***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Although humanism has emerged as an important issue in medical education and practice , there is no st and ardized definition of humanism or an instrument that measures patients ' perceptions of their physician 's level of humanism . This study addressed these three issues : 1 ) A definition of physician humanism was developed based on the current literature ; 2 ) an instrument was design ed that measured patients ' perceptions of humanism in their family physicians ; and 3 ) health outcome variables were measured relative to these perceptions . The design was a cross-sectional survey of 185 r and omly selected patients from two family practice sites . The question naire consisted of a  humanism scale  , in addition to items to assess patient satisfaction and patients ' adherence to medical advice regarding exercise , diet , and smoking cessation .  A positive association was found between perceived physician humanism and patient satisfaction . Greater success in patients ' attempts to quit smoking was associated with higher physician humanism . The implication s of these findings for evaluation and training of health care providers and patients ' use of health care services are discussed Purpose This study explored factors that contribute to objectivity in  objective structured clinical examinations ( OSCEs ) .  The authors quantified the effect of examiners on interrater reliability and separated this effect from that of station construction , determined the effect of objectification on station reliability and validity , and explored examiner factors that may contribute to interrater reliability . Method Data came from examiners ' mark sheets from four annual OSCEs ( 1997–2000 ) . The OSCEs were conducted identically and simultaneously at three sites , within the University of Otago medical school in New Zeal and , with two examiners at each station . The contribution to interrater correlations of station construction and mark sheet compared with examiners ' contribution was partitioned out using a r and om-effects analysis of variance . For one OSCE , a multiple linear regression was used to determine the independent contributions to interrater reliability of the number of checklist items per mark sheet , examiner experience , and examiner involvement in station construction . Results Station construction and mark sheets contributed 10.1 % and examiners contributed 89.9 % to the variation in interrater reliability . Following multivariate analysis , the number of items per mark sheet was negatively associated , and examiner involvement in station construction was positively associated , with interrater reliability . Examiner experience in examining or in clinical medicine was not associated with interrater reliability . There was a negative , but nonsignificant , correlation between number of items per mark sheet and that station 's correlation with the aggregate OSCE mark . Conclusions The contribution of objective mark sheets to objectivity is relatively minor compared with examiners ' contribution . Increasing the number of checklist items per mark sheet decreased both reliability and validity . Achieving objectivity requires diligent examiners who are involved in the whole assessment Existing scales to measure  trust in physicians  have differing content and limited testing . To improve on these measures , a large item pool ( n = 78 ) was generated following a detailed conceptual model and expert review . After pilot testing , the best-performing items were vali date d with a r and om national sample ( n = 9 ) and a regional sample of HMO members ( n = 99 ) . Various psychometric tests produced a 10-item unidimensional scale consistent with most aspects of the conceptual model . Compared with previous scales , the Wake Forest physician trust scale has a somewhat improved combination of internal consistency , variability , and discriminability . The scale is more strongly correlated with satisfaction , desire to remain with a physician , willingness to recommend to friends , and not seeking second opinions ; it is less correlated with insurer trust , membership in managed care , and choice of physician ; and correlations are equivalent with lack of disputes , length of relationship , and number of visits Purpose To explore residents ’ competency in medical knowledge and in empathy , one element of professionalism , and to evaluate the relationship between competencies in these domains . Method In 2003–2004 and 2004–2005 , first-year internal medicine residents at the Mayo Clinic College of Medicine in Rochester , Minnesota were invited to participate in a prospect i ve , longitudinal study of resident competency . Participating residents completed the annual Internal Medicine In-Training Examination ( ITE ) each October and the Interpersonal Reactivity Index ( IRI )  , a st and ardized tool to measure empathy administered at multiple time points during training . Changes in medical knowledge and empathy between the fall of postgraduate years one and two were evaluated , and associations between medical knowledge and empathy were explored . Results Residents ’ medical knowledge as measured by the ITE increased over the first year of training ( mean increase 8.7 points , P < .0001 ) , whereas empathy as measured by the empathic concern subscale of the IRI decreased over this same time period ( mean decrease 1.6 points , P = .0003 ) . No significant correlation was found between medical knowledge and empathy or between changes in these domains of competency over time . Conclusions Resident competency in the domains of medical knowledge and empathy seems to be influenced by separate and independent aspects of training . Training environments may promote competency in one domain while simultaneously eroding competency in another . Residency programs should devise specific curricula to promote each domain of physician competency PURPOSE To evaluate the effectiveness of binary content checklists in measuring increasing levels of clinical competence . METHOD Fourteen clinical clerks , 14 family practice residents , and 14 family physicians participated in two 15-minute st and ardized patient interviews . An examiner rated each participant 's performance using a binary content checklist and a global process rating . The participants provided a diagnosis two minutes into and at the end of the interview . RESULTS On global scales , the experienced clinicians scored significantly better than did the residents and clerks , but on checklists , the experienced clinicians scored significantly worse than did the residents and clerks . Diagnostic accuracy increased for all groups between the two-minute and 15-minute marks without significant differences between the groups . CONCLUSION These findings are consistent with the hypothesis that binary checklists may not be valid measures of increasing clinical competence OBJECTIVE To assess the feasibility and measurement characteristics of ratings completed by professional associates to evaluate the performance of practicing physicians . DESIGN The clinical performance of physicians was evaluated using written question naires mailed to professional associates ( physicians and nurses ) . Physician-associates were r and omly selected from lists provided by both the subjects and medical supervisors , and detailed information was collected concerning the professional and social relationships between the associate and the subject . Responses were analyzed to determine factors that affect ratings and measurement characteristics of  peer ratings . SETTING AND PARTICIPANTS Physician-subjects were selected from among practicing internists in New York , New Jersey , and Pennsylvania who received American Board of Internal Medicine certification 5 to 15 years previously . MAIN OUTCOME MEASURE Physician performance as assessed by peers .  RESULTS  Peer ratings  are not biased substantially by the method of selection of the peers or the relationship between the rater and the subject . Factor analyses suggest a two-dimensional conceptualization of clinical skills : one factor represents cognitive and clinical management skills and the other factor represents humanistic qualities and management of psychosocial aspects of illness . Ratings from 11 peer physicians are needed to provide a reliable assessment in these two areas . CONCLUSIONS These findings suggest that it is feasible to obtain assessment s from professional associates of practicing physicians in areas such as clinical skills , humanistic qualities , and communication skills . Using a shorter version of the question naire used in this study ,  peer ratings  provide a practical method to assess clinical performance in areas such as humanistic qualities and communication skills that are difficult to assess with other measures Purpose To determine whether writing , one-on-one interviews with faculty , or a combination of these interventions effectively elicited reflection on professionalism for medical students . Method The study was a r and omized trial conducted in 2001 at Harborview Medical Center , Seattle , Washington , with fourth-year medical students on a four-week clinical clerkship in emergency medicine . Three interventions were evaluated : the critical incident report ( CIR ) , the CIR followed by a one-on-one interview with a faculty member , and one-on-one interview with no CIR .  Quality and quantity of professional issues raised were addressed . Results All students ( n = 68 ) agreed to participate ; 66 completed the study components . On average , the students addressed significantly more issues of professionalism in their interviews alone than in their CIRs , 15.9 ( 95 % confidence interval [ CI ] 18.2–13.6 ) and 7.15 ( CI 8.88–5.40 ) issues respectively ( p < .0001 ) . Interviews preceded by CIRs were not significantly different from interviews with no CIR ( 13.5 versus 15.9 professionalism issues raised , respectively ) . In-depth explorations , including problem solving and projection to the future , occurred 2.59 times in interviews alone ( CI 3.62–1.56 ) and 0.794 times in CIRs ( CI 1.12–0.46 ) ( p < .001 ) . When analyzed as a proportion of total statements , the groups had similar ratios of in-depth statements ( 11.2 % in CIRs and 15.7 % in interviews alone ) . Conclusion Writing did not significantly affect the quantity or quality of reflection in interviews . One-on-one interviews with a faculty mentor most effectively elicited reflection on professionalism . Future studies should examine how reflective exercises such as those evaluated can be used to promote professional development 
    Output:
    
CONCLUSIONS Professionalism can be assessed using a combination of observed clinical encounters , multi source feedback , patients ' opinions , paper-based tests or simulations , measures of research and /or teaching activities , and scrutiny of self- assessment s compared with assessment s by others .