Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02114, USA.
J Hosp Med. 2009 Sep;4(7):430-2. doi: 10.1002/jhm.507.
Knowledge of core medical procedures is required by the American Board of Internal Medicine (ABIM) for certification. Efforts to improve the training of residents in these procedures have been limited by the absence of a validated tool for the assessment of knowledge. In this study we aimed to develop a standardized test of procedural knowledge in 3 medical procedures associated with potentially serious complications.
Placement of an arterial line, central venous catheter, and thoracentesis were selected for test development. Learning objectives and multiple-choice questions were constructed for each topic. Content evidence was evaluated by critical care subspecialists. Item test characteristics were evaluated by administering the test to students, residents and specialty clinicians. Reliability of the 32-item instrument was established through its administration to 192 medical residents in 4 hospitals.
Reliability of the instrument as measured by Cronbach's alpha was 0.79 and its test-retest reliability was 0.82. Median score was 53% on a test comprising elements deemed important by critical care subspecialists. Increasing number of procedures attempted, higher self-reported confidence, and increasing seniority were predictors of overall test scores. Procedural confidence correlated significantly with increasing seniority and experience. Residents performed few procedures.
We have successfully developed a standardized instrument to assess residents' cognitive competency for 3 common procedures. Residents' overall knowledge about procedures is poor. Experiential learning is the dominant source for knowledge improvement, but these experiences are increasingly rare.
美国内科医师委员会（ABIM）认证要求掌握核心医疗程序。由于缺乏评估知识的有效工具，因此限制了对住院医师进行这些程序培训的努力。在这项研究中，我们旨在开发一种标准化的测试工具，用于评估与潜在严重并发症相关的 3 种医疗程序的知识。
选择动脉置管、中心静脉导管和胸腔穿刺术进行测试开发。为每个主题构建了学习目标和多项选择题。关键护理专家评估了内容证据。通过向学生、住院医师和专业临床医生施测该测试，评估了项目的测试特性。通过在 4 家医院对 192 名住院医师进行测试，建立了包含 32 个项目的仪器的可靠性。
通过 Cronbach 的 alpha 衡量，该仪器的可靠性为 0.79，重测信度为 0.82。在由关键护理专家认为重要的元素组成的测试中，中位数得分为 53%。尝试的程序数量增加、自我报告的信心增加以及级别提高是总体测试成绩的预测因素。程序信心与级别提高和经验增加显著相关。住院医师实施的程序很少。
我们已经成功开发了一种标准化工具来评估住院医师对 3 种常见程序的认知能力。住院医师对程序的整体知识较差。经验学习是知识提高的主要来源，但这些经验越来越少。
