Thomas Roger E, Kreptul Dennis
Department of Family Medicine, University of Calgary.
Fam Med. 2015 Feb;47(2):101-17.
Evidence-based medicine (EBM) is increasingly important in resident education, and reliable and valid tests of competence for family medicine residents are needed.
MEDLINE, PsycINFO, ERIC, ERC, and the Research & Development Resource Base (University of Toronto) were searched from inception to June 2014 to identify competence tests of family medicine and general practice residents in EBM. Two authors independently assessed all titles, abstracts, and full texts and abstracted data.
Three EBM courses were evaluated by the Fresno test. Seven other authors designed EBM interventions and individual tests to evaluate them. Content validity was assessed by nine studies, construct validity by five, face validity by three, and concurrent validity by one. Internal reliability was reported by seven studies, inter-rater by four, item difficult and item discrimination by two, and intra-rater by one. Eight studies reported that knowledge scores increased significantly after the intervention.
Content validity and internal reliability were the most frequently assessed measures. The basic EBM activities of identifying Population, Intervention, Comparison, Outcome, and Study Design (PICOS questions) and computing sensitivity, specificity, and number needed to treat (NNT) are unlikely to change. However, guidelines are often used in EBM courses, and they are updated regularly, which will involve new clinical scenarios, PICOS questions, and statistical computations. The Fresno test has been evaluated with three groups of family medicine residents, has the best documentation of validity and reliability, and is the best candidate for future development. Evaluation tools also need to be developed to measure if care received by patients is EBM.
循证医学（EBM）在住院医师教育中日益重要，因此需要针对家庭医学住院医师进行可靠且有效的能力测试。
检索MEDLINE、PsycINFO、ERIC、ERC以及多伦多大学研发资源库，检索时间从建库至2014年6月，以确定针对家庭医学和全科住院医师循证医学能力的测试。两位作者独立评估所有标题、摘要和全文，并提取数据。
通过弗雷斯诺测试对三门循证医学课程进行了评估。其他七位作者设计了循证医学干预措施及个体测试以对其进行评估。九项研究评估了内容效度，五项评估了结构效度，三项评估了表面效度，一项评估了同时效度。七项研究报告了内部信度，四项报告了评分者间信度，两项报告了项目难度和项目区分度，一项报告了评分者内信度。八项研究报告称干预后知识得分显著提高。
内容效度和内部信度是评估最频繁的指标。识别人群、干预措施、对照、结局和研究设计（PICOS问题）以及计算敏感度、特异度和治疗所需人数（NNT）等循证医学基本活动不太可能改变。然而，循证医学课程中经常使用指南，且指南会定期更新，这将涉及新的临床场景、PICOS问题和统计计算。弗雷斯诺测试已在三组家庭医学住院医师中进行了评估，其效度和信度的文献记录最为完善，是未来发展的最佳候选测试。还需要开发评估工具，以衡量患者接受的治疗是否为循证医学治疗。
