What is a clinical skill? Searching for order in chaos through a modified Delphi process.

BACKGROUND: Everybody seems to know what a clinical skill (CS) is but closer consideration shows that the concept of a CS is not as clear as might be assumed. Some seem to use "CSs" when just referring to physical examination skills, whereas others use the term to also include diagnostic, communication and practical skills. CSs are more than a simple performance, but clinicians are often not consciously aware of the complex interplay of different components of a CS that they are practicing and accordingly do not teach all these aspects to students. METHODS: A modified Delphi research was designed to explore concepts around the definition of a CS and its components for learning and teaching. The panel consisted of a group of British doctors, all involved in teaching CSs. RESULTS: One hundred and twenty-two items were identified and ranked through two rounds of a Delphi process, coded into thirty-seven codes and clustered into six principle themes: professional roles; components of CSs; performance; psychomotor aspects; educational environment; and teacher versus student centeredness. CONCLUSIONS: A CS may contain one or several different domains such as: physical examination skills, practical procedure, communication skills, and management. Acquiring CSs includes three components: learning how to perform certain movements (procedural knowledge), why one should do so (underlying basic science knowledge), and what the findings might mean (clinical reasoning). If we are to teach CSs for clinical practice, we must take these three different components into account in our instructional design.

The impact of donor policies in Europe: a steady increase, but not everywhere.

BACKGROUND: Transplantable organs are scarce everywhere. Therefore, countries have developed policies to support the efficient use of potential donors. Nevertheless, the shortage of organs remains. Were these policies in vain? The aim of this study is to assess the impact of donor policies on donor procurement in 10 Western European countries from 1995 to 2005. METHOD: To assess the impact of the donor policies we studied the conversion of potential donors into effectuated donors. 80% of the donors died from CVAs or a (traffic) accident. We considered these mortality rates to be a good proxy for potential donors. Here we call the conversion of potential donors into actual donors 'the donor efficiency rate by proxy'. RESULTS: The mortality rates for CVA and (traffic) accidents have decreased in the countries under study. At the same time, in most countries the donor efficiency rates have steadily increased. The variance in donor efficiency rates between countries has also increased from 1995 to 2005. Four countries introduced a new consent system or changed their existing system, without (visible) long-term effects. CONCLUSION: The overall increase in donor efficiency means that the efforts to improve donor policies have paid off. However, substantial differences between countries were found. The success of donor policies in terms of the number of absolute donors is blurred by the success of policies on traffic safety and CVA treatment. It remains unclear which specific policy measures are responsible for the increase in donor efficiency rates. This increase is not related to having a presumed consent system. Furthermore, an analysis of countries that introduced a new consent system or changed their system showed no effect on donor efficiency.

The impact of changes in practice in organ procurement on the satisfaction of donor relatives.

In the past decade several interventions have been undertaken to close the gap between demand and supply of donor organs. Family refusal is an important factor contributing to the shortage of donor organs. The importance of the quality of communication between staff and relatives has been underestimated. It is in the frontline of practice where decisions are made and behaviour of staff is critical. The current study, undertaken to explore if any changes had occurred in the behaviour of professionals involved in organ donation, took satisfaction ratings of relatives of donors in 1995, 1998 and 2001 as outcome measures. Our results show that relatives in 2001 are significantly more satisfied than those in 1995 and 1998 about staff behaviour. Changes all relate to specific interactions between key professionals and relatives. Results indicate that future interventions may be more effective if macro-oriented and regulatory policies are combined with competence-based educational programmes.