Simone A van Dulmen1, Marjo Maas2, J Bart Staal3, Geert Rutten4, Henri Kiers5, Maria Nijhuis-van der Sanden6, Philip van der Wees7. 1. S.A. van Dulmen, MSc, Radboud University Medical Center, Scientific Institute for Quality of Healthcare, Internal Code 114, PO Box 9101, 6500 HB Nijmegen, the Netherlands. simone.vandulmen@radboudumc.nl. 2. M. Maas, MSc, Radboud University Medical Center, Scientific Institute for Quality of Healthcare, and Department of Allied Health Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands. 3. J.B. Staal, PhD, Radboud University Medical Center, Scientific Institute for Quality of Healthcare. 4. G. Rutten, PhD, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands. 5. H. Kiers, MSc, Research Group Lifestyle and Health, University of Applied Sciences Utrecht, Utrecht, the Netherlands. 6. M. Nijhuis-van der Sanden, PhD, Radboud University Medical Center, Scientific Institute for Quality of Healthcare. 7. P. van der Wees, PhD, Radboud University Medical Center, Scientific Institute for Quality of Healthcare.
Abstract
BACKGROUND: Clinical practice guidelines are considered important instruments to improve quality of care. However, success is dependent on adherence, which may be improved using peer assessment, a strategy in which professionals assess performance of their peers in a simulated setting. OBJECTIVE: The aim of this study was to determine whether peer assessment is more effective than case-based discussions to improve knowledge and guideline-consistent clinical reasoning in the Dutch physical therapy guideline for low back pain (LBP). DESIGN: A cluster randomized controlled trial was conducted. SETTING AND PARTICIPANTS: Ten communities of practice (CoPs) of physical therapists were cluster randomized (N=90): 6 CoPs in the peer-assessment group (n=49) and 4 CoPs in the case-based discussion group (control group) (n=41). INTERVENTION: Both groups participated in 4 educational sessions and used clinical patient cases. The peer-assessment group reflected on performed LBP management in different roles. The control group used structured discussions. MEASUREMENTS: Outcomes were assessed at baseline and at 6 months. The primary outcome measure was knowledge and guideline-consistent reasoning, measured with 12 performance indicators using 4 vignettes with specific guideline-related patient profiles. For each participant, the total score was calculated by adding up the percentage scores (0-100) per vignette, divided by 4. The secondary outcome measure was reflective practice, as measured by the Self-Reflection and Insight Scale (20-100). RESULTS: Vignettes were completed by 78 participants (87%). Multilevel analysis showed an increase in guideline-consistent clinical reasoning of 8.4% in the peer-assessment group, whereas the control group showed a decline of 0.1% (estimated group difference=8.7%, 95% confidence interval=3.9 to 13.4). No group differences were found on self-reflection. LIMITATIONS: The small sample size, a short-term follow-up, and the use of vignettes as a proxy for behavior were limitations of the study. CONCLUSIONS: Peer assessment leads to an increase in knowledge and guideline-consistent clinical reasoning.
RCT Entities:
BACKGROUND: Clinical practice guidelines are considered important instruments to improve quality of care. However, success is dependent on adherence, which may be improved using peer assessment, a strategy in which professionals assess performance of their peers in a simulated setting. OBJECTIVE: The aim of this study was to determine whether peer assessment is more effective than case-based discussions to improve knowledge and guideline-consistent clinical reasoning in the Dutch physical therapy guideline for low back pain (LBP). DESIGN: A cluster randomized controlled trial was conducted. SETTING AND PARTICIPANTS: Ten communities of practice (CoPs) of physical therapists were cluster randomized (N=90): 6 CoPs in the peer-assessment group (n=49) and 4 CoPs in the case-based discussion group (control group) (n=41). INTERVENTION: Both groups participated in 4 educational sessions and used clinical patient cases. The peer-assessment group reflected on performed LBP management in different roles. The control group used structured discussions. MEASUREMENTS: Outcomes were assessed at baseline and at 6 months. The primary outcome measure was knowledge and guideline-consistent reasoning, measured with 12 performance indicators using 4 vignettes with specific guideline-related patient profiles. For each participant, the total score was calculated by adding up the percentage scores (0-100) per vignette, divided by 4. The secondary outcome measure was reflective practice, as measured by the Self-Reflection and Insight Scale (20-100). RESULTS: Vignettes were completed by 78 participants (87%). Multilevel analysis showed an increase in guideline-consistent clinical reasoning of 8.4% in the peer-assessment group, whereas the control group showed a decline of 0.1% (estimated group difference=8.7%, 95% confidence interval=3.9 to 13.4). No group differences were found on self-reflection. LIMITATIONS: The small sample size, a short-term follow-up, and the use of vignettes as a proxy for behavior were limitations of the study. CONCLUSIONS: Peer assessment leads to an increase in knowledge and guideline-consistent clinical reasoning.
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Authors: Marjo J M Maas; Simone A van Dulmen; Margaretha H Sagasser; Yvonne F Heerkens; Cees P M van der Vleuten; Maria W G Nijhuis-van der Sanden; Philip J van der Wees Journal: BMC Med Educ Date: 2015-11-12 Impact factor: 2.463