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超越检查清单:开发和验证用于床边手术的多维临床能力评估工具
August Longino1, Braidie Campbell2, Eric Grimm3
1August Longino is a Clinician Researcher at Denver Health Medical Center, Denver, CO.
一个新的临床能力评估工具 (CAT) 结合了检查清单,全球技能评估和委托分数,显示了评估居民程序技能的可行性. 这种多维方法提供了比单独的检查清单更准确的能力评估.
科学领域:
- 医学教育 医学教育
- 临床技能评估 临床技能评估
- 患者安全 患者安全
背景情况:
- 住院医生执行关键的床边手术,影响患者的治疗结果.
- 对于独立居民程序的执行,缺乏标准化的国家标准.
- 目前评估程序能力的方法在实用性和可行性方面不清楚.
研究的目的:
- 开发和评估一个多维临床能力评估工具 (CAT) 的可行性和可靠性,用于评估居民的程序性表现.
- 在CAT中比较一个检查清单,全球技能评估 (GSA) 和信任分数 (ES) 的有效性.
主要方法:
- 创建了一个新的CAT,结合了检查清单,GSA和ES,并定义了通过切断线.
- CAT评估了内科实习生进行大体积体 (LVP) 和中央静脉导管插入 (CVC).
- 通过同时对程序进行双重评估来评估评级者之间的可靠性.
主要成果:
- 在观察到的LVP和CVC手术中,CAT被用于29.7%.
- 虽然很高的百分比符合检查清单标准 (85%的LVP,75%的CVC),但很少有人符合GSA (20%的LVP,14%的CVC) 或ES (15%的LVP,7%的CVC) 截止值.
- 评价者之间的可靠性显示了对LVP的强烈同意 (科恩的卡帕=1.0),但对CVC的不同 (87%的同意).
结论:
- 多维CAT是可行和可靠的,用于评估居民的程序能力.
- 单独的检查清单是不够的;将它们与整体分数 (GSA,ES) 结合起来,可以提高能力评估的准确性和通过率.
- 建议采用多种互补的评估方法,以可靠地识别合格的程序性表现.
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