Publications

Books and Chapters

Scholarly Journals--Published

  • Validity Evidence and Scoring Guidelines for Standardized Patient Encounters and Patient Notes from a Multisite Study of Clinical Performance Examinations in Seven Medical Schools PurposeTo examine validity evidence of localgraduation competency examinationscores from seven medical schools usingshared cases and to provide rater trainingprotocols and guidelines for scoringpatient notes (PNs).MethodBetween May and August 2016, clinicalcases were developed, shared, andadministered across seven medicalschools (990 students participated).Raters were calibrated using trainingprotocols, and guidelines weredeveloped collaboratively across sites tostandardize scoring. Data included scoresfrom standardized patient encountersfor history taking, physical examination,and PNs. Descriptive statistics were usedto examine scores from the differentassessment components. Generalizabilitystudies (G-studies) using variancecomponents were conducted to estimatereliability for composite scores.ResultsValidity evidence was collected forresponse process (rater perception),internal structure (variance components,reliability), relations to other variables(interassessment correlations), andconsequences (composite score). Studentperformance varied by case and task.In the PNs, justification of differentialdiagnosis was the most discriminatingtask. G-studies showed that schoolsaccounted for less than 1% of totalvariance; however, for the PNs, therewere differences in scores for varyingcases and tasks across schools, indicatinga school effect. Composite scorereliability was maximized when the PNwas weighted between 30% and 40%.Raters preferred using case-specificscoring guidelines with clear pointscoringsystems.ConclusionsThis multisite study presents validityevidence for PN scores based onscoring rubric and case-specific scoringguidelines that offer rigor and feedbackfor learners. Variability in PN scoresacross participating sites may signaldifferent approaches to teaching clinicalreasoning among medical schools. (11/2017) (link)
  • "Exploring Students' Perceptions of the Educational Value of Formative OSCE in a Nutrition Program" Elaf Farahat, Heather Javaherian-Dysinger, Gail Rice, Louise Schneider, Noha Daher, Nancy Heine J Allied Health 2016; 45(1):20-26 Explored effect of an OSCE as a tool to provide realistic formative experience for nutrition/dietetic students as they prepare for clinical placement. (04/2016) (link)
  • Farahat, E., Rice, G., Daher, N., Heine, N., Schneider, L., & Connell, B. (2015). Objective Structured Clinical Examination (OSCE) Improves Perceived Readiness for Clinical Placement in Nutrition and Dietetic Students. Journal of Allied Health, 44(4), 208-214. It is increasingly difficult to provide adequate clinical training for new dietetics graduates. Dietetic students obtain clinical experience by visiting patients and viewing their charts in hospital settings but rarely counsel them.OBJECTIVE: To examine the change in nutrition and dietetic students' perceived readiness to practice after completing three Objective Structured Clinical Examinations (OSCE). SUBJECTS: 37 students (mean age 26.6±5.4 yrs, 95% female) from the Schools of Public Health and Allied Health Professions enrolled in a medical nutrition therapy course. METHODS: Using a pre-post test design, 37 students completed the first 3 weeks of the laboratory section of the course at the medical center, followed by 3 weeks of OSCE. OSCE stations included reviewing a chart, counseling a standardized patient, and discussing findings with other healthcare professionals. Students answered the Perceived Readiness for Dietetic Practice questionnaire before and after the OSCE. RESULTS: OSCE significantly improved students' mean readiness to practice their role as clinical dietitians (4.9±2.5 vs 5.8±1.9,p=0.03). There was a significant improvement in the professional role (p=0.04) and charting (p=0.01). Students improved in all areas, but not all areas reached statistical significance. Seventy-six percent of students found the OSCE to be superior to the medical center experience, and 78% of students agreed that collaboration with other healthcare professionals helped prepare them for the dietetic role. CONCLUSION: The OSCE experience improved students' perceived clinical skills. The OSCE format can provide a realistic patient experience for dietetic students to develop their patient evaluation and counseling skills. (12/2015) (link)
  • “Loma Linda University School of Medicine” Leonard S. Werner MD, Nancy Heine RN CANP MSEd, Loretta Johns PhD. Academic Medicine, Vol. 85, No. 9/September Supplement 2010. (09/2010) (link)
  • “An Analysis of Standardized Patient Checklist Errors and the Effect on Student Scores”  Nancy Heine, Karen Garman, Peggy Wallace, Rebekah Bartos and Anita Richards. Medical Education 2003; 37:99-104 (01/2003) (link)
  • “Effect of Varying Amounts of Feedback on Standardized Patient Checklist Accuracy in Clinical Practice Examinations”  Peggy Wallace, Nancy Heine, Karen Garman, Rebekah Bartos, Anita Richards.  Teaching and Learning in Medicine, 1999:11(3), 148-152. (11/1999) (link)