Srinivasan Malathi, Litzelman Debra, Seshadri Roopa, Lane Kathleen, Zhou Wei, Bogdewic Stephen, Gaffney Margaret, Galvin Matt, Mitchell Gary, Treadwell Patricia, Willis Lynn
Department of Medicine, University of California, Davis, School of Medicine, 4150 V. Street, Sacramento, CA 95817, USA.
Acad Med. 2004 Sep;79(9):888-96. doi: 10.1097/00001888-200409000-00017.
To develop an instrument for measuring medical educators' responses to learners' lapses in professional behavior.
In 1999, at the Indiana University School of Medicine, a 22-item checklist of behaviors was developed to describe common responses used by educators responding to learners' lapses in professional behavior. Four medical students were trained to portray lapses in professional behaviors. These students and seven clinical observers trained to categorize behaviors as present or absent. Interrater reliability was assessed during 18 objective structured teaching evaluations (OSTEs). Videotaped OSTEs were coded twice at a one-month interval for test-retest reliability. Items were classified as low, moderate, or high inference behaviors. Script realism and educator effectiveness were assessed.
Educators rated OSTE scripts as realistic. Raters observed an average of 6 +/- 2 educator behaviors in reaction to learners' lapses in professional behavior. Educators' responses were rated as moderately effective. More experienced educators attempted more interventions and were more effective. Agreement was high among raters (86% +/- 7%), while intraclass correlation coefficients decreased with increasing inference level. From videotaped OSTEs, raters scored each behavior identically 86% of the time.
Accurate feedback on educators' interactions in addressing learners' professionalism is essential for faculty development. Traditionally, educators have felt that faculty's responses to learners' lapses in professional behavior were difficult to observe and categorize. These data suggest that educators' responses to learners' lapses in professional behavior can be defined and reliably coded. This work will help provide objective feedback to faculty when engaging learners about lapses in professional behavior.
开发一种用于测量医学教育工作者对学习者职业行为失误反应的工具。
1999年，印第安纳大学医学院制定了一份包含22项行为的清单，以描述教育工作者对学习者职业行为失误的常见反应。培训了四名医学生来表现职业行为失误。这些学生和七名临床观察员接受培训，将行为分类为存在或不存在。在18次客观结构化教学评估（OSTE）中评估评分者间信度。对录像的OSTE进行两次编码，间隔一个月以评估重测信度。项目被分类为低、中或高推断行为。评估脚本真实性和教育工作者有效性。
教育工作者将OSTE脚本评为真实。评分者观察到教育工作者对学习者职业行为失误的平均反应行为为6±2种。教育工作者的反应被评为中等有效。经验更丰富的教育工作者尝试的干预更多且更有效。评分者之间的一致性很高（86%±7%），而组内相关系数随着推断水平的提高而降低。从录像的OSTE中，评分者在86%的时间里对每种行为的评分相同。
对于教师发展而言，提供关于教育工作者在处理学习者职业素养方面互动的准确反馈至关重要。传统上，教育工作者认为教师对学习者职业行为失误的反应难以观察和分类。这些数据表明，教育工作者对学习者职业行为失误的反应可以被定义并可靠地编码。这项工作将有助于在教师与学习者讨论职业行为失误时为教师提供客观反馈。
