Brett-Fleegler Marisa B, Vinci Robert J, Weiner Debra L, Harris Sion Kim, Shih Mei-Chiung, Kleinman Monica E
Division of Emergency Medicine, Main South Basement, Room CB0120, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115, USA.
Pediatrics. 2008 Mar;121(3):e597-603. doi: 10.1542/peds.2005-1259. Epub 2008 Feb 18.
Competency in pediatric resuscitation is an essential goal of pediatric residency training. Both the exigencies of patient care and the Accreditation Council for Graduate Medical Education require assessment of this competency. Although there are standard courses in pediatric resuscitation, no published, validated assessment tool exists for pediatric resuscitation competency.
The purpose of this work was to develop a simulation-based tool for the assessment of pediatric residents' resuscitation competency and to evaluate the tool's reliability and preliminarily its validity in a pilot study.
We developed a 72-question yes-or-no questionnaire, the Tool for Resuscitation Assessment Using Computerized Simulation, representing 4 domains of resuscitation competency: basic resuscitation, airway support, circulation and arrhythmia management, and leadership behavior. We enrolled 25 subjects at each of 5 different training levels who all participated in 3 standardized code scenarios using the Laerdal SimMan universal patient simulator. Performances were videotaped and then reviewed by 2 independent expert raters.
The final version of the tool is presented. The intraclass correlation coefficient between the 2 raters ranged from 0.70 to 0.76 for the 4 domain scores and was 0.80 for the overall summary score. Between the 2 raters, the mean percent exact agreement across items in each domain ranged from 81.0% to 85.1% and averaged 82.1% across all of the items in the tool. Across subject groups, there was a trend toward increasing scores with increased training, which was statistically significant for the airway and summary scores.
In this pilot study, the Tool for Resuscitation Assessment Using Computerized Simulation demonstrated good interrater reliability within each domain and for summary scores. Performance analysis shows trends toward improvement with increasing years of training, providing preliminary construct validity.
儿科复苏能力是儿科住院医师培训的一项重要目标。患者护理的紧急需求以及毕业后医学教育认证委员会都要求对这一能力进行评估。尽管有儿科复苏的标准课程，但尚无已发表的、经过验证的儿科复苏能力评估工具。
本研究旨在开发一种基于模拟的工具，用于评估儿科住院医师的复苏能力，并在一项试点研究中评估该工具的可靠性及初步有效性。
我们开发了一份包含72个是非题的问卷——《计算机模拟复苏评估工具》，该问卷代表复苏能力的4个领域：基本复苏、气道支持、循环与心律失常管理以及领导行为。我们招募了处于5个不同培训水平的受试者，每个水平25人，他们均使用Laerdal SimMan通用患者模拟器参与3个标准化的模拟急救场景。操作过程被录像，然后由2名独立的专家评分者进行评估。
展示了该工具的最终版本。两位评分者之间，4个领域分数的组内相关系数在0.70至0.76之间，总体汇总分数的组内相关系数为0.80。两位评分者之间，每个领域各项的平均完全一致百分比在81.0%至85.1%之间，该工具所有项目的平均完全一致百分比为82.1%。在各受试者组中，随着培训增加有分数上升的趋势，这在气道分数和汇总分数方面具有统计学意义。
在这项试点研究中，《计算机模拟复苏评估工具》在每个领域以及汇总分数方面均显示出良好的评分者间可靠性。绩效分析表明随着培训年限增加有改善趋势，提供了初步的结构效度。
