Stillbirth and newborn mortality in India after helping babies breathe training.

OBJECTIVE: This study evaluated the effectiveness of Helping Babies Breathe (HBB) newborn care and resuscitation training for birth attendants in reducing stillbirth (SB), and predischarge and neonatal mortality (NMR). India contributes to a large proportion of the worlds annual 3.1 million neonatal deaths and 2.6 million SBs. METHODS: This prospective study included 4187 births at >28 weeks' gestation before and 5411 births after HBB training in Karnataka. A total of 599 birth attendants from rural primary health centers and district and urban hospitals received HBB training developed by the American Academy of Pediatrics, using a train-the-trainer cascade. Pre-post written trainee knowledge, posttraining provider performance and skills, SB, predischarge mortality, and NMR before and after HBB training were assessed by using χ(2) and t-tests for categorical and continuous variables, respectively. Backward stepwise logistic regression analysis adjusted for potential confounding. RESULTS: Provider knowledge and performance systematically improved with HBB training. HBB training reduced resuscitation but increased assisted bag and mask ventilation incidence. SB declined from 3.0% to 2.3% (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.59-0.98) and fresh SB from 1.7% to 0.9% (OR 0.54, 95% CI 0.37-0.78) after HBB training. Predischarge mortality was 0.1% in both periods. NMR was 1.8% before and 1.9% after HBB training (OR 1.09, 95% CI 0.80-1.47, P = .59) but unknown status at 28 days was 2% greater after HBB training (P = .007). CONCLUSIONS: HBB training reduced SB without increasing NMR, indicating that resuscitated infants survived the neonatal period. Monitoring and community-based assessment are recommended.

An analysis of long-term outcomes of the impact of curriculum: a comparison of the three- and four-year medical school curricula.

PURPOSE: To determine the long-term effects of curriculum length on physician competence, the authors compared the performance of graduates from the University of Calgary (U of C; a school with a three-year curriculum) with matched samples from the University of Alberta (U of A) and from other Canadian schools with a four-year curriculum. METHOD: The authors used data from the College of Physicians and Surgeons of Alberta, Physician Achievement Review (PAR) program to determine curricular outcomes. The authors analyzed PAR program data, comprising reviews from medical colleagues, nonphysician coworkers (e.g., nurses, pharmacists), patients, and the physicians themselves, for 166 physicians from U of C, U of A, and other universities. They compared groups using one-way analysis of covariance (ANCOVA) and multivariate analysis of covariance (MANCOVA), with years since graduation as a covariate, and a Cohen d effect size calculation to assess the magnitude of the differences. RESULTS: The authors analyzed review data for 498 physicians. The results of ANCOVA showed that no significant differences existed among schools for the self and the patient aggregate mean questionnaire scores. Aggregate mean questionnaire scores from the medical colleague and coworker surveys were significant, albeit with a small effect size. MANCOVA showed small but significant differences among schools on the aggregate mean factor scores for medical colleague, coworker, and patient questionnaires. CONCLUSIONS: Although differences among schools exist, they are small. They suggest at least equivalent performance for graduates of three- and four-year medical schools who practice in Alberta.

Assessment of radiology physicians by a regulatory authority.

PURPOSE: To determine whether it is possible to develop a feasible, valid, and reliable multisource feedback program for radiologists. MATERIALS AND METHODS: Surveys with 38, 29, and 20 items were developed to assess individual radiologists by eight radiologic colleagues (peers), eight referring physicians, and eight co-workers (eg, technicians), respectively, by using five-point scales along with an "unable to assess" category. Radiologists completed a self-assessment on the basis of the peer questionnaire. Items addressed key competencies related to clinical competence, collegiality, professionalism, workplace behavior, and self-management. The study was approved by the University of Calgary Conjoint Health Ethics Research Board. RESULTS: Data from 190 radiologists were available. The mean numbers of respondents per physician were 7.5 of eight (1259 of 1520, 83%), 7.15 of eight (1337 of 1520, 88%), and 7.5 of eight (1420 of 1520, 93%) for peers, referring physicians, and co-workers, respectively. The internal consistency reliability indicated all instruments had a Cronbach alpha of more than 0.95. The generalizability coefficient analysis indicated that the peer, referring physicians, and co-worker instruments achieved a generalizability coefficient of 0.88, 0.79, and 0.87, respectively. The factor analysis indicated that four factors on the colleague questionnaire accounted for 70% of the total variance: clinical competence, collegiality, professional development, and workplace behavior. For the referring physician survey, three factors accounted for 64.1% of the variance: professional development, professional consultation, and professional responsibility. Two factors on the co-worker questionnaire accounted for 63.2% of the total variance: professional responsibility and patient interaction. CONCLUSION: The psychometric examination of the data suggests that the instruments developed to assess radiologists are a feasible way to assess radiology practice and provide evidence for validity and reliability.

What multisource feedback factors influence physician self-assessments? A five-year longitudinal study.

BACKGROUND: Multisource feedback, in which medical colleagues, patients, coworkers, and the physician involved provide data, is a tool to inform physician practice. Its impact on physicians' self-assessment through two iterations is unknown. METHOD: Data from 250 family physicians in Alberta who participated in two iterations, five years apart-1999 and 2006--allowed the authors to determine the change in self-assessment scores, using a t test. A multiple regression was used to account for the variance in the scores from the second self-assessment by the data from the multisource feedback and sociodemographics from the first iteration. RESULTS: Physicians rated themselves higher in the second iteration. The linear regression model accounted for 27.4% of the variance in the ratings at the second iteration and incorporated data from the self-assessment. CONCLUSIONS: Physician self-assessment seems driven by stable perceptions that physicians hold about themselves and that may be slow to change.