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Glossary of Medical Terms

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Case Management
Coordination of services to help meet a patient's health care needs, usually when the patient requires multiple services from multiple providers. This term is also used to refer to coordination of care during and after a hospital stay.

Certification
The process by which governmental, non-governmental or professional organizations or other statutory bodies grant recognition to an individual who has met certain predetermined specified qualifications. In most cases such recognition is on a voluntary basis.

Chart Stimulated Recall Oral Examination (CSR)
A measurement tool for assessing clinical decision-making and the application of medical knowledge using actual patients and a standardized oral examination. A trained and experienced physician/examiner questions the examinee about the provided care, probing for the reasons behind the work-up diagnoses, interpretation of clinical findings and treatment plans. The examiners rate the examinee using an established protocol and scoring procedure. In an efficiently designed CSR, each patient case (test item) takes 5 to 10 minutes. A typical CSR exam involves one or two physicians as examiners per separate 30 to 60-minute sessions. The examinee's performance is measured by combining scores from all the cases tested for a pass/fail decision overall, or by scoring for each session. Exam score reliabilities have been reported between 0.65 and 0.88. In assessing recall ability or medical knowledge, multiple-choice questions (MCQ) are more effective than CSR exams.

Checklist Evaluation
A method that is useful for assessing any competency or competency component that can be broken down into specific behaviors or actions. To obtain consistent scores and satisfactory reliability of observed performance using checklists, trained evaluators are required. To ensure the validity of content and scoring rules, checklist development requires consensus by several experts on the essential behaviors, actions and criteria for evaluating performance. The usefulness of checklists is well documented for evaluation of patient care skills (history and physical examination) and interpersonal and communication skills. Checklists have also been used for self-assessment of practice-based learning skills, and in addition are very useful in providing feedback on performance.

Clerkships
A rotation around the clinical settings of the medical school. Some clerkships are obligatory (e.g., internal medicine, pediatrics, surgery), while others are elective or selective. In the United States, medical students do clerkships in their third and fourth year while in Europe, this typically occurs in the fourth through sixth year of medical school.

Clinical Competence
The mastery of relevant knowledge and the acquisition of a range of relevant skills at a satisfactory level including interpersonal, clinical and technical components at a certain point of education, such as at graduation. In the case of clinical training, which is primarily based on an apprenticeship model, teachers define what the student is expected to do and then test their ability to do it. However, in actuality, most clinical actions are concerned with problems for which there are no clear answers and no single solution. In such situations, an experienced doctor searches his or her mind and sifts through a wide range of options and in some cases the solution will be something he or she has never arrived at before. Therefore, competence itself is only of value as a prerequisite for performance in a real clinical setting and does not always correlate highly with performance in practice.

Clinical Oral Examination (COE)
Unstructured clinical and oral examination which is the traditional form of clinical examination and continues to be popular in many parts of the world. With face-to-face contact, examiners explore both the breadth and depth of a student's understanding in real-life clinical situations. Aspects of competence which can be tested include the ability to respond to new information, a variety of interpersonal skills, and those aspects of competence that cannot be easily measured by more objective methods, such as an OSCE . Case variability can be reduced by recruiting a small group of patients with the same condition and similar symptoms or by the use of simulated patients. The use of videotapes of students undertaking a long-case examination with subsequent scoring of the performance by the examiner, who then discusses the results with the examinee, enhances the value of this form of examination. Proper briefing and training of examiners and a very structured approach to scoring contribute to the quality of this exam.

Communication
The process by which information and feelings are shared by people through an exchange of verbal and non-verbal messages. In the context of medical education, its primary function is to establish understanding between patient and doctor. In an atmosphere of effective communication, patients improve faster, cope better with post-operative pain, require less psychotropic drugs, and experience numerous other health benefits.

Communication Skills
Proficiency in the interchange of information. These are essential skills for clinical practitioners because of the large and varied number of people they must communicate with every day. The idea that doctors automatically learn communication through experience or that doctors are inherently either good or bad communicators is being largely abandoned. It is now widely believed that such skills can be taught to both students and doctors by a variety of professionals including doctors and specialists in communication skills as an important part of undergraduate as well as postgraduate and continuing medical education.

Community
A group of individuals living together in some form of social organization with cohesion in planning and operation and/or manifesting some unifying trait or common interest. In health care organization, it refers to the most local level of the health system. The form of services provided to a locality will vary according to each country's political, economic, social, cultural and epidemiological patterns.

Community Diagnosis
Appraisal of the health status of a community in general or limited to specific health conditions, determinants or subgroups.

Community Medicine
The specialty that deals with the health and disease of a population or of a specified community. The goal is to identify health problems and needs, to identify means by which these needs may be met, and to evaluate the extent to which health services do so. Community medicine is concerned with specified populations rather than individuals.

Community-Based Education (CBE), Community-Based Learning (CBL), or Community-Based Teaching (CBT)
A form of instruction where trainees learn professional competencies in a community setting focusing on population groups and also individuals and their everyday problems. The amount of time students spend in the community and organizational settings may vary. Instruction may take place at a general practice, family planning clinic, community health center or a rural hospital. During their training in the community, students learn about social and economic aspects of illness, about health services in the community and methods of health promotion, about working in teams, and about frequency and types of problems encountered outside a hospital setting.

Competence
Possession of a satisfactory level of relevant knowledge and acquisition of a range of relevant skills that include interpersonal and technical components at a certain point in the educational process. Such knowledge and skills are necessary to perform the tasks that reflect the scope of professional practices. Competence may differ from "performance", which denotes actions taken in a real life situation. Competence is therefore not the same as "knowing" on the contrary, it may well be about recognizing one's own limits. The more experienced the professional being tested, the more difficult it is to create a tool to assess their actual understandings and the complex skills of the tasks they undertake. A holistic integration of understandings, abilities and professional judgments i.e. a "generic" model, is one where competence is not necessarily directly observable, but rather can be inferred from performance.

Constructed Response Questions
A method of written examination in which examinees are required to construct their responses as opposed to selecting them from a set of options.

Continuing Medical Education (CME)
A continuous process of acquiring new knowledge and skills throughout one's professional life. As undergraduate and postgraduate education is insufficient to ensure lifelong physicians' competencies, it is essential to maintain the competencies of physicians, to remedy gaps in skills, and to enable professionals to respond to the challenges of rapidly growing knowledges and technologies, changing health needs and the social, political and economic factors of the practice of medicine. Continuing medical education depends highly upon learner motivation and self-directed learning skills.

Cost-Benefit Analysis
A comparison of all the costs and benefits of a given activity or program expressed in monetary terms. It is used for the allocation of funds in health care services. This form of analysis permits one to measure the costs for reaching particular objectives. In the case of health programs, benefits are often difficult to express in monetary terms, and furthermore, benefits may extend beyond the achievement of the desired effect, which makes such evaluation difficult.

Cost-Containment
Measures taken to control or restrict medical care expenditures or to reduce the rate of their growth. This includes a broad range of cost control mechanisms e.g. limiting budgets, cost-sharing, regulation of supply of services and staff, patients' waiting lists, exclusion of certain people from entitlement to services, standard costing, privatization, and managed competition.

Cost-Effectiveness Analysis
A method for evaluating the relationship between the cost and the effectiveness of an activity or to compare similar or alternative activities to determine the relative degree to which they will produce the desired objectives or outcomes. The degree of effectiveness is understood to be the extent to which a given activity or program contributes to attaining the objectives of reducing the dimension of a problem or improving an unsatisfactory situation. The preferred action is the one that requires the least cost to produce a given level of effectiveness. In the health care field, the cost is expressed in monetary terms but the consequences may be expressed in physical units such as healthy life-years gained, the number of cases of disease detected or the improvement in health status of a population.

Cost-Efficiency Analysis
A method for evaluating program or activity efficiency such as the extent to which resources are being used as productively as possible. In health care, it measures medical services provided in relation to their cost. This enables comparison between different health care providers.

Curriculum
An educational plan that spells out which goals and objectives should be achieved, which topics should be covered and which methods are to be used for learning, teaching and evaluation.