Development and Initial Testing of a Structured Clinical Observation Tool to Assess Pharmacotherapy Competence
- 86 Downloads
The authors developed and tested the feasibility and utility of a new direct-observation instrument to assess trainee performance of a medication management session.
The Psychopharmacotherapy-Structured Clinical Observation (P-SCO) instrument was developed based on multiple sources of expertise and then implemented in 4 university-based outpatient medication management clinics with 7 faculty supervising 17 third-year residents. After each observation by a faculty member of a medication management session, residents received feedback in writing (the completed P-SCO) and verbally in person. Targets were 8 P-SCO observations per academic year per resident (or 0.67 per month) and 16 observations per year completed by each faculty (or 1.3 per month). Qualitative thematic analysis was employed to compare the frequency, specificity, type (reinforcing vs. corrective), and content of comments documented on the P-SCO forms to midpoint and end of rotation global assessments by the same faculty for the same residents in the same rotation.
Faculty completed 2.4 (SD=1,2) P-SCOs per month during the study period. Each resident received 1.1 (SD=0.53) P-SCO observations per month. Faculty and residents completed significantly more observations than targeted (p=0.03 and p=0.003, respectively). Two percent of the P-SCOs had no written comments. Less than 3% of the P-SCO comments were nonspecific compared with 43% for the global assessments. Residents received, on average, 3.3 times more total, 2.6 times more reinforcing, and 5.3 times more corrective patient care specific comments on the P-SCO than on the global assessment (p<0.001). For the numerical ratings, residents received an average of 4.2 “exceeds expectations” and 1.7 “below expectations” ratings on P-SCOs compared with 2.6 and 0, respectively, on global assessments (p<0.02).
Faculty can feasibly use the P-SCO instrument in a training clinic. Compared with traditional global assessment, the P-SCO provided much more specific feedback information, a better balance of corrective to re-enforcing comments, and a greater spread of ratings related to competency in pharmacodverbally
Unable to display preview. Download preview PDF.
- 2.US Institute of Medicine: Committee on Crossing the Quality Chasm: adaptation to mental health and addictive disorders, improving the quality of health care for mental and substance-use conditions. Quality Chasm Series. Washington, DC, National Academies Press, 2006Google Scholar
- 12.Schatzberg AF, Nemeroff CB: The American Psychiatric Publishing Textbook of Psychopharmacology, 3rd ed. Washington, DC, American Psychiatric Publishing, 2004Google Scholar
- 13.Janicak PG, Davis JM, Preskorn SH, et al: Principles and Practice of Psychopharmacotherapy, 4th ed. Philadelphia, Lippincott Williams & Wilkins, 2006Google Scholar
- 14.Scheiber SC, Kramer TAM: Core Competencies for Psychiatric Practice: What Clinicians Need To Know: A Report of the American Board of Psychiatry and Neurology, 1st ed. Washington, DC, American Psychiatric Publishing, 2003Google Scholar
- 15.ACGME: ACGME Psychiatry Program Requirements, 2007. Available at http://www.acgme.org/acWebsite/navPages/nav_400.asp
- 17.Miller M: Medication Clinic Training Procedures and Treatment Manual. Pittsburgh, University of Pittsburgh Medical Center Late-Life Depression Prevention Clinic, 1998, pp 1–21Google Scholar
- 19.Elstein AS, Shulman LS, Sprafka SA: Medical problem solving: an analysis of clinical reasoning. Cambridge, Mass, Harvard University Press, 1978, pp xvi, 330Google Scholar