approach to action and research in the area.