Boston University School of Medicine, Boston, Massachusetts.
Arthritis Care Res (Hoboken). 2014 Jan;66(1):2-6. doi: 10.1002/acr.22105.
To determine the reliability and validity of an objective structured clinical examination (OSCE) for musculoskeletal ultrasound (MSUS).
A 9-station OSCE was administered to 35 rheumatology fellows trained in MSUS and to 3 expert faculty (controls). Participants were unaware of joint health (5 diseased/4 healthy). Faculty assessors (n = 9) graded image quality with predefined checklists and a 0-5 global rating, blinded to who performed the study. Interrater reliability, correlation between a written multiple choice question examination (MCQ) and OSCE performance, and comparison of fellow OSCE results with those of the faculty were measured to determine OSCE reliability, concurrent validity, and construct validity.
Assessors' interrater reliability was good (intraclass correlation coefficient [ICC] 0.7). Score reliability was good in the normal wrist and ankle stations (ICC 0.7) and moderate in the abnormal wrist and ankle stations (ICC 0.4). MCQ grades significantly correlated with OSCE grades (r = 0.52, P < 0.01). The fellows in the bottom quartile of the MCQ scored 3.07 on the OSCE, significantly worse than the top quartile fellows (3.32) and the faculty (3.29; P < 0.01). Scores also significantly discriminated bottom quartile fellows from faculty in the normal wrist and ankle stations (3.38 versus 3.78; P < 0.01), but not in the abnormal stations (3.37 versus 3.49; P = 0.08).
MSUS OSCE is a reliable and valid method for evaluation of MSUS skill. Normal joint assessment stations are more reliable than abnormal joint assessment stations and better discriminate poorly performing fellows from faculty. Therefore, MSUS OSCE with normal joints can be used for the assessment of MSUS skill competency.
确定肌肉骨骼超声（MSUS）客观结构化临床考试（OSCE）的可靠性和有效性。
对 35 名接受过 MSUS 培训的风湿病研究员和 3 名专家教师（对照组）进行了 9 站 OSCE。参与者不知道关节健康状况（5 个患病/4 个健康）。教师评估员（n = 9）使用预定义的检查表和 0-5 分的整体评分对图像质量进行评分，对谁进行了研究不知情。为了确定 OSCE 的可靠性、同时效度和结构效度，测量了评估者之间的信度、书面多项选择题考试（MCQ）和 OSCE 表现之间的相关性，以及研究员的 OSCE 结果与教师的比较。
评估者之间的评分可靠性良好（组内相关系数 [ICC] 0.7）。正常腕关节和踝关节站的评分可靠性良好（ICC 0.7），异常腕关节和踝关节站的评分可靠性中等（ICC 0.4）。MCQ 等级与 OSCE 等级显著相关（r = 0.52，P < 0.01）。MCQ 得分最低的四分之一研究员在 OSCE 中得分为 3.07，明显低于得分最高的四分之一研究员（3.32）和教师（3.29；P < 0.01）。在正常腕关节和踝关节站，分数也明显区分了得分最低的四分之一研究员和教师（3.38 与 3.78；P < 0.01），但在异常站则没有（3.37 与 3.49；P = 0.08）。
MSUS OSCE 是评估 MSUS 技能的可靠有效的方法。正常关节评估站比异常关节评估站更可靠，并且更好地区分了表现不佳的研究员和教师。因此，可使用带正常关节的 MSUS OSCE 来评估 MSUS 技能能力。
