Rhoton M F, Barnes A, Flashburg M, Ronai A, Springman S
Department of Anesthesiology, Case Western Reserve University, Cleveland, Ohio.
Acad Med. 1991 Jun;66(6):359-61. doi: 10.1097/00001888-199106000-00011.
The authors examined residents' clinical performances in five anesthesiology departments in U.S. teaching hospitals. The data were organized by daily use of the Clinical Anesthesia System of Evaluation, which categorizes and quantifies the narrative comments of faculty. The study was designed to identify predictor categories (particular performance characteristics of residents) for the residents' overall performances and their scores in handling critical incidents (those incidents that could or would have caused significant morbidity or mortality had faculty not intervened). More than 9,000 comments made by 163 faculty about 45 residents were analyzed. Residents' noncognitive skills that were predictors of overall performance were Conscientiousness, Management, Confidence, Critical Incidents, and Knowledge. Conscientiousness and Composure predicted two-thirds of the variability in critical incidents' scores. Path analysis verified causal relationships between the hypothesized predictors and critical incidents. For the residents studied, inadequate noncognitive performance in some areas was a powerful (p less than .0005) predictor of overall clinical performance and was related to the occurrence of critical incidents.
作者们调查了美国教学医院五个麻醉科住院医师的临床操作表现。数据是通过日常使用临床麻醉评估系统整理的，该系统对教员的叙述性评语进行分类和量化。这项研究旨在确定住院医师总体表现以及处理危急事件（即那些若教员不干预就可能或将会导致严重发病或死亡的事件）得分的预测类别（住院医师的特定操作特征）。分析了163名教员对45名住院医师做出的9000多条评语。作为总体表现预测因素的住院医师非认知技能包括尽责性、管理能力、自信、危急事件处理能力和知识水平。尽责性和沉着冷静预测了危急事件得分中三分之二的变异性。路径分析验证了假设的预测因素与危急事件之间的因果关系。对于所研究的住院医师而言，某些领域非认知操作不足是总体临床操作表现的一个有力（p小于0.0005）预测因素，并且与危急事件的发生有关。
