Young Meredith E, Cruess Sylvia R, Cruess Richard L, Steinert Yvonne
Department of Medicine, Centre for Medical Education, Faculty of Medicine, McGill University, 1110 Pine Ave West, Montreal, QC, H3A 1A3, Canada,
Adv Health Sci Educ Theory Pract. 2014 Mar;19(1):99-113. doi: 10.1007/s10459-013-9466-4. Epub 2013 Jun 11.
Physicians function as clinicians, teachers, and role models within the clinical environment. Negative learning environments have been shown to be due to many factors, including the presence of unprofessional behaviors among clinical teachers. Reliable and valid assessments of clinical teacher performance, including professional behaviors, may provide a foundation for evidence-based feedback to clinical teachers, enable targeted remediation or recognition, and help to improve the learning environment. However, few tools exist for the evaluation of clinical teachers that include a focus on both professional and clinical teaching behaviors. The Professionalism Assessment of Clinical Teachers (PACT) was developed and implemented at one Canadian institution and was assessed for evidence of reliability and validity. Following each clerkship rotation, students in the 2009-2010 third-year undergraduate clerkship cohort (n = 178) anonymously evaluated a minimum of two clinical teachers using the PACT. 4,715 forms on 567 faculty members were completed. Reliability, validity, and free text comments (present in 45 % of the forms) were examined. An average of 8.6 PACT forms were completed per faculty (range 1-60), with a reliability of 0.31 for 2.9 forms (harmonic mean); 12 forms were necessary for a reliability of 0.65. Global evaluations of teachers aligned with ratings of free-text comments (r = 0.77, p < 0.001). Comment length related negatively with overall rating (r = -0.19, p < 0.001). Mean performance related negatively with variability of performance (r = -0.72, p < 0.001), although this may be related to a ceiling effect. Most faculty members were rated highly; however 'provided constructive feedback' was the least well-rated item. Respectful interactions with students appeared to be the most influential item in the global rating of faculty performance. The PACT is a moderately reliable tool for the assessment of professional behaviors of clinical teachers, with evidence supporting its validity.
医生在临床环境中扮演着临床工作者、教师和榜样的角色。负面的学习环境已被证明是由多种因素造成的，包括临床教师中存在的不专业行为。对临床教师表现（包括专业行为）进行可靠且有效的评估，可为基于证据的临床教师反馈提供基础，实现有针对性的补救或表彰，并有助于改善学习环境。然而，很少有工具能用于评估临床教师，且这些工具同时关注专业和临床教学行为。临床教师专业素养评估（PACT）在加拿大的一家机构开发并实施，并对其可靠性和有效性进行了评估。在2009 - 2010学年本科三年级临床实习的每个轮转结束后，该届学生（n = 178）使用PACT对至少两名临床教师进行匿名评估。共完成了针对567名教员的4715份评估表。对可靠性、有效性以及自由文本评论（45%的评估表中存在）进行了检查。每位教员平均完成8.6份PACT评估表（范围为1 - 60份），2.9份评估表（调和平均数）的可靠性为0.31；可靠性达到0.65需要12份评估表。对教师的总体评价与自由文本评论的评分一致（r = 0.77，p < 0.001）。评论长度与总体评分呈负相关（r = -0.19，p < 0.001）。平均表现与表现的变异性呈负相关（r = -0.72，p < 0.001），不过这可能与天花板效应有关。大多数教员得到了高分；然而，“提供建设性反馈”是评分最低的项目。与学生的尊重性互动似乎是教员表现总体评分中最具影响力的项目。PACT是评估临床教师专业行为的一个中等可靠的工具，有证据支持其有效性。
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