Trudel Judith L, Bordage Georges, Downing Steven M
Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Ann Surg. 2008 Aug;248(2):252-8. doi: 10.1097/SLA.0b013e31818233d3.
The purpose of this study was to determine the reliability and validity of the scores from "key feature" cases in the self-assessment of colon and rectal surgeons.
Key feature (KF) cases specifically focus on the assessment of the unique challenges, critical decisions, and difficult aspects of the identification and management of clinical problems in practice. KF cases have been used to assess medical students and residents but rarely for specialists.
Responses from all 256 participants taking the American Society of Colon and Rectal Surgeons (ASCRS) Colon and Rectal Surgery Educational Program (CARSEP) V Self-assessment Examination (SAE) from 1997 to 2002 were scored and analyzed, including score reliability, item analysis for the factual (50 multiple-choice questions (MCQ)) and applied (9 KF cases) knowledge portions of the SAE, and the effect of examination preparation, examination setting, specialization, Board certification, and clinical experience on scores.
The reliability (Cronbach alpha) of the scores for the MCQ and KF components was 0.97 and 0.95, respectively. The applied KF component of the SAE was more difficult than the factual MCQ component (0.52 versus 0.80, P < 0.001). Mean item discrimination (upper-lower groups) was 0.59 and 0.66 for the MCQ and KF components, respectively. Taking the test at the annual meeting was harder than at home (0.41 versus 0.81, P < 0.001). Content-related validity evidence for the KF cases was supported by mapping KF cases onto the examination blueprint and by judgments from expert colorectal surgeons about the challenging and critical nature of the KFs used. Construct validity of the KF cases was supported by incremental performance related to types of practice (general, anorectal, and colorectal), levels and types of Board certification, and years of clinical experience.
The self-assessment of surgical specialists, in this case colorectal surgeons, using KF cases is possible and yielded reliable and valid scores.
本研究旨在确定结肠直肠外科医生自我评估中“关键特征”病例评分的可靠性和有效性。
关键特征（KF）病例专门侧重于评估实践中临床问题识别与管理的独特挑战、关键决策和困难方面。KF病例已用于评估医学生和住院医师，但很少用于专科医生。
对1997年至2002年参加美国结肠直肠外科医师学会（ASCRS）结肠直肠外科教育项目（CARSEP）V自我评估考试（SAE）的所有256名参与者的回答进行评分和分析，包括评分可靠性、SAE事实性（50道多项选择题（MCQ））和应用性（9个KF病例）知识部分的项目分析，以及考试准备、考试环境、专业、委员会认证和临床经验对分数的影响。
MCQ和KF部分分数的可靠性（Cronbachα系数）分别为0.97和0.95。SAE的应用性KF部分比事实性MCQ部分更难（0.52对0.80，P<0.001）。MCQ和KF部分的平均项目区分度（高低分组）分别为0.59和0.66。在年会上参加考试比在家考试更难（0.41对0.81，P<0.001）。通过将KF病例映射到考试蓝图以及结直肠外科专家对所使用KF的挑战性和关键性的判断，支持了KF病例与内容相关的效度证据。KF病例的结构效度得到了与实践类型（普通、肛门直肠和结肠直肠）、委员会认证的水平和类型以及临床经验年限相关的增量表现的支持。
使用KF病例对手术专科医生（在本案例中为结直肠外科医生）进行自我评估是可行的，并且产生了可靠且有效的分数。
