Training trainers in risk assessment

1997 ◽  
Vol 170 (S32) ◽  
pp. 35-36 ◽  
Author(s):  
Michael Harris

Risk assessment has always been an essential part of all medical practice, and doctors have always been trained to make rapid assessment of risk. Much of the early training of doctors in both medicine and surgery centres on risk assessment. However, the method of acquiring that knowledge is predominantly through the apprenticeship model with observation by the trainee of the trainer's decision-making process. Those decisions, however, are often skewed and biased by a whole variety of influences, rather than always being based on scientific evidence. Clearly the increasing influence of evidence-based medicine will help this. At one extreme, however, there are heroic surgeons taking unnecessary risk or taking on cases which might more appropriately have been left without treatment, and at the other extreme, consultants who may feel demoralised or depressed might well become nihilistic about medicine and therefore might not attempt to treat cases that are treatable.

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisanne S. Welink ◽  
Kaatje Van Roy ◽  
Roger A. M. J. Damoiseaux ◽  
Hilde A. Suijker ◽  
Peter Pype ◽  
...  

Abstract Background Evidence-based medicine (EBM) in general practice involves applying a complex combination of best-available evidence, the patient’s preferences and the general practitioner’s (GP) clinical expertise in decision-making. GPs and GP trainees learn how to apply EBM informally by observing each other’s consultations, as well as through more deliberative forms of workplace-based learning. This study aims to gain insight into workplace-based EBM learning by investigating the extent to which GP supervisors and trainees recognise each other’s EBM behaviour through observation, and by identifying aspects that influence their recognition. Methods We conducted a qualitative multicentre study based on video-stimulated recall interviews (VSI) of paired GP supervisors and GP trainees affiliated with GP training institutes in Belgium and the Netherlands. The GP pairs (n = 22) were shown fragments of their own and their partner’s consultations and were asked to elucidate their own EBM considerations and the ones they recognised in their partner’s actions. The interview recordings were transcribed verbatim and analysed with NVivo. By comparing pairs who recognised each other’s considerations well with those who did not, we developed a model describing the aspects that influence the observer’s recognition of an actor’s EBM behaviour. Results Overall, there was moderate similarity between an actor’s EBM behaviour and the observer’s recognition of it. Aspects that negatively influence recognition are often observer-related. Observers tend to be judgemental, give unsolicited comments on how they would act themselves and are more concerned with the trainee-supervisor relationship than objective observation. There was less recognition when actors used implicit reasoning, such as mindlines (internalised, collectively reinforced tacit guidelines). Pair-related aspects also played a role: previous discussion of a specific topic or EBM decision-making generally enhanced recognition. Consultation-specific aspects played only a marginal role. Conclusions GP trainees and supervisors do not fully recognise EBM behaviour through observing each other’s consultations. To improve recognition of EBM behaviour and thus benefit from informal observational learning, observers need to be aware of automatic judgements that they make. Creating explicit learning moments in which EBM decision-making is discussed, can improve shared knowledge and can also be useful to unveil tacit knowledge derived from mindlines.


Criminology ◽  
2021 ◽  
Author(s):  
James C. Oleson

The evidence-based practice (EBP) movement can be traced to a 1992 article in the Journal of the American Medical Association, although decision-making with empirical evidence (rather than tradition, anecdote, or intuition) is obviously much older. Neverthless, for the last twenty-five years, EBP has played a pivotal role in criminal justice, particularly within community corrections. While the prediction of recidivism in parole or probation decisions has attracted relatively little attention, the use of risk measures by sentencing judges is controversial. This might be because sentencing typically involves both backward-looking decisions, related to the blameworthiness of the crime, as well as forward-looking decisions, about the offender’s prospective risk of recidivism. Evidence-based sentencing quantifies the predictive aspects of decision-making by incorporating an assessment of risk factors (which increase recidivism risk), protective factors (which reduce recidivism risk), criminogenic needs (impairments that, if addressed, will reduce recidivism risk), the measurement of recidivism risk, and the identification of optimal recidivism-reducing sentencing interventions. Proponents for evidence-based sentencing claim that it can allow judges to “sentence smarter” by using data to distinguish high-risk offenders (who might be imprisoned to mitigate their recidivism risk) from low-risk offenders (who might be released into the community with relatively little danger). This, proponents suggest, can reduce unnecessary incarceration, decrease costs, and enhance community safety. Critics, however, note that risk assessment typically looks beyond criminal conduct, incorporating demographic and socioeconomic variables. Even if a risk factor is facially neutral (e.g., criminal history), it might operate as a proxy for a constitutionally protected category (e.g., race). The same objectionable variables are used widely in presentence reports, but their incorporation into an actuarial risk score has greater potential to obfuscate facts and reify underlying disparities. The evidence-based sentencing literature is dynamic and rapidly evolving, but this bibliography identifies sources that might prove useful. It first outlines the theoretical foundations of traditional (non-evidence-based) sentencing, identifying resources and overviews. It then identifies sources related to decision-making and prediction, risk assessment logic, criminogenic needs, and responsivity. The bibliography then describes and defends evidence-based sentencing, and identifies works on sentencing variables and risk assessment instruments. It then relates evidence-based sentencing to big data and identifies data issues. Several works on constitutional problems are listed, the proxies problem is described, and sources on philosophical issues are described. The bibliography concludes with a description of validation research, the politics of evidence-based sentencing, and the identification of several current initiatives.


2016 ◽  
Vol 14 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Eduardo Rocha Dias ◽  
Geraldo Bezerra da Silva Junior

ABSTRACT Objective To analyze, from the examination of decisions issued by Brazilian courts, how Evidence-Based Medicine was applied and if it led to well-founded decisions, searching the best scientific knowledge. Methods The decisions made by the Federal Courts were searched, with no time limits, at the website of the Federal Court Council, using the expression “Evidence-Based Medicine”. With regard to decisions issued by the court of the State of São Paulo, the search was done at the webpage and applying the same terms and criterion as to time. Next, a qualitative analysis of the decisions was conducted for each action, to verify if the patient/plaintiff’s situation, as well as the efficacy or inefficacy of treatments or drugs addressed in existing protocols were considered before the court granted the provision claimed by the plaintiff. Results In less than one-third of the decisions there was an appropriate discussion about efficacy of the procedure sought in court, in comparison to other procedures available in clinical guidelines adopted by the Brazilian Unified Health System (Sistema Único de Saúde) or by private health insurance plans, considering the individual situation. The majority of the decisions involved private health insurance plans (n=13, 68%). Conclusion The number of decisions that did consider scientific evidence and the peculiarities of each patient was a concern. Further discussion on Evidence-Based Medicine in judgments involving public healthcare are required.


2011 ◽  
Vol 35 (11) ◽  
pp. 413-418 ◽  
Author(s):  
Matthew M. Large ◽  
Olav B. Nielssen

SummaryRisk assessment has been widely adopted in mental health settings in the hope of preventing harms such as violence to others and suicide. However, risk assessment in its current form is mainly concerned with the probability of adverse events, and does not address the other component of risk – the extent of the resulting loss. Although assessments of the probability of future harm based on actuarial instruments are generally more accurate than the categorisations made by clinicians, actuarial instruments are of little assistance in clinical decision-making because there is no instrument that can estimate the probability of all the harms associated with mental illness, or estimate the extent of the resulting losses. The inability of instruments to distinguish between the risk of common but less serious harms and comparatively rare catastrophic events is a particular limitation of the value of risk categorisations. We should admit that our ability to assess risk is severely limited, and make clinical decisions in a similar way to those in other areas of medicine – by informed consideration of the potential consequences of treatment and non-treatment.


2007 ◽  
Vol 15 (3) ◽  
pp. 508-511 ◽  
Author(s):  
Cristina Mamédio da Costa Santos ◽  
Cibele Andrucioli de Mattos Pimenta ◽  
Moacyr Roberto Cuce Nobre

Evidence based practice is the use of the best scientific evidence to support the clinical decision making. The identification of the best evidence requires the construction of an appropriate research question and review of the literature. This article describes the use of the PICO strategy for the construction of the research question and bibliographical search.


2009 ◽  
Vol 24 (4) ◽  
pp. 298-305 ◽  
Author(s):  
David A. Bradt

AbstractEvidence is defined as data on which a judgment or conclusion may be based. In the early 1990s, medical clinicians pioneered evidence-based decision-making. The discipline emerged as the use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine required the integration of individual clinical expertise with the best available, external clinical evidence from systematic research and the patient's unique values and circumstances. In this context, evidence acquired a hierarchy of strength based upon the method of data acquisition.Subsequently, evidence-based decision-making expanded throughout the allied health field. In public health, and particularly for populations in crisis, three major data-gathering tools now dominate: (1) rapid health assessments; (2) population based surveys; and (3) disease surveillance. Unfortunately, the strength of evidence obtained by these tools is not easily measured by the grading scales of evidence-based medicine. This is complicated by the many purposes for which evidence can be applied in public health—strategic decision-making, program implementation, monitoring, and evaluation. Different applications have different requirements for strength of evidence as well as different time frames for decision-making. Given the challenges of integrating data from multiple sources that are collected by different methods, public health experts have defined best available evidence as the use of all available sources used to provide relevant inputs for decision-making.


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