Dr. Brydges is assistant professor, Department of Medicine, University of Toronto, and scientist, Wilson Centre, University Health Network, Toronto, Ontario, Canada. Dr. Hatala is associate professor, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Dr. Zendejas is a resident, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota. Ms. Erwin is assistant professor of medical education, Mayo Clinic Libraries, Mayo Clinic College of Medicine, Rochester, Minnesota. Dr. Cook is professor of medicine and medical education and consultant, Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota.
Acad Med. 2015 Feb;90(2):246-56. doi: 10.1097/ACM.0000000000000549.
To examine the evidence supporting the use of simulation-based assessments as surrogates for patient-related outcomes assessed in the workplace.
The authors systematically searched MEDLINE, EMBASE, Scopus, and key journals through February 26, 2013. They included original studies that assessed health professionals and trainees using simulation and then linked those scores with patient-related outcomes assessed in the workplace. Two reviewers independently extracted information on participants, tasks, validity evidence, study quality, patient-related and simulation-based outcomes, and magnitude of correlation. All correlations were pooled using random-effects meta-analysis.
Of 11,628 potentially relevant articles, the 33 included studies enrolled 1,203 participants, including postgraduate physicians (n = 24 studies), practicing physicians (n = 8), medical students (n = 6), dentists (n = 2), and nurses (n = 1). The pooled correlation for provider behaviors was 0.51 (95% confidence interval [CI], 0.38 to 0.62; n = 27 studies); for time behaviors, 0.44 (95% CI, 0.15 to 0.66; n = 7); and for patient outcomes, 0.24 (95% CI, -0.02 to 0.47; n = 5). Most reported validity evidence was favorable, though studies often included only correlational evidence. Validity evidence of internal structure (n = 13 studies), content (n = 12), response process (n = 2), and consequences (n = 1) were reported less often. Three tools showed large pooled correlations and favorable (albeit incomplete) validity evidence.
Simulation-based assessments often correlate positively with patient-related outcomes. Although these surrogates are imperfect, tools with established validity evidence may replace workplace-based assessments for evaluating select procedural skills.
考察支持将基于模拟的评估作为工作场所中评估的患者相关结果的替代指标的证据。
作者系统地检索了 MEDLINE、EMBASE、Scopus 和主要期刊，检索时间截至 2013 年 2 月 26 日。他们纳入了使用模拟技术评估卫生保健专业人员和学员的原始研究，并将这些分数与工作场所中评估的患者相关结果相联系。两位审稿人独立提取了参与者、任务、有效性证据、研究质量、患者相关和基于模拟的结果以及相关性大小等信息。所有相关性均使用随机效应荟萃分析进行汇总。
在 11628 篇潜在相关文章中，33 项研究共纳入 1203 名参与者，包括研究生医生（24 项研究）、执业医生（8 项研究）、医学生（6 项研究）、牙医（2 项研究）和护士（1 项研究）。提供者行为的汇总相关性为 0.51（95%置信区间 [CI]，0.38 至 0.62；27 项研究）；时间行为的相关性为 0.44（95%CI，0.15 至 0.66；7 项研究）；患者结局的相关性为 0.24（95%CI，-0.02 至 0.47；5 项研究）。虽然研究通常仅包含相关性证据，但大多数报告的有效性证据都是有利的。内部结构（13 项研究）、内容（12 项研究）、反应过程（2 项研究）和后果（1 项研究）的有效性证据报告较少。有 3 种工具显示出较大的汇总相关性和有利的（尽管不完整）有效性证据。
基于模拟的评估通常与患者相关结果呈正相关。尽管这些替代指标并不完美，但具有既定有效性证据的工具可能会取代基于工作场所的评估，用于评估某些程序技能。
