National Board of Osteopathic Medical Examiners, Conshohocken, PA 19428, USA.
Med Educ Online. 2012;17. doi: 10.3402/meo.v17i0.18812. Epub 2012 Jul 23.
High stakes medical licensing programs are planning to augment and adapt current examinations to be relevant for a two-decision point model for licensure: entry into supervised practice and entry into unsupervised practice. Therefore, identifying which skills should be assessed at each decision point is critical for informing examination development, and gathering input from residency program directors is important.
Using data from previously developed surveys and expert panels, a web-delivered survey was distributed to 3,443 residency program directors. For each of the 28 procedural and 18 advanced communication skills, program directors were asked which clinical skills should be assessed, by whom, when, and how. Descriptive statistics were collected, and Intraclass Correlations (ICC) were conducted to determine consistency across different specialties.
Among 347 respondents, program directors reported that all advanced communication and some procedural tasks are important to assess. The following procedures were considered 'important' or 'extremely important' to assess: sterile technique (93.8%), advanced cardiovascular life support (ACLS) (91.1%), basic life support (BLS) (90.0%), interpretation of electrocardiogram (89.4%) and blood gas (88.7%). Program directors reported that most clinical skills should be assessed at the end of the first year of residency (or later) and not before graduation from medical school. A minority were considered important to assess prior to the start of residency training: demonstration of respectfulness (64%), sterile technique (67.2%), BLS (68.9%), ACLS (65.9%) and phlebotomy (63.5%).
Results from this study support that assessing procedural skills such as cardiac resuscitation, sterile technique, and phlebotomy would be amenable to assessment at the end of medical school, but most procedural and advanced communications skills would be amenable to assessment at the end of the first year of residency training or later.
Gathering data from residency program directors provides support for developing new assessment tools in high-stakes licensing examinations.
高风险的医学许可项目正计划扩充和调整当前的考试，使其适用于两个决策点的许可模式：进入监督实践和进入无监督实践。因此，确定应在每个决策点评估哪些技能对于告知考试开发至关重要，并且从居住项目主任那里收集意见很重要。
使用先前开发的调查和专家小组的数据，通过网络向 3443 名居住项目主任分发了一份调查。对于 28 项程序性和 18 项高级沟通技能中的每一项，项目主任都被要求评估哪些临床技能、由谁评估、何时评估以及如何评估。收集了描述性统计数据，并进行了组内相关系数（ICC）以确定不同专业之间的一致性。
在 347 名答复者中，项目主任报告说所有高级沟通和一些程序性任务都需要评估。以下程序被认为是评估的“重要”或“极其重要”：无菌技术（93.8%）、高级心血管生命支持（ACLS）（91.1%）、基本生命支持（BLS）（90.0%）、心电图（89.4%）和血气分析（88.7%）。项目主任报告说，大多数临床技能应在居住培训的第一年结束（或之后）进行评估，而不是在医学院毕业之前。少数人被认为在居住培训开始之前评估很重要：表现出尊重（64%）、无菌技术（67.2%）、BLS（68.9%）、ACLS（65.9%）和采血（63.5%）。
这项研究的结果支持评估心脏复苏术、无菌技术和采血等程序性技能在医学院毕业时即可进行评估，但大多数程序性和高级沟通技能可在居住培训的第一年结束或之后进行评估。
从居住项目主任那里收集数据为在高风险许可考试中开发新的评估工具提供了支持。
