[Method for evaluating the competence of specialists--the validation of 360-degree-questionnaire]. / Metode til kompetenceevaluering af speciallaeger--validering af 360-graders-skema.

INTRODUCTION: Assessment of physicians' performance focuses on the quality of their work. The aim of this study was to develop a valid, usable and acceptable multisource feedback assessment tool (MFAT) for hospital consultants. MATERIAL AND METHODS: Statements were produced on consultant competencies within non-medical areas like collaboration, professionalism, communication, health promotion, academics and administration. The statements were validated by physicians and later by non-physician professionals after adjustments had been made. In a pilot test, a group of consultants was assessed using the final collection of statements of the MFAT. They received a report with their personal results and subsequently evaluated the assessment method. RESULTS: In total, 66 statements were developed and after validation they were reduced and reformulated to 35. Mean scores for relevance and "easy to understand" of the statements were in the range between "very high degree" and "high degree". In the pilot test, 18 consultants were assessed by themselves, by 141 other physicians and by 125 other professionals in the hospital. About two thirds greatly benefited of the assessment report and half identified areas for personal development. About a third did not want the head of their department to know the assessment results directly; however, two thirds found a potential value in discussing the results with the head. CONCLUSION: We developed an MFAT for consultants with relevant and understandable statements. A pilot test confirmed that most of the consultants gained from the assessment, but some did not like to share their results with their heads. For these specialists other methods should be used.

Screening for congenital malformations by ultrasonography in the general population of pregnant women: factors affecting the efficacy.

OBJECTIVES: To assess whether the efficacy of screening for fetal malformations is affected by patient-, staff-, team- or work environment-related factors. METHODS: A prospective cohort study was carried out at a Danish university hospital with 4000 deliveries per year. In total, 7963 fetuses were examined by midtrimester ultrasound scan during 1997 and 1998. The infants were followed up to the age of at least 1 year. The main outcome measures were the detection rate (DR) of fetal abnormalities in relation to patient factors, staff factors, team and work environment factors. RESULTS: Significant malformations were detected in 100 fetuses or infants, corresponding to an incidence of 1.3%. The prenatal DR was 60%. High maternal body mass index (BMI) was associated with a lower DR, while the presence of twins, the gestational age at time of screening and the sonographer's level of experience were not. Fetuses with a prenatally undetected malformation were more often examined by more than one sonographer than fetuses without congenital malformations. Workload or monotony did not seem to affect the efficacy of screening. There was a trend towards a lower detection rate at midday and when most of the staff were at work. CONCLUSIONS: Some team and work environment factors that may affect the detection rate of fetal abnormalities were identified and have been changed: appointments for screening have been reorganized, regular breaks for all the staff introduced and second opinions are given by a specialist in fetomaternal medicine. The new system will be followed up to ensure that the reorganization has not created new organizational mistakes.