Palliative Care Competencies and Readiness for Independent Practice: A Report on the American Academy of Hospice and Palliative Medicine Review of the U.S. Medical Licensing Step Examinations
| Autor: | Jeffrey Klick, Robert M. Arnold, Solomon Liao, Joseph Rotella, Stacie Levine, Laura J. Morrison, Gary T. Buckholz, Elise C. Carey, Julie Bruno, Miguel A. Paniagua |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Palliative care Students Medical Adolescent media_common.quotation_subject Context (language use) Subspecialty 01 natural sciences 03 medical and health sciences Young Adult 0302 clinical medicine medicine Humans 030212 general & internal medicine 0101 mathematics Child Palliative Medicine General Nursing media_common Aged Licensure Aged 80 and over business.industry Addiction 010102 general mathematics Palliative Care Infant Internship and Residency Middle Aged medicine.disease Hospice and palliative medicine United States Test (assessment) Substance abuse Anesthesiology and Pain Medicine Family medicine Child Preschool Female Neurology (clinical) Clinical Competence business |
| Zdroj: | Journal of pain and symptom management. 56(3) |
| ISSN: | 1873-6513 |
| Popis: | Context It is unknown whether the palliative care (PC) content tested in the U.S. Medical Licensing Examination (USMLE) step examinations reflects the consensus-developed PC competencies. Objectives To review the USMLE step examinations to determine whether they test the PC knowledge necessary for graduating medical students and residents applying for licensure. Methods Eight PC physicians reviewed three complete examination forms and a focused 509-item bundle of multiple-choice questions (MCQs) identified by the USMLE content outline as potentially assessing PC content. Reviewers determined MCQs to be PC items if the patient was seriously ill and PC knowledge was required to answer correctly. PC items' competency domains were determined using reference domains from PC subspecialty consensus competencies. Results Reviewers analyzed 1090 MCQs and identified 242 (22%) as PC items. PC items were identified in each step examination. Patients in PC items were mostly males (62.8%), older than 65 years (62%), and diagnosed with cancer (43.6%). Only 6.6% and 6.2%, respectively, had end-stage heart disease or multimorbid illness. Fifty-one percent of PC items addressed ethics (31%) or communication (19.8%), focusing on patient autonomy, surrogate decision makers, or conflict between decision makers. Pain and symptom management was assessed in 28.5% of PC items, and one-third of those addressed addiction or substance use disorder. Conclusion We identified PC content in each step examination. However, heart disease and multimorbidity were under-represented in PC items relative to their prevalence. In addition, there was heavy overlap with ethics, a focus on conflict in assessing communication skills, and emphasis on addiction when testing pain management. Our findings highlight opportunities to enhance testing of clinical PC skills essential for all licensed physicians practicing medicine. |
| Databáze: | OpenAIRE |
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