A paired-comparisons study of Patient Management Problem (PMP) test scores was undertaken to investigate the relationship between performance and corresponding scores (proficiency and pathway). Findings suggest that assigning points at the "option level" culminates in scores that cannot readily be linked to behavior they are supposed to…

This issue presents six papers that provide both a historical perspective on and state-of-the-art knowledge about the study of clinical reasoning in medicine. A retrospective is followed by reviews of four approaches to clinical reasoning and an empirical study of current work in the field. (SLD)

The dimensionality was assessed of 20 problem score measures derived from a nationally standardized written clinical simulation examination--the National Board for Respiratory Care--for which prior evidence of validity exists. The stability and generalizability of the resulting factor structure across examinee groups and test forms (N=5,679…

This article describes an interactive computer program that allows medical students to enter a completely free-form problem list at the keyboard and receive immediate analysis of the accuracy and thoroughness of their diagnostic impressions. (Author/LMO)

Standardized patient case problems were administered to approximately 280 final year medical students. Results indicate that performance on a given component of clinical competence shows less consistency when measured on different cases than does performance on different components measured on the same case. (TJH)

Three commonly used indices of cost-effectiveness are compared for their usefulness to health care professionals. The methods are the cost-benefit ratio, the cost-effectiveness ratio, and the net benefit methods. The net benefit is considered the preferred index of cost-effectiveness. (TJH)

A computer-assisted interaction analysis system that describes behavior in small groups and focuses on active clinical problem-solving was developed and tested. Teacher and class characteristics are incorporated into the simulation, allowing feedback for improvement of medical teaching skills. (TJH)

Studied variation in physicians' practice styles and policies through a survey of 46 family physicians and internists. Overall, the results indicate that a brief open-ended survey can assess practice variations quickly, providing a basis to guide interventions. (SLD)

Physician impact analysis (PIA) is a planning tool intended to provide a way to evaluate the impact of a new or replacement physician's practice profile on the clinical program priorities, staffing resources, and costs of a hospital. Key methods for PIA and issues related to its use are considered. (SLD)

In this review of the literature evaluating the effectiveness of continuing medical education (CME), 238 studies from 1935 to 1982 were reviewed and annotated using previously established and tested assessment criteria. CME interventions were found to have an impact on physician competence and, less consistently, on physician performance and…

The new quality assurance system for nursing homes implemented by the New York State Department of Health in 1981 was compared to the previous system. The new system devoted more resources to on-site activities and identified more patient-care deficiencies and more repeat deficiencies. (SLD)

Explores the nature of meta-analysis by placing it in the context of research synthesis. Methods of meta-analysis are described and compared with other forms of research integration, and findings for several meta-analyses are provided to show advantages of quantitative review methods. (SLD)

Factors that might bias outcomes of meta-analytic reviews are discussed. The role of meta-analysis in theory development is considered, describing three types of meta-analytic tests of theory. A final section discusses the applicability of meta-analysis in the assessment of convergent and discriminant construct validity. (SLD)

Some guidelines are offered for interpreting and evaluating meta-analytic reviews of research. The choice of unit of analysis, the issue of fixed versus random effects, the meaning of heterogeneity, the determination of appropriate contrasts, and the choice of measures of central tendency are discussed. (SLD)

This study derives the economic costs of misclassification in nursing home patient classification systems. These costs are then used as weights to estimate the reliability of a functional assessment instrument. Results suggest that reliability must be redefined and remeasured with each substantively new application of an assessment instrument.…