Shanedling Janet, Van Heest Ann, Rodriguez Michael, Putnam Matthew, Agel Julie
J Grad Med Educ. 2010 Sep;2(3):435-41. doi: 10.4300/JGME-D-09-00103.1.
Surgical competence requires both cognitive and technical skills. Relatively little is found in the literature regarding the value of Web-based assessments to measure surgery residents' mastery of the competencies.
To determine the validity and reliability of 2 online instruments for predicting the cognitive preparedness of residents for performing carpal tunnel release surgery.
Twenty-eight orthopedic residents and 2 medical school students responded to an online measure of their perception of preparedness and to an online cognitive skills assessment prior to an objective structured assessment of technical skills, in which they performed carpal tunnel release surgery on cadaveric specimens and received a pass/fail assessment. The 2 online assessments were analyzed for their internal reliability, external correlation with the pass/fail decision, and construct validity.
The internal consistency of the perception of preparedness measure was high (α = .92) while the cognitive assessment was less strong (α = .65). Both instruments demonstrated moderately strong correlations with the pass/fail decision, with Spearman correlation of .606 (P = .000) and .617 (P = .000), respectively. Using logistic regression to analyze the predictive strength of each instrument, the perception of preparedness measure demonstrated a 76% probability (η(2) = .354) and the cognitive skills assessment a 73% probability (η(2) = .381) of correctly predicting the pass/fail decision. Analysis of variance modeling resulted in significant differences between levels at P < .005, supporting good construct validity.
The online perception of preparedness measure and the cognitive skills assessment both are valid and reliable predictors of readiness to successfully pass a cadaveric motor skills test of carpal tunnel release surgery.
手术能力需要认知和技术技能。关于基于网络的评估在衡量外科住院医师对这些能力掌握程度方面的价值，文献中报道相对较少。
确定两种在线工具预测住院医师进行腕管松解手术认知准备情况的有效性和可靠性。
28名骨科住院医师和2名医学生在进行客观结构化技术技能评估前，对其准备情况的在线评估和在线认知技能评估做出回应，在该技术技能评估中，他们对尸体标本进行腕管松解手术并接受通过/未通过评估。对这两种在线评估进行内部信度、与通过/未通过判定的外部相关性以及结构效度分析。
准备情况评估的内部一致性较高（α = 0.92），而认知评估的内部一致性较弱（α = 0.65）。两种工具与通过/未通过判定均呈现中等强度的相关性，斯皮尔曼相关系数分别为0.606（P = 0.000）和0.617（P = 0.000）。使用逻辑回归分析每种工具的预测强度，准备情况评估正确预测通过/未通过判定的概率为76%（η(2) = 0.354），认知技能评估为73%（η(2) = 0.381）。方差分析模型显示在P < 0.005水平上各水平之间存在显著差异，支持良好的结构效度。
准备情况的在线评估和认知技能评估都是成功通过腕管松解手术尸体运动技能测试准备情况的有效且可靠预测指标。
