用于评估患者问诊技巧的ECHOWS工具的可靠性
Reliability of the ECHOWS Tool for Assessment of Patient Interviewing Skills.
作者信息
Boissonnault Jill S, Evans Kerrie, Tuttle Neil, Hetzel Scott J, Boissonnault William G
机构信息
J.S. Boissonnault, PT, PhD, WCS, Department of Physical Therapy and Health Care Sciences, The George Washington University School of Medicine and Health Sciences, 2000 Pennsylvania Ave NW, Suite 227, Washington, DC 20006 (USA). Dr Boissonnault was affiliated with the Department of Orthopedics and Rehabilitation, Physical Therapy Program, University of Wisconsin-Madison, Madison, Wisconsin, at the time of the study.
K. Evans, PT, PhD, School of Allied Health Sciences, Menzies Health Institute Queensland, Griffith University-Gold Coast Campus, Gold Coast, Australia.
出版信息
Phys Ther. 2016 Apr;96(4):443-55. doi: 10.2522/ptj.20150172. Epub 2015 Aug 27.
BACKGROUND
History taking is an important component of patient/client management. Assessment of student history-taking competency can be achieved via a standardized tool. The ECHOWS tool has been shown to be valid with modest intrarater reliability in a previous study but did not demonstrate sufficient power to definitively prove its stability.
OBJECTIVE
The purposes of this study were: (1) to assess the reliability of the ECHOWS tool for student assessment of patient interviewing skills and (2) to determine whether the tool discerns between novice and experienced skill levels.
DESIGN
A reliability and construct validity assessment was conducted.
METHODS
Three faculty members from the United States and Australia scored videotaped histories from standardized patients taken by students and experienced clinicians from each of these countries. The tapes were scored twice, 3 to 6 weeks apart. Reliability was assessed using interclass correlation coefficients (ICCs) and repeated measures. Analysis of variance models assessed the ability of the tool to discern between novice and experienced skill levels.
RESULTS
The ECHOWS tool showed excellent intrarater reliability (ICC [3,1]=.74-.89) and good interrater reliability (ICC [2,1]=.55) as a whole. The summary of performance (S) section showed poor interrater reliability (ICC [2,1]=.27). There was no statistical difference in performance on the tool between novice and experienced clinicians.
LIMITATIONS
A possible ceiling effect may occur when standardized patients are not coached to provide complex and obtuse responses to interviewer questions. Variation in familiarity with the ECHOWS tool and in use of the online training may have influenced scoring of the S section.
CONCLUSION
The ECHOWS tool demonstrates excellent intrarater reliability and moderate interrater reliability. Sufficient training with the tool prior to student assessment is recommended. The S section must evolve in order to provide a more discerning measure of interviewing skills.
背景
病史采集是患者/客户管理的重要组成部分。可以通过标准化工具评估学生的病史采集能力。在先前的一项研究中，ECHOWS工具已被证明是有效的，具有适度的评分者内信度，但没有显示出足够的效力来明确证明其稳定性。
目的
本研究的目的是：（1）评估ECHOWS工具在学生评估患者访谈技能方面的信度，以及（2）确定该工具是否能够区分新手和经验丰富者的技能水平。
设计
进行了信度和结构效度评估。
方法
来自美国和澳大利亚的三名教员对来自这些国家的学生和经验丰富的临床医生对标准化患者进行的录像病史进行评分。录像带分两次评分，间隔3至6周。使用组内相关系数（ICC）和重复测量来评估信度。方差分析模型评估该工具区分新手和经验丰富者技能水平的能力。
结果
ECHOWS工具总体上显示出出色的评分者内信度（ICC[3,1]=0.74-0.89）和良好的评分者间信度（ICC[2,1]=0.55）。表现总结（S）部分显示评分者间信度较差（ICC[2,1]=0.27）。新手和经验丰富的临床医生在该工具上的表现没有统计学差异。
局限性
当标准化患者未被指导对访谈者的问题提供复杂和模糊的回答时，可能会出现天花板效应。对ECHOWS工具的熟悉程度以及在线培训的使用差异可能影响了S部分的评分。
结论
ECHOWS工具显示出出色的评分者内信度和中等的评分者间信度。建议在学生评估之前对该工具进行充分培训。S部分必须改进，以便提供更具辨别力的访谈技能测量方法。
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