Department of Epidemiology & Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Rd, Melbourne VIC 3004, Australia.
BMC Med Educ. 2014 Jun 9;14:114. doi: 10.1186/1472-6920-14-114.
While a variety of instruments have been developed to assess knowledge and skills in evidence based medicine (EBM), few assess all aspects of EBM - including knowledge, skills attitudes and behaviour - or have been psychometrically evaluated. The aim of this study was to develop and validate an instrument that evaluates medical trainees' competency in EBM across knowledge, skills and attitude.
The 'Assessing Competency in EBM' (ACE) tool was developed by the authors, with content and face validity assessed by expert opinion. A cross-sectional sample of 342 medical trainees representing 'novice', 'intermediate' and 'advanced' EBM trainees were recruited to complete the ACE tool. Construct validity, item difficulty, internal reliability and item discrimination were analysed.
We recruited 98 EBM-novice, 108 EBM-intermediate and 136 EBM-advanced participants. A statistically significant difference in the total ACE score was observed and corresponded to the level of training: on a 0-15-point test, the mean ACE scores were 8.6 for EBM-novice; 9.5 for EBM-intermediate; and 10.4 for EBM-advanced (p < 0.0001). Individual item discrimination was excellent (Item Discrimination Index ranging from 0.37 to 0.84), with internal reliability consistent across all but three items (Item Total Correlations were all positive ranging from 0.14 to 0.20).
The 15-item ACE tool is a reliable and valid instrument to assess medical trainees' competency in EBM. The ACE tool provides a novel assessment that measures user performance across the four main steps of EBM. To provide a complete suite of instruments to assess EBM competency across various patient scenarios, future refinement of the ACE instrument should include further scenarios across harm, diagnosis and prognosis.
虽然已经开发出各种工具来评估循证医学（EBM）中的知识和技能，但很少有工具评估 EBM 的所有方面 - 包括知识、技能、态度和行为 - 或经过心理测量学评估。本研究旨在开发和验证一种评估医学受训者在 EBM 方面知识、技能和态度的综合能力的工具。
“评估 EBM 能力”（ACE）工具由作者开发，内容和表面效度由专家意见评估。我们招募了 342 名医学受训者，代表 EBM 初学者、中级和高级受训者，让他们完成 ACE 工具。分析了结构效度、项目难度、内部可靠性和项目区分度。
我们招募了 98 名 EBM 初学者、108 名 EBM 中级和 136 名 EBM 高级参与者。在 ACE 总分上观察到统计学上的显著差异，并且与培训水平相对应：在 0-15 分测试中，EBM 初学者的 ACE 平均分数为 8.6；EBM 中级为 9.5；EBM 高级为 10.4（p<0.0001）。单个项目的区分度极好（项目区分指数范围为 0.37 至 0.84），除了三个项目外，内部可靠性在所有项目中都一致（项目总相关系数均为正，范围为 0.14 至 0.20）。
15 项 ACE 工具是一种可靠且有效的工具，可评估医学受训者在 EBM 方面的综合能力。ACE 工具提供了一种新颖的评估方法，可衡量用户在 EBM 的四个主要步骤中的表现。为了提供一套完整的工具来评估各种患者情况下的 EBM 能力，未来应进一步细化 ACE 工具，包括涵盖伤害、诊断和预后的更多场景。
