Departments of Neuroscience, Learning Technology Section and Clinical Pharmacology Unit, University of Edinburgh, College of Medicine and Veterinary Medicine, Edinburgh, UK.
Br J Clin Pharmacol. 2010 Oct;70(4):492-9. doi: 10.1111/j.1365-2125.2010.03609.x.
Dose calculation errors can cause serious life-threatening clinical incidents. We designed eDrugCalc as an online self-assessment tool to develop and evaluate calculation skills among medical students.
We undertook a prospective uncontrolled study involving 1727 medical students in years 1-5 at the University of Edinburgh. Students had continuous access to eDrugCalc and were encouraged to practise. Voluntary self-assessment was undertaken by answering the 20 questions on six occasions over 30 months. Questions remained fixed but numerical variables changed so each visit required a fresh calculation. Feedback was provided following each answer.
Final-year students had a significantly higher mean score in test 6 compared with test 1 [16.6, 95% confidence interval (CI) 16.2, 17.0 vs. 12.6, 95% CI 11.9, 13.4; n= 173, P < 0.0001 Wilcoxon matched pairs test] and made a median of three vs. seven errors. Performance was highly variable in all tests with 2.7% of final-year students scoring < 10/20 in test 6. Graduating students in 2009 (30 months' exposure) achieved significantly better scores than those in 2007 (only 6 months): mean 16.5, 95% CI 16.0, 17.0, n= 184 vs. 15.1, 95% CI 14.5, 15.6, n= 187; P < 0.0001, Mann-Whitney test. Calculations based on percentage concentrations and infusion rates were poorly performed. Feedback showed that eDrugCalc increased confidence in calculating doses and was highly rated as a learning tool.
Medical student performance of dose calculations improved significantly after repeated exposure to an online formative dose-calculation package and encouragement to develop their numeracy. Further research is required to establish whether eDrugCalc reduces calculation errors made in clinical practice.
剂量计算错误可能导致严重危及生命的临床事件。我们设计了 eDrugCalc 作为一种在线自我评估工具，以培养和评估医学生的计算技能。
我们进行了一项前瞻性、无对照的研究，纳入了爱丁堡大学 1 至 5 年级的 1727 名医学生。学生可以持续访问 eDrugCalc 并进行练习。学生在 30 个月内自愿进行 6 次自我评估，回答 20 个问题。问题保持不变，但数值变量会发生变化，因此每次访问都需要进行新的计算。每次回答后都会提供反馈。
与测试 1（12.6，95%置信区间 11.9，13.4）相比，最后一年学生在测试 6 的平均得分明显更高[16.6，95%置信区间 16.2，17.0；n=173，P<0.0001 配对 Wilcoxon 检验]，且错误中位数为 3 次，而非 7 次。在所有测试中，学生表现高度可变，2009 年毕业的学生（30 个月暴露）在测试 6 中的得分明显优于 2007 年毕业的学生（仅 6 个月）：平均 16.5，95%置信区间 16.0，17.0，n=184 与 15.1，95%置信区间 14.5，15.6，n=187；P<0.0001，Mann-Whitney 检验。基于百分比浓度和输注率的计算表现较差。反馈表明，eDrugCalc 增加了计算剂量的信心，并被高度评价为一种学习工具。
医学生在多次接触在线形成性剂量计算包并鼓励培养其计算能力后，剂量计算的表现显著提高。需要进一步研究以确定 eDrugCalc 是否可以减少临床实践中的计算错误。
