Ringsted C, Østergaard D, Ravn L, Pedersen J A, Berlac P A, van der Vleuten C P M
Copenhagen Hospital Corporation, Postgraduate Medical Institute, Bispebjerg Hospital, Copenhagen, Denmark.
Med Teach. 2003 Nov;25(6):654-8. doi: 10.1080/01421590310001605642.
This study evaluated the feasibility of two different scoring forms for assessing the clinical performance of residents in anaesthesiology. One of the forms had a checklist format including task-specific items and the other was a global rating form with general dimensions of competence including 'clinical skills', 'communication skills' and 'knowledge'. Thirty-two clinicians representing 25 (83%) of the 30 training hospitals in the country participated in the study. The clinicians were randomized into two groups, each of which used one of the scoring formats to assess a resident's performance in four simulated clinical scenarios on videotape. Clinicians' opinions about the appropriateness of the scoring forms were rated on a scale of 1-5. The checklist format was rated significantly higher compared with the global rating form (mean 4.6, 0.5 vs. mean 3.5, 1.4, p < 0.001). The inter-rater agreement regarding pass/fail decisions was poor irrespective of the scoring form used. This was explained by clinicians' leniency as assessors rather than by lack of vigilance in the observations or disagreements on standards for good performance.
本研究评估了两种不同评分形式用于评估麻醉学住院医师临床能力的可行性。其中一种形式为包含特定任务项目的检查表格式,另一种是具有“临床技能”“沟通技能”和“知识”等总体能力维度的整体评分表。代表该国30家培训医院中25家(83%)的32名临床医生参与了该研究。这些临床医生被随机分为两组,每组使用其中一种评分形式,通过观看录像对一名住院医师在四个模拟临床场景中的表现进行评估。临床医生对评分形式适宜性的意见按1至5分进行评分。检查表格式的评分显著高于整体评分表(平均分4.6, 标准差0.5 对比 平均分3.5, 标准差1.4, p < 0.001)。无论使用哪种评分形式,评估者之间关于及格/不及格判定的一致性都很差。这是由于临床医生作为评估者较为宽松,而非观察时不够警觉或对良好表现的标准存在分歧。