Ram P, Grol R, Rethans J J, Schouten B, van der Vleuten C, Kester A
Centre for Quality Research, Universities of Maastricht and Nijmegen, The Netherlands.
Med Educ. 1999 Jun;33(6):447-54. doi: 10.1046/j.1365-2923.1999.00348.x.
To develop a video assessment method for General Practitioners (GPs) by analysing issues of validity, reliability and feasibility of observation of videotaped regular consultations.
In a cross-sectional study consultations of 93 GPs were video recorded in the practice during 1 week. The GPs registered consultation and patient data in a logbook; 16 consultations per GP were selected using preset criteria. The quality of communicative and medical performance of these consultations was assessed by GP observers with a validated instrument. The validity of the procedure was evaluated by checking the content of each GP's sample using specific sample criteria. Selection bias was estimated by multiple regression analysis, with sample characteristics as independent variables and scores on communication and medical performance as dependent variables. The influence of observation on GPs and patients was assessed by a questionnaire. Generalizability theory was used to estimate reliability. Feasibility was assessed by conducting a questionnaire, by keeping accounts, and by checking the technical quality of the videotaped consultations.
Universities of Nijmegen and Maastricht, The Netherlands.
General Practitioners (GPs).
The domain of general practice was well covered in the samples; content validity was satisfactory. With regard to the sample characteristics, only the total duration of consultations appeared to correlate significantly with both the score on communication and the score on medical performance. A majority (71%) of GPs reported not being influenced by the observation, except in the first cases, and recognizing their usual daily performance in the videotaped consultations. An acceptable level of reliability was reached after 2.5 hours of observation, i.e. 12 cases by a single observer. The method was well accepted by both GPs and patients. The costs were pound250 per GP.
Video assessment of GPs in daily practice according to the procedures described is a valid and reliable method, one which is useful for education and quality improvement. There is a trade-off between feasibility on one hand and validity, reliability and credibility on the other hand. Compared to investments in observation methods in standardized settings, the costs of video observation of GPs' actual performance are acceptable.
通过分析视频记录的常规诊疗观察的有效性、可靠性和可行性，为全科医生（GPs）开发一种视频评估方法。
在一项横断面研究中，93名全科医生在1周内的诊疗过程被录像。全科医生在日志中记录诊疗和患者数据；根据预设标准从每位全科医生的诊疗中选取16次进行分析。这些诊疗的沟通和医疗表现质量由全科医生观察者使用经过验证的工具进行评估。通过使用特定样本标准检查每位全科医生样本的内容来评估该程序的有效性。通过多元回归分析估计选择偏倚，将样本特征作为自变量，沟通和医疗表现得分作为因变量。通过问卷调查评估观察对全科医生和患者的影响。使用概化理论估计可靠性。通过问卷调查、记账以及检查录像诊疗的技术质量来评估可行性。
荷兰奈梅亨大学和马斯特里赫特大学。
全科医生（GPs）。
样本很好地涵盖了全科医疗领域；内容效度令人满意。关于样本特征，只有诊疗的总时长似乎与沟通得分和医疗表现得分均显著相关。大多数（71%）全科医生报告除了最初的病例外，未受到观察的影响，并在录像诊疗中认识到自己日常的表现。在观察2.5小时（即一名观察者观察12个病例）后达到了可接受的可靠性水平。该方法得到了全科医生和患者的良好接受。每位全科医生的成本为250英镑。
按照所述程序对全科医生日常诊疗进行视频评估是一种有效且可靠的方法，对教育和质量改进有用。一方面是可行性，另一方面是有效性、可靠性和可信度之间存在权衡。与在标准化环境中观察方法的投入相比，对全科医生实际表现进行视频观察的成本是可以接受的。
