Crossley Jim, Eiser Christine, Davies Helena A
Sheffield Children's Hospital, Western Bank, Sheffield S10 2TH, UK.
Med Educ. 2005 Aug;39(8):820-8. doi: 10.1111/j.1365-2929.2005.02230.x.
Only a patient and his or her family can judge many of the most important aspects of the doctor-patient interaction. This study evaluates the feasibility and reliability of children and their families assessing the quality of paediatricians' interactions using a rating instrument developed specifically for this purpose.
A reliability analysis using generalisability theory on the ratings from 352 doctor-patient interactions across different speciality clinics.
Ratings were normally distributed. They were highest for 'overall' performance, and lowest for giving time to discuss the families' agenda. An appropriate sample of adults' ratings provided a reliable score (G = 0.7 with 15 raters), but children's ratings were too idiosyncratic to be reproducible (G = 0.36 with 15 raters). CONCLUSIONS AND FURTHER WORK: Accompanying adults can provide reliable ratings of doctors' interactions with children. Because an adult is usually present at the consultation their ratings provide a highly feasible and authentic approach. Sampling doctors' interactions from different clinics and with patients of both genders provides a universal picture of performance. The method is ideal to measure performance for in-training assessment or revalidation. Further work is in progress to evaluate the educational impact of feeding ratings back to the doctors being assessed, and their use in a range of clinical contexts.
只有患者及其家属能够评判医患互动中许多最重要的方面。本研究使用专门为此目的开发的评分工具，评估儿童及其家属对儿科医生互动质量进行评估的可行性和可靠性。
运用概化理论对不同专科门诊的352次医患互动评分进行信度分析。
评分呈正态分布。“总体”表现评分最高，留出时间讨论家庭议程的评分最低。适量的成人评分样本能提供可靠分数（15名评分者时G = 0.7），但儿童评分过于独特，无法重复（15名评分者时G = 0.36）。结论与进一步工作：陪同的成人能够对医生与儿童的互动提供可靠评分。由于通常有成人陪同就诊，他们的评分提供了一种高度可行且真实的方法。从不同诊所及不同性别的患者中抽取医生互动样本，可全面了解其表现。该方法非常适合用于培训期间评估或再认证的表现测量。目前正在开展进一步工作，以评估将评分反馈给被评估医生所产生的教育影响，以及在一系列临床环境中的应用情况。
