Performance of Emergency Department (ED) physicians (MDs) is multi-faceted since it impacts multiple dimensions such as health outcomes of patients, utilization of resources, throughput of patients and timeliness of care. Therefore, the assessment of their performance demands the use of a tool that allows considering multiple evaluation criteria. However, commonly used multi-criteria evaluation methods often require assigning weights to dimensions in order to define their relative importance on a final performance score. This feature introduces subjectivity in the development of weights and has the potential to produce biased results. The purpose of this thesis research is to develop a multi-dimensional evaluation tool for evaluating performance of ED MDs. The proposed evaluation tool relies on a mathematical programming model known as Data Envelopment Analysis (DEA). The use of DEA does not ask for subjective weighting assignments for each dimension that describe the ED MDs’ performance. It is capable of considering multiple heterogeneous performance measures to identify benchmark practice and the individual improvements leading to best practice of each evaluated unit. The DEA model described here was developed from real data to assess the performance of 20 PED MDs from the Children’s Hospital of Eastern Ontario (CHEO). Multiple evaluations were run on stratified data in order to identify benchmark practice in each of seven categories of patients’ complaints and to determine the impact of accompanying MD trainees on PED MDs’ performance. For each PED MD, performance scores and improvements in each category of patients’ complaints (i.e. respiratory, trauma, abdominal, fever, gastroenterology, allergy and Ear-Nose-Throat complaints) were determined. This helped identifying the required improvements that would lead PED MDs to achieve benchmark performance. Regarding the influence of MD trainees on PED MDs’ performance, results show that most PED MDs (15 out of 20) perform better when they are not accompanied by a trainee which motivates further research to assess trade-offs between teaching and clinical performance. In summary, DEA proved to be an appropriate tool for performance evaluation of PED MDs because it helped to identify benchmark performers and provided information for performance improvements under a multi dimensional performance evaluation framework.

<p>Since the anecdotal assumption is that GPs do not effectively diagnose and manage problem drinking amongst their patients, this study investigated the role of GPs in addressing problem drinking in Cape Town as well as the prevalence of problem drinking amongst their patients.</p>

Communication skills are essential to the practice of medicine, and are now included in most medical curricula. Training in communication skills requires an experiential approach to teaching and assessment that focuses on mastery of performance. Simulated patients were introduced to the Communication Skills course for third year medical students at The University of Melbourne in 1995. This thesis describes the evaluation from the first two years of their use, and is set within the body of literature regarding this innovative educational method. The fundamental research question was: Did the introduction of simulated patients represent an improvement and enrichment in the teaching of communication skills to third year medical students? A qualitative evaluation was undertaken by focus groups with students, tutors and simulated patients, and by student questionnaire. (For complete abstract open document)

Good medical care depends on effective communication between patient and health professional. Misunderstandings can occur in any medical setting but can be further compounded by language and cultural factors in those interactions which occur in a cross-cultural context. The medical consultation is an institutional interaction and as such can involve additional, taken-for-granted evaluative and interpretive criteria which are applied by interactants automatically, without conscious reflection. Non-native speakers who may have a good functional control of the language and have few problems at the level of propositional content may experience significant difficulties at the necessary interpretative level. / Questions act to allow the questioner a degree of interactional control and when patients ask questions they not only increase their access to information but also indicate to the doctor that they wish to play a more active role in the consultation. This thesis examines the discourse of doctor-patient interactions and in particular the ways in which questions are framed and presented by patients and, because the patients in this case are children, their parents. Fifty three medical consultations were observed from both public and private pediatric clinics with patients and their parents comprising 33 native and 20 non-native speakers of English. Data for the study comprise 28 of those consultations. The data include post-consultation interviews with patients and their parents, and interviews with the treating doctors. / The analysis indicates that there are considerable differences in the patterns of questioning behaviour of native speakers and non-native speakers, and that the questioning behaviour of patients and parents seems to be influenced by the communication style of the doctor. / These findings indicate that the questioning behaviour of non-native speaking parents in medical consultations has the potential to lead to less access to information, fewer explanations about their child's condition and a less active role overall in the medical consultation. This in turn can lead to different outcomes for those parents such as lower levels of satisfaction and, potentially, lower levels of compliance with medical advice and directives. These findings also indicate that the needs of non-native speakers in such circumstances are more successfully addressed by a doctor-centred approach. / Finally, this study argues that the observed differences in the patterns of questioning behaviour between native speakers and non-native speakers is more than simple lack of linguistic resources but rather is a result of the clash between the often subtle differences in communicative competence of non-native speakers and the specialised inferential frameworks inherent in institutional discourse.

Thesis (Ph.D.)--McMaster University, 2003. / Advisor: Elisabeth Boetzkes Gedge. Includes bibliographical references (leaves 189-198). Also available via World Wide Web.

Thesis (M.S.)--University of Nevada, Reno, 2007. / "May 2007." Includes bibliographical references (leaves 38-41). Online version available on the World Wide Web. Library also has microfilm. Ann Arbor, Mich. : ProQuest Information and Learning Company, [2007]. 1 microfilm reel ; 35 mm.

Diss. Linköping : Univ.

Thesis (Ph.D.)--University of Central Florida, 2008. / Advisers: Edward H. Robinson, III, Glenn Lambie. Includes bibliographical references (p. 134-155).

Thesis (Ph. D.)--University of Washington, 1997. / Vita. Includes bibliographical references (leaves [99]-103).

Thesis (doctoral)--Friedrich-Wilhelm-Universität Bonn.