Isomorphic patient management problems: a method of creating equivalent problem-solving tests.

Multiple choice format pre- and post-tests have a high likelihood of being equivalent (i.e. parallel) if well-known guidelines are followed. In the absence of such guidelines for pre- and post-tests of problem-solving, the authors devised a simple method of creating problems that are likely to be equivalent. The method was employed with patient management problems (PMPs) and focuses on maintaining the same form or structure of the problems while making the problems appear different to the examinee. Such problems are 'isomorphic'. The equivalence or parallelism of 10 PMPs with their isomorphic counterparts was demonstrated. The method for creating isomorphic PMPs appears to be applicable for creating equivalent pre- and post-tests composed of problems other than PMPs.

The mandate project: institutionalizing a system of patient care quality assurance.

In 1970, prior to present-day requirements for quality assurance programs, a project was undertaken to institute such a program voluntarily in ten hospitals. Five hospitals succeeded in fully implementing the program which was based on the "Bi-Cycle Process" and each documented improvements in desired patient care behaviors. Two hospitals partially implemented the process and demonstrated no significant changes in desired patient care behaviors. Two hospitals failed to provide the data upon which assessments could be made and one hospital never got beyond preliminary efforts at instituting the process. The project demonstrates that a voluntary quality assurance program is feasible and has important implications for PSROs and continuing medical education. It also provides evidence that attention to psychosocial factors is essential in the institutionalization of programs designed to produce desired changes in patient care behaviors.