住院医师能否评估其他医疗人员的婴儿腰椎穿刺技能？：全球评定量表和子成分技能检查表的效度证据

Can Residents Assess Other Providers' Infant Lumbar Puncture Skills?: Validity Evidence for a Global Rating Scale and Subcomponent Skills Checklist.

作者信息

Braun Colleen, Kessler David O, Auerbach Marc, Mehta Renuka, Scalzo Anthony J, Gerard James M

机构信息

From the *Department of Pediatrics, Saint Louis University School of Medicine, St Louis, MO; †Department of Pediatrics, Columbia University Medical Center, New York, NY; ‡Department of Pediatrics, Yale University School of Medicine, New Haven, CT; and §Department of Pediatrics, Medical College of Georgia at Georgia Regents University, Augusta, GA.

出版信息

Pediatr Emerg Care. 2017 Feb;33(2):80-85. doi: 10.1097/PEC.0000000000000890.

DOI:10.1097/PEC.0000000000000890

PMID:27763954

Abstract

OBJECTIVES

The aims of this study were to provide validity evidence for infant lumbar puncture (ILP) checklist and global rating scale (GRS) instruments when used by residents to assess simulated ILP performances and to compare these metrics to previously obtained attending rater data.

METHODS

In 2009, the International Network for Simulation-based Pediatric Innovation, Research, and Education (INSPIRE) developed checklist and GRS scoring instruments, which were previously validated among attending raters when used to assess simulated ILP performances. Video recordings of 60 subjects performing an LP on an infant simulator were collected; 20 performed by subjects in 3 categories (beginner, intermediate, and expert). Six blinded pediatric residents independently scored each performance (3 via the GRS, 3 via the checklist). Four of the 5 domains of validity evidence were collected: content, response process, internal structure (reliability and discriminant validity), and relations to other variables.

RESULTS

Evidence for content and response process validity is presented. When used by residents, the checklist performed similarly to what was found for attending raters demonstrating good internal consistency (Cronbach α = 0.77) and moderate interrater agreement (intraclass correlation coefficient = 0.47). Residents successfully discerned beginners (P < 0.01, effect size = 2.1) but failed to discriminate between expert and intermediate subjects (P = 0.68, effect size = 0.34). Residents, however, gave significantly higher GRS scores than attending raters across all subject groups (P < 0.001). Moderate correlation was found between GRS and total checklist scores (P = 0.49, P < 0.01).

CONCLUSIONS

This study provides validity evidence for the checklist instrument when used by pediatric residents to assess ILP performances. Compared with attending raters, residents appeared to over-score subjects on the GRS instrument.

摘要

目的

本研究旨在为住院医师使用婴儿腰椎穿刺（ILP）检查表和整体评分量表（GRS）工具评估模拟ILP操作表现提供效度证据，并将这些指标与之前获得的主治评分者数据进行比较。

方法

2009年，国际儿科模拟创新、研究与教育网络（INSPIRE）开发了检查表和GRS评分工具，这些工具之前在用于评估模拟ILP操作表现时已在主治评分者中得到验证。收集了60名受试者在婴儿模拟器上进行腰椎穿刺的视频记录；由3类受试者（初学者、中级和专家）中的20名进行操作。6名盲法儿科住院医师独立对每个操作进行评分（3名通过GRS评分，3名通过检查表评分）。收集了效度证据的5个领域中的4个：内容、反应过程、内部结构（信度和区分效度）以及与其他变量的关系。

结果

呈现了内容和反应过程效度的证据。住院医师使用检查表时的表现与主治评分者的表现相似，显示出良好的内部一致性（Cronbach α = 0.77）和中等程度的评分者间一致性（组内相关系数 = 0.47）。住院医师成功辨别出初学者（P < 0.01，效应量 = 2.1），但未能区分专家和中级受试者（P = 0.68，效应量 = 0.34）。然而，在所有受试者组中，住院医师给出的GRS分数显著高于主治评分者（P < 0.001）。GRS与检查表总分之间存在中等程度的相关性（P = 0.49，P < 0.01）。