Department of Medicine, Northwestern University Feinberg School of Medicine, Galter 3-150, 251 East Huron Street, Chicago, IL 60611, USA.
Acad Med. 2009 Oct;84(10 Suppl):S94-6. doi: 10.1097/ACM.0b013e3181b38e8c.
Cardiac auscultation is a critical clinical skill for physicians, but minimum performance standards do not exist.
One hundred third-year medical students from three schools completed a case-based computerized examination that assessed their ability to identify 12 major cardiac findings. Cohort performance was reviewed by a panel of expert judges who provided item-based (Angoff method) and group-based (Hofstee method) judgments on two occasions. Judges' ratings were used to calculate a minimum passing standard (MPS) for cardiac auscultation skills. Interrater reliabilities and test-retest reliability (stability) were calculated.
Both methods produced reliable and stable data. Use of the Angoff method yielded a more lenient MPS than the Hofstee method. Two thirds of the students (66%) did not achieve the MPS.
Use of a defensible standard allows for reliable evaluation of cardiac auscultation skills. Further work is needed to improve the performance of this important clinical skill by medical students.
心脏听诊是医生的一项关键临床技能，但目前不存在最低绩效标准。
来自三所学校的 100 名三年级医学生完成了一项基于案例的计算机考试，评估他们识别 12 项主要心脏发现的能力。专家组对队列表现进行了审查，专家们在两次会议上提供了基于项目（安戈夫法）和基于组（霍夫斯泰德法）的判断。根据评审员的评分，计算出心脏听诊技能的最低通过标准（MPS）。计算了组内信度和重测信度（稳定性）。
两种方法都产生了可靠且稳定的数据。安戈夫法产生的 MPS 比霍夫斯泰德法更宽松。三分之二的学生（66%）没有达到 MPS。
使用有防御能力的标准可以可靠地评估心脏听诊技能。需要进一步努力提高医学生的这项重要临床技能。
