Friedman M, Prywes M, Benbassat J
Centre for Medical Education, Ben Gurion University of the Negev, Beer-Sheeva, Israel.
Med Educ. 1989 May;23(3):270-5. doi: 10.1111/j.1365-2923.1989.tb01544.x.
The uncertain validity of written simulations could be due to the difficulty in setting criteria for optimal performance. Usually criteria are set by definition of a limited number of 'correct answers' by a panel of experts reached through an open discussion. This is an artificial situation which entails mutual influence and forces the participants to respond to the necessity to reach a consensus. In the present report we describe an attempt to set 'correct answers' by the independent performance of 15 board-certified internists on four written simulations. There was a marked variability in responses due to legitimate differences in approach, to obvious errors in interpretation of the provided data and to possible differences between the expert behaviour in a real life and in a simulated setting. We believe that the criteria for acceptable performance on written clinical simulations should be determined by independent experts, rather than by a group consensus. Students who receive after the examination a compiled list of options selected by experts in response to the same questions may obtain a more realistic insight into the complexity of clinical problem-solving.
书面模拟的有效性不确定可能是由于难以设定最佳表现的标准。通常，标准是由专家小组通过公开讨论定义有限数量的“正确答案”来设定的。这是一种人为的情况，会产生相互影响，并迫使参与者回应达成共识的必要性。在本报告中，我们描述了一项尝试，通过15名获得委员会认证的内科医生对四个书面模拟的独立表现来设定“正确答案”。由于方法上的合理差异、对所提供数据解释的明显错误以及现实生活与模拟环境中专家行为可能存在的差异，回答存在显著差异。我们认为，书面临床模拟可接受表现的标准应由独立专家确定，而不是通过群体共识。考试后收到专家针对相同问题选择的选项汇编列表的学生，可能会对临床问题解决的复杂性有更现实的认识。
