评估EMS临床判断理论框架的应用
Nicole T McAllister1, Nadine L McBride2, Hussam E Salhi1
1Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Prehospital emergency care
|September 23, 2024
概括
在紧急医疗服务 (EMS) 中评估临床判断 (CJ) 的新标题显示,与专家评估的高度一致. 这个工具可以客观地评估EMS提供商的推理和决策,以培训和能力.
科学领域:
- 紧急医疗服务 (EMS)
- 临床判断 (CJ) 临床判断
- 医疗模拟 医疗模拟
背景情况:
- 临床判断 (CJ) 在紧急医疗服务 (EMS) 中至关重要,涉及临床推理和决策.
- 对于EMS CJ存在一个理论模型,但需要在培训和评估环境中进行评估.
- 客观地评估CJ对于确保有能力的EMS提供商至关重要.
研究的目的:
- 评估理论EMSCJ模型在评估临床推理和决策方面的表现.
- 为了确定客观标题的可靠性和有效性,用于在模拟环境中评估EMS临床判断.
主要方法:
- 在家庭环境中,EMS临床医生团队 (2-3名成员) 管理了一个模拟的老年人跌倒场景.
- 模拟被视频录制和编码;临床判断被评估使用两种方法:EMS医疗总监 (MD) 评分和基于EMSCJ模型的客观标题评分.
- 该标题侧重于提示识别,行动绩效和行动后再评估,评估四个关键的CJ问题.
主要成果:
- 临床判断决策的MD分数和标签分数之间的总体一致性为88.1%,超过了70%的有效度值.
- 对于特定的CJ问题,一致性在79.9%至95.0%之间,表明在临床判断的不同方面有很强的一致性.
- 客观标题显示了与主观专家评估的高度一致.
结论:
- 一个客观的评估标题,从理论的EMSCJ框架中得出的,显示高一致性与主观的EMSMD评估.
- 这种基于标题的方法提供了一种可重复和客观的方法来评估EMS中的临床判断.
- 结果表明,这种方法可以有效地用于EMS培训和实践中的能力评估.
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