Haspel Richard L, Lin Yulia, Mallick Ranjeeta, Tinmouth Alan, Cid Joan, Eichler Hermann, Lozano Miguel, van de Watering Leo, Fisher Patrick B, Ali Asma, Parks Eric
Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
Department of Clinical Pathology, Sunnybrook Health Sciences Centre, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
Transfusion. 2015 Jun;55(6):1355-61. doi: 10.1111/trf.12968. Epub 2014 Dec 19.
Blood transfusion is the most common hospital procedure performed in the United States. While inadequate physician transfusion medicine knowledge may lead to inappropriate practice, such an educational deficit has not been investigated on an international scale using a validated assessment tool. Identifying specific deficiencies is critical for developing curricula to improve patient care.
Rasch analysis, a method used in high-stakes testing, was used to validate an assessment tool consisting of a 23-question survey and a 20-question examination. The assessment tool was administered to internal medicine residents to determine prior training, attitudes, perceived ability, and actual knowledge related to transfusion medicine.
A total of 474 residents at 23 programs in nine countries completed the examination. The overall mean score of correct responses was 45.7% (site range, 32%-56%). The mean score for Postgraduate Year (PGY)1 (43.9%) was significantly lower than for PGY3 (47.1%) and PGY4 (50.6%) residents. Although 89% of residents had participated in obtaining informed consent from a patient for transfusion, residents scored poorly (<25% correct) on questions related to transfusion reactions. The majority of residents (65%) would find additional transfusion medicine training "very" or "extremely" helpful.
Internationally, internal medicine residents have poor transfusion medicine knowledge and would welcome additional training. The especially limited knowledge of transfusion reactions suggests an initial area for focused training. This study not only represents the largest international assessment of transfusion medicine knowledge, but also serves as a model for rigorous, collaborative research in medical education.
输血是美国医院最常见的操作。虽然医生输血医学知识不足可能导致不当操作，但尚未使用经过验证的评估工具在国际范围内对这种教育缺陷进行调查。识别具体缺陷对于制定改善患者护理的课程至关重要。
Rasch分析是一种用于高风险测试的方法，用于验证一个评估工具，该工具包括一份23道题的调查问卷和一份20道题的考试。该评估工具用于内科住院医师，以确定他们与输血医学相关的先前培训、态度、感知能力和实际知识。
九个国家23个项目的474名住院医师完成了考试。正确回答的总体平均分数为45.7%（各地点范围为32%-56%）。第一年住院医师（PGY1）的平均分数（43.9%）显著低于第三年住院医师（PGY3，47.1%）和第四年住院医师（PGY4，50.6%）。虽然89%的住院医师参与过为患者输血获取知情同意，但住院医师在与输血反应相关问题上的得分很低（<25%正确）。大多数住院医师（65%）认为额外的输血医学培训“非常”或“极其”有帮助。
在国际上，内科住院医师的输血医学知识较差，并且欢迎额外的培训。对输血反应的了解尤其有限，这表明了一个重点培训的初始领域。这项研究不仅是对输血医学知识最大规模的国际评估，也为医学教育中严谨的合作研究提供了一个范例。
