Jones T V, Gerrity M S, Earp J
Department of Medicine, University of North Carolina, Chapel Hill 27599.
J Clin Epidemiol. 1990;43(8):805-15. doi: 10.1016/0895-4356(90)90241-g.
Written case simulations are often used to investigate physicians' decision making and clinical competence. Their use rests on the assumption that physicians' responses to written simulations closely agree with their responses to actual clinical encounters, yet this assumption of criterion validity has received little attention. To determine the ability of written case simulations to predict actual clinical behavior, we applied methodologic criteria to published articles that used written simulations. Only 11 (15%) of 74 articles included an assessment of the criterion validity of their written case simulations. Only 2 of those 11 studies were designed and executed in such a way that criterion validity could be fully interpreted. No clear consensus emerged from an examination on the 11 studies on how well responses to written case simulations perform as proxy measures of actual behavior. More work is needed before assuming that written case simulations measure actual behavior.
书面病例模拟常常被用于研究医生的决策过程和临床能力。其应用基于这样一种假设，即医生对书面模拟的反应与他们对实际临床情况的反应高度一致，然而这种标准效度的假设很少受到关注。为了确定书面病例模拟预测实际临床行为的能力，我们将方法学标准应用于使用书面模拟的已发表文章。74篇文章中只有11篇（15%）对其书面病例模拟的标准效度进行了评估。在这11项研究中，只有2项的设计和实施方式能够充分解读标准效度。对这11项研究的审查并未就书面病例模拟的反应作为实际行为的替代指标的表现达成明确共识。在假定书面病例模拟能够衡量实际行为之前，还需要开展更多工作。
