Evaluation & the Health Professions

This study evaluated a direct mail intervention called the "Call Fast, Call 911" campaign designed to increase use of emergency medical services for symptoms of acute myocardial infarction. The campaign was targeted at individuals over the age of 50. Persons over 50 years of age (N = 130,000) in King County, Washington, were randomly assigned to intervention or control groups. Individuals in the intervention groups received six direct mail pieces over a 1-year period encouraging them to call 911 quickly in response to chest pain. A postintervention telephone survey of a random sample of households (N = 434) assessed the impact of the campaign on knowledge, attitudes, and behavioral intentions regarding use of emergency medical services for symptoms of acute myocardial infarction. The results showed no significant differences between intervention and control groups in terms of knowledge of AMI. However, there were significant differences in beliefs and behavioral intentions to call 911 in a cardiac emergency.

A college laboratory was used as the setting to test the reliability and validity of a newly designed Breast Self-Examination Proficiency Rating Instrument (BSEPRI). The instrument was tested on two groups of nursing students, one instructed prior to testing and one not. BSE proficiency was scored individually for each subject as she demonstrated the procedure on a breast simulation model. Independent sample t tests were used to compare the groups. Mean scores of the instructed group were significantly higher than mean scores of the uninstructed group on the total test and on subscales of palpation and inspection. Criterion-referenced concurrent validity was assessed by correlating palpation scores with lump detection in a silicone model. Interrater reliability using percentage agreement between raters was high on 19 out of 23 criteria. Kuder-Richardson internal reliability coefficients ranged from .67 to .74.

The purpose of the present study is to address the issue of physicians' concerns in practice and their perception of a medical school's curriculum with an emphasis on comparisons between primary and nonprimary care physicians. The sample consisted of 663 physicians who graduated from Jefferson Medical College (JMC) between 1982 and 1986, and also responded to a mailed questionnaire. Comparisons were made between physicians in primary care (n = 234) and in nonprimary care (n = 429) specialties on their responses regarding concerns in medical practice and evaluation of the medical school curriculum. Primary care physicians were more concerned about the time for their professional developmentwhereas nonprimary care physicians were more concerned about an oversupply of physicians in their specialties, prospective hospital payment, and malpractice litigation. Regardless of the specialties, the physicians overall seemed very concerned about their personal time. Interpersonal skills were regarded by all respondents as an important aspect of the medical school 's curriculum The importance of psychological, social, and cultural factors in the curriculum was strongly supported by these physicians'responses, particularly among primary care and women physicians.

The purpose of this study was to explore the effects of interactive audiovisual (AV) enhancement on examinee problem-solving and decision-making activities during a Computerized Clinical Simulation Test (CST) of nursing competence and to determine which activities were most affected by AV inclusion. Two forms of CST and a questionnaire requesting examinee opinions about CST were administered to two different groups. Findings suggest that no reliability was lost by a change in format. An analysis of the item difficulty calibrations under the different administration conditions revealed that some items (particularly data-gathering items) functioned differently when cases were presented in an AV format. Those exposed to an AVformat presentation took significantly longer to complete the AV-enhanced cases but committed significantly fewer risky and inappropriate actions. Examinees exposed to AV format reported feeling more involved with the patients and better able to identify patient problems.

The purpose of this study was to determine if adequate levels of interrater reliability could be attained on a national standardizedperformance test, using one examiner per observation. Traditionally, performance assessments have relied on two examiners because of the subjectivity involved in grading. However, for nationally administered health-professions performance tests involving process evaluation, cost and logistical issues render two examiners unrealistic. Datafor this study were obtained during a national clinical skills examination for optometry. Surplus examiners were available to serve as secondary examiners in four evaluation stations, yielding 101 paired candidate observations. The results indicated high levels of interrater reliability. At each station, the agreement between examiners in their dichotomous yes-no observations was 90% or greater The agreement among examiner-determined scores based on the differentially weighted items was greater These results indicate that adequate, psychometrically sound examiner judgments and scores can be attained with one examiner per observation.

Given concerns about survey nonresponse bias as well as the need to plan resources for participant recruitment, this study tracked each step of the recruitment process (location, response, consent, and completion) of sociodemographically diverse older women for a survey concerning mammography experience. Younger, less educated poor women were likely to be lost due to inability to locate them, while older middle and upper-economic-group women were more likely to be lost due to refusal to participate. Hispanic and Black women were significantly more likely to respond on successive attempts to recruit them than were White, non-Hispanic women. There was no significant difference in refusal rates by minority women over the successive contacts, as contrasted with White women, who refused at significantly higher rates with each attempt.