Rawlings Arthur, Knox Aaron D C, Park Yoon Soo, Reddy Shalini, Williams Sarah R, Issa Nabil, Jameel Abid, Tekian Ara
A. Rawlings is assistant professor, Department of Surgery, University of Missouri School of Medicine, Columbia, Missouri. A.D.C. Knox is a resident, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada. Y.S. Park is assistant professor, Department of Medical Education, University of Illinois College of Medicine, Chicago, Illinois. S. Reddy is associate professor, Department of Medicine, Section of Hospital Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois. S.R. Williams is clinical associate professor, Division of Emergency Medicine, Stanford University School of Medicine, Stanford, California. N. Issa is assistant professor, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois. A. Jameel is professor, Department of Medical Oncology, Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, Pakistan. A. Tekian is associate professor, Department of Medical Education, University of Illinois College of Medicine, Chicago, Illinois.
Acad Med. 2015 Aug;90(8):1109-15. doi: 10.1097/ACM.0000000000000739.
Residency programs now are required to use educational milestones, which has led to the need for new methods of assessment. The literature suggests that narrative cases are a promising tool to track residents' progress. This study demonstrates the process for developing and evaluating narrative cases representing the five levels of the professionalism milestones.
In 2013, the authors identified 28 behaviors in the Accreditation Council for Graduate Medical Education general surgery professionalism milestones. They modified previously published narrative cases to fit these behaviors. To evaluate the quality of these cases, the authors developed a 28-item, five-point scale instrument, which 29 interdisciplinary faculty completed. The authors compared the faculty ratings by narrative case and specialty with the authors' initial rankings of the cases by milestone level. They used t tests and analysis of variance to compare mean scores across specialties.
The authors developed 10 narrative cases, 2 for each of the 5 milestone levels. Each case contained at least 20 of the 28 behaviors identified in the milestones. Mean faculty ratings matched the milestone levels. Reliability was good (G coefficient = 0.86, phi coefficient = 0.85), indicating consistency in raters' ability to determine the proper milestone level for each case.
The authors demonstrate a process for using specialty-specific milestones to develop narrative cases that map to a spectrum of professionalism behaviors. This process can be applied to other competencies and specialties to facilitate faculty awareness of resident performance descriptors and provide a frame of reference for milestones assessment.
住院医师培训项目现在需要使用教育里程碑，这导致了对新评估方法的需求。文献表明，叙事病例是跟踪住院医师进展的一种有前景的工具。本研究展示了开发和评估代表专业精神里程碑五个水平的叙事病例的过程。
2013年，作者在毕业后医学教育认证委员会普通外科专业精神里程碑中确定了28种行为。他们修改了先前发表的叙事病例以符合这些行为。为了评估这些病例的质量，作者开发了一个包含28个项目的五点量表工具，29名跨学科教员完成了该工具的填写。作者将按叙事病例和专业划分的教员评分与作者按里程碑水平对病例的初始排名进行了比较。他们使用t检验和方差分析来比较各专业的平均得分。
作者开发了10个叙事病例，每个里程碑水平有2个。每个病例至少包含里程碑中确定的28种行为中的20种。教员平均评分与里程碑水平相符。信度良好（G系数 = 0.86，phi系数 = 0.85），表明评分者确定每个病例适当里程碑水平的能力具有一致性。
作者展示了一个利用特定专业里程碑来开发叙事病例的过程，这些病例对应一系列专业精神行为。这个过程可以应用于其他能力和专业，以促进教员对住院医师表现描述符的认识，并为里程碑评估提供一个参考框架。
