Global overall rating for assessing clinical competence: what does it really show?

CONTEXT: Single-item global overall ratings are often used as a method of assessing learners' clinical competence at the end of a clerkship. The purpose of this study was to identify which aspects of clinical competence are assessed through these ratings. METHODS: At the end of a clinical clerkship in primary health units, 106 Year 4 students are routinely assessed by faculty staff of three disciplines (obstetrics and gynaecology, internal medicine, paediatrics), using a single global numeric rating (on a scale of 0-10). Faculty scores across disciplines for each learner are averaged to produce a global overall rating (GOR). In this study, the same students were assessed by the same faculty staff 2 weeks later using a newly developed, more detailed form composed of 13 domains, of which six related to technical skills and seven to humanistic skills, each scored on a scale of 0-10. Scores for each domain across disciplines were averaged as global itemised ratings (GIRs). Statistical analysis included Cronbach's alpha coefficient and Pearson's correlation coefficients. Statistical significance was set at P < or = 0.05. RESULTS: The internal consistency of GIR items was high (alpha coefficient = 0.935). Global overall rating scores were higher than most technical domains of GIRs and lower than the humanistic domains of GIRs. The highest significant correlations were found between the GOR and the technical domains of the GIR. CONCLUSIONS: When faculty staff attribute a global single-item overall rating to a student's clinical competence, they tend to focus more on technical skills.

Effect of expiratory flow increase technique on pulmonary function of infants on mechanical ventilation.

BACKGROUND AND PURPOSE: Although chest physiotherapy techniques are commonly used in the treatment of respiratory diseases, there are, however, few studies in the literature on the effectiveness of these techniques in paediatric patients. The purpose of the present study was to evaluate the effect of the expiratory flow increase technique (EFIT) on the pulmonary function of infants on invasive mechanical pulmonary ventilation. METHOD: A prospective, non-randomized study design was used, with consecutive enrolment conducted in the paediatric intensive care unit (PICU) of a university hospital. All infants with acute obstructive respiratory failure who were on invasive mechanical pulmonary ventilation between April 2001 and April 2003 were included in this study. Respiratory rate, PaO2, PaCO2, SatO2, PaO2/FiO2, P(A-a)O2/PaO2, PaO2/PAO2, VD/VT, dynamic compliance, inspiratory and expiratory resistance values were compared before and after application of the EFIT. RESULTS: Blood gas and pulmonary function measurements were recorded before and after EFIT. Repeated-measures analysis of variance (ANOVA) was used. The results were considered statistically significant when p values were < 0.05. Twenty-two infants were enrolled. There was a significant increase in respiratory rate, SatO2 and PaO2/PAO2 and a significant decrease in P(A-a)O2/PaO2 after application of the EFIT. CONCLUSION: There was a short-term improvement in the oxygenation of infants who were submitted to the EFIT. Additional studies are necessary to establish the efficacy and effectiveness of this technique.

[Monitoring growth]. / Acompanhamento do crescimento.

OBJECTIVE: To present concepts related to growth assessment, with emphasis on aspects concerning the evaluation of individuals. SOURCES: The present paper is based on reports published by the WHO regarding the use anthropometry for the assessment of nutritional status; on original articles; and on book chapters about the same topic, as well as on the criticisms of auxologists of this type of assessment when employed at the individual level. SUMMARY OF THE FINDINGS: Concepts concerning reference, skeletal maturity, mid-parental target height, z score, short stature, growth rate, body mass index, and their assumptions and limitations are presented. CONCLUSIONS: The assessment of the nutritional status of a population is based on cut-off points, taking into consideration that whoever is below or above that point presents a nutritional problem. Clinical evaluation is based on the idea of variability, which can be both biological and social, and on the idea that it is the clinician's task to establish whether a child within or outside given parameters presents normal growth and nutritional status. When monitoring the growth of a child or adolescent, the most important parameter to be considered is growth rate.

Acompanhamento do crescimento / Monitoring growth

Objetivo: apresentar conceitos relacionados à avaliação docrescimento, ressaltando os aspectos da avaliação do indivíduo. Fontes dos dados: o artigo foi desenvolvido tomando como base as publicações que discutem a aplicação da antropometria na avaliação do estado nutricional, publicadas pela OMS, artigos originais e capítulos de livros com esse mesmo conteúdo, e as críticas que osauxologistas fazem a esse tipo de avaliação, quando aplicadas individualmente. Síntese dos dados: são apresentados conceitos de referência, maturidade esquelética, alvo parental, escore z, baixa estatura,velocidade de crescimento, índice de massa corporal e seus pressupostos e limitações. Conclusões: a avaliação do estado nutricional de populações baseia-se em pontos de corte, partindo do pressuposto de que quem está abaixo ou acima daquele ponto apresenta um problema nutricional. A avaliação clínica baseia-se na idéia de variabilidade, e que esta pode ser tanto biológica quanto social, e cabe ao clínico estabelecer se a criança está dentro ou fora de determinados parâmetros e se tem um crescimento, ou um diagnóstico nutricional, normais. Ao acompanhar o crescimento de uma criança ou adolescente, o parâmetromais importante a ser considerado é a velocidade de crescimento