采用评分指南对医学生临床推理能力进行“外行”与医师评定者评估：多学科客观结构化临床考试中的评分者间信度。
Assessment of medical student clinical reasoning by "lay" vs physician raters: inter-rater reliability using a scoring guide in a multidisciplinary objective structured clinical examination.
机构信息
Department of Surgery, New York University School of Medicine, New York, NY, USA.
出版信息
Am J Surg. 2012 Jan;203(1):81-6. doi: 10.1016/j.amjsurg.2011.08.003.
BACKGROUND
To determine whether a "lay" rater could assess clinical reasoning, interrater reliability was measured between physician and lay raters of patient notes written by medical students as part of an 8-station objective structured clinical examination.
METHODS
Seventy-five notes were rated on core elements of clinical reasoning by physician and lay raters independently, using a scoring guide developed by physician consensus. Twenty-five notes were rerated by a 2nd physician rater as an expert control. Kappa statistics and simple percentage agreement were calculated in 3 areas: evidence for and against each diagnosis and diagnostic workup.
RESULTS
Agreement between physician and lay raters for the top diagnosis was as follows: supporting evidence, 89% (κ = .72); evidence against, 89% (κ = .81); and diagnostic workup, 79% (κ = .58). Physician rater agreement was 83% (κ = .59), 92% (κ = .87), and 96% (κ = .87), respectively.
CONCLUSIONS
Using a comprehensive scoring guide, interrater reliability for physician and lay raters was comparable with reliability between 2 expert physician raters.
背景
为了确定“外行”评分者是否能够评估临床推理能力，我们测量了医生和非医学专业人员对医学生在 8 站式客观结构化临床考试中所写病历的临床推理核心要素的评分之间的组间信度。
方法
75 份病历由医生和非医学专业人员独立使用由医生共识制定的评分指南进行核心要素的临床推理评分。25 份病历由第 2 位医生进行了重评，作为专家控制。在 3 个领域计算了 Kappa 统计量和简单百分比一致性：每个诊断和诊断检查的支持证据和反对证据。
结果
医生和非医学专业人员对主要诊断的评分一致如下：支持证据，89%（κ=0.72）；反对证据，89%（κ=0.81）；诊断检查，79%（κ=0.58）。医生评分者的一致性分别为 83%（κ=0.59）、92%（κ=0.87）和 96%（κ=0.87）。
结论
使用全面的评分指南，医生和非医学专业人员之间的组间信度与 2 位专家医生评分者之间的信度相当。
Zotero 插件