McKinley Robert K, Strand Janice, Ward Linda, Gray Tracey, Alun-Jones Tom, Miller Helen
Keele University School of Medicine, Keele University, Keele, UK.
Med Educ. 2008 Apr;42(4):338-49. doi: 10.1111/j.1365-2923.2007.02970.x.
To develop generic criteria for the global assessment of clinical procedural competence and to quantify the extent to which existing checklists allow for holistic assessment of procedural competencies.
We carried out a systematic review and qualitative analysis of published clinical procedural skills assessment checklists and enumerated the contents of each. Source materials included all English-language papers published from 1990 to June 2005, identified from 18 databases, which described or referred to an assessment document for any clinical procedural skill. A pair of reviewers identified key generic themes and sub-themes through in-depth analysis of a subset of 20 checklists with iterative agreement and independent retesting of a coding framework. The resulting framework was independently applied to all checklists by pairs of reviewers checking for the emergence of new themes and sub-themes. Main outcome measures were identification of generic clinical procedural skills and the frequency of occurrence of each in the identified checklists.
We identified 7 themes ('Procedural competence', represented in 85 [97%] checklists; 'Preparation', 65 [74%]; 'Safety', 45 [51%]; 'Communication and working with the patient', 32 [36%]; 'Infection control', 28 [32%]; 'Post-procedural care', 24 [27%]; 'Team working', 13 [15%]) and 37 sub-themes, which encapsulated all identified checklists. Of the sub-themes, 2 were identified after the initial coding framework had been finalised.
It is possible to develop generic criteria for the global assessment of clinical procedural skills. A third and a half of checklists, respectively, do not enable explicit assessment of the key competencies 'Infection control' and 'Safety'. Their assessment may be inconsistent in assessments which use such checklists.
制定临床操作能力全球评估的通用标准，并量化现有检查表对操作能力进行全面评估的程度。
我们对已发表的临床操作技能评估检查表进行了系统综述和定性分析，并列举了每份检查表的内容。来源材料包括1990年至2005年6月发表的所有英文论文，这些论文从18个数据库中识别出来，描述或提及了任何临床操作技能的评估文件。一对评审员通过对20份检查表的子集进行深入分析，确定了关键的通用主题和子主题，并通过反复达成一致意见和对编码框架进行独立重新测试。最终的框架由成对的评审员独立应用于所有检查表，检查新主题和子主题的出现情况。主要观察指标是确定通用的临床操作技能以及每个技能在已识别检查表中的出现频率。
我们确定了7个主题（“操作能力”，85份[97%]检查表中有体现；“准备”，65份[74%]；“安全”，45份[51%]；“与患者沟通和合作”，32份[36%]；“感染控制”，28份[32%]；“操作后护理”，24份[27%]；“团队协作”，13份[15%]）和37个子主题，这些主题涵盖了所有已识别的检查表。在子主题中，有2个是在初始编码框架最终确定后才识别出来的。
有可能制定临床操作技能全球评估的通用标准。分别有三分之一和一半的检查表无法对“感染控制”和“安全”这两个关键能力进行明确评估。在使用此类检查表的评估中，它们的评估可能不一致。
