Kesselheim Jennifer C, McMahon Graham T, Joffe Steven
J Grad Med Educ. 2012 Jun;4(2):242-5. doi: 10.4300/JGME-D-11-00280.1.
Professionalism is one of the Accreditation Council for Graduate Medical Education's core competencies. Residency programs must teach residents about ethical principles, which is an essential component of professionalism.
We aimed to formally develop a valid and reliable test of ethics knowledge that effectively discriminated among learners in pediatric residency training and to improve methods for measuring outcomes of resident education in medical ethics.
We created an instrument with 36 true/false questions that tested knowledge in several domains of pediatric ethics: professionalism, adolescent medicine, genetic testing and diagnosis, neonatology, end-of-life decisions, and decision making for minors. All questions and their correct answers were derived from published statements from the American Academy of Pediatrics Committee on Bioethics. We invited a range of participants from novices to experts to complete the test. We evaluated the instrument's reliability and explored item discrimination, omitting 13 items with the least discriminatory power. Score differences between the 3 categories of examinees were evaluated.
The 23-item test, completed by 54 participants, demonstrated good internal reliability (Kuder-Richardson 20 statistic = 0.73). The test was moderately difficult and had a mean overall score of 17.3 (±3.3 standard deviation). Performance appropriately improved with degree of expertise: median scores for medical students, postgraduate year-3 residents, and ethicists were 15 (65%, range, 11-19), 19 (83%, range, 14-23), and 22 (96%, range, 20-23), respectively. Ethicists' scores were significantly higher than those of medical students (P < .001) and residents (P = .007). Moreover, residents performed significantly better than medical students (P = .001).
We developed a standardized instrument, entitled Test of Residents' Ethics Knowledge for Pediatrics (TREK-P), to evaluate residents' knowledge of pediatric ethics. The TREK-P is easy to administer, reliably discriminates among learners, and highlights content areas in which knowledge may be deficient.
职业素养是毕业后医学教育认证委员会的核心能力之一。住院医师培训项目必须向住院医师传授伦理原则，这是职业素养的重要组成部分。
我们旨在正式开发一种有效且可靠的伦理知识测试，以有效区分儿科住院医师培训中的学习者，并改进测量住院医师医学伦理教育成果的方法。
我们创建了一个包含36道是非题的工具，测试儿科伦理几个领域的知识：职业素养、青少年医学、基因检测与诊断、新生儿学、临终决策以及未成年人决策。所有问题及其正确答案均来自美国儿科学会生物伦理委员会发布的声明。我们邀请了从新手到专家的一系列参与者完成测试。我们评估了该工具的可靠性，并探讨了项目区分度，剔除了区分度最小的13个项目。评估了三类考生之间的分数差异。
由54名参与者完成的23道题测试显示出良好的内部可靠性（库德-理查森20统计量=0.73）。该测试难度适中，平均总分17.3（±3.3标准差）。随着专业程度的提高，表现相应改善：医学生、三年级住院医师和伦理学家的中位数分数分别为15（65%，范围11 - 19）、19（83%，范围14 - 23）和22（96%，范围20 - 23）。伦理学家的分数显著高于医学生（P <.001）和住院医师（P =.007）。此外，住院医师的表现明显优于医学生（P =.001）。
我们开发了一种标准化工具，名为儿科住院医师伦理知识测试（TREK - P），以评估住院医师对儿科伦理的知识。TREK - P易于实施，能可靠地区分学习者，并突出可能存在知识不足的内容领域。
