Birnbaum Alice, McBurnie Mary Ann, Powell Judy, Ottingham Lois Van, Riegel Barbara, Potts Jerry, Hedges Jerris R
Department of Biostatistics, University of Washington, Seattle, WA, PAD Clinical Trial Center, Box 354806, 1107 NE 45th St., Ste. 505, Seattle, WA 98105-4689, USA.
Resuscitation. 2005 Mar;64(3):333-9. doi: 10.1016/j.resuscitation.2004.08.019.
Cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skills competency can be tested using a checklist of component skills, individually graded "pass" or "fail." Scores are typically calculated as the percentage of skills passed, but may differ from an instructor's overall subjective assessment of simulated CPR or AED adequacy.
To identify and evaluate composite measures (methods for scoring checklists) that reflect instructors' subjective assessments of CPR or AED skills performance best.
Associations between instructor assessment and lay-volunteer skill performance were made using 6380 CPR and 3313 AED skill retention tests collected in the Public Access Defibrillation Trial. Checklists included CPR skills (e.g., calling 911, administering compressions) and AED skills (e.g., positioning electrodes, shocking within 90 s of AED arrival). The instructor's subjective overall assessment (adequate/inadequate) of CPR performance (perfusion) or AED competence (effective shock) was compared to composite measures. We evaluated the traditional composite measure (assigning equal weights to individual skills) and several nontraditional composite measures (assigning variable weights). Skills performed out of sequence were further weighted from 0% (no credit) to 100% (full credit).
Composite measures providing full credit for skills performed out of sequence and down-weighting process skills (e.g., calling 911, clearing oneself from the AED) had the strongest association with the instructor's subjective assessment; the traditional CPR composite measure had the weakest association.
Our findings suggest that instructors in public CPR and AED classes may tend to down-weight process skills and to excuse step sequencing errors when evaluating CPR and AED skills subjectively for overall proficiency. Testing methods that relate classroom performance to actual performance in the field and to clinical outcomes require further research.
心肺复苏术（CPR）和自动体外除颤器（AED）技能能力可通过组成技能清单进行测试，单项技能分别评定为“通过”或“未通过”。分数通常计算为通过技能的百分比，但可能与教员对模拟心肺复苏术或自动体外除颤器操作是否充分的整体主观评估有所不同。
识别并评估能最佳反映教员对心肺复苏术或自动体外除颤器技能表现主观评估的综合测量方法（清单评分方法）。
利用在公众可获取除颤试验中收集的6380次心肺复苏术和3313次自动体外除颤器技能保留测试，建立教员评估与非专业志愿者技能表现之间的关联。清单包括心肺复苏术技能（如拨打911、进行按压）和自动体外除颤器技能（如放置电极、在自动体外除颤器到达后90秒内电击）。将教员对心肺复苏术表现（灌注）或自动体外除颤器能力（有效电击）的主观整体评估（充分/不充分）与综合测量方法进行比较。我们评估了传统综合测量方法（对各项技能赋予同等权重）和几种非传统综合测量方法（赋予可变权重）。未按顺序执行的技能进一步加权，从0%（无学分）到100%（满分）。
对未按顺序执行的技能给予满分并降低过程技能（如拨打911、离开自动体外除颤器）权重的综合测量方法与教员的主观评估关联最强；传统的心肺复苏术综合测量方法关联最弱。
我们研究结果表明，在对心肺复苏术和自动体外除颤器技能进行整体熟练程度主观评估时，公共心肺复苏术和自动体外除颤器课程的教员可能倾向于降低过程技能的权重，并原谅步骤顺序错误。将课堂表现与实际现场表现及临床结果相关联的测试方法需要进一步研究。
