Lee Victor, Brain Keira, Martin Jenepher
V. Lee is codirector of emergency medicine training, Department of Emergency Medicine, Austin Health, Heidelberg, Victoria, Australia.K. Brain is doctor, South West Healthcare, Warrnambool, Victoria, Australia.J. Martin is associate professor and director, Medical Student Programs, Monash University and Deakin University, Eastern Health Clinical School, Box Hill, Victoria, Australia.
Acad Med. 2017 Jun;92(6):880-887. doi: 10.1097/ACM.0000000000001537.
At present, little is known about how mini-clinical evaluation exercise (mini-CEX) raters translate their observations into judgments and ratings. The authors of this systematic literature review aim both to identify the factors influencing mini-CEX rater judgments in the medical education setting and to translate these findings into practical implications for clinician assessors.
The authors searched for internal and external factors influencing mini-CEX rater judgments in the medical education setting from 1980 to 2015 using the Ovid MEDLINE, PsycINFO, ERIC, PubMed, and Scopus databases. They extracted the following information from each study: country of origin, educational level, study design and setting, type of observation, occurrence of rater training, provision of feedback to the trainee, research question, and identified factors influencing rater judgments. The authors also conducted a quality assessment for each study.
Seventeen articles met the inclusion criteria. The authors identified both internal and external factors that influence mini-CEX rater judgments. They subcategorized the internal factors into intrinsic rater factors, judgment-making factors (conceptualization, interpretation, attention, and impressions), and scoring factors (scoring integration and domain differentiation).
The current theories of rater-based judgment have not helped clinicians resolve the issues of rater idiosyncrasy, bias, gestalt, and conflicting contextual factors; therefore, the authors believe the most important solution is to increase the justification of rater judgments through the use of specific narrative and contextual comments, which are more informative for trainees. Finally, more real-world research is required to bridge the gap between the theory and practice of rater cognition.
目前，对于迷你临床评估演练（mini-CEX）评分者如何将其观察结果转化为判断和评分知之甚少。本系统文献综述的作者旨在识别医学教育环境中影响mini-CEX评分者判断的因素，并将这些发现转化为对临床评估者的实际启示。
作者使用Ovid MEDLINE、PsycINFO、ERIC、PubMed和Scopus数据库，检索了1980年至2015年医学教育环境中影响mini-CEX评分者判断的内部和外部因素。他们从每项研究中提取了以下信息：原产国、教育水平、研究设计与环境、观察类型、评分者培训的情况、向受训者提供反馈的情况、研究问题以及识别出的影响评分者判断的因素。作者还对每项研究进行了质量评估。
17篇文章符合纳入标准。作者识别出了影响mini-CEX评分者判断的内部和外部因素。他们将内部因素细分为评分者内在因素、决策因素（概念化、解释、注意力和印象）以及评分因素（评分整合和领域区分）。
当前基于评分者的判断理论并未帮助临床医生解决评分者特质、偏差、格式塔和相互冲突的背景因素等问题；因此，作者认为最重要的解决办法是通过使用具体的叙述性和背景性评论来增加评分者判断的合理性，这对受训者来说更具信息量。最后，需要更多的实际研究来弥合评分者认知理论与实践之间的差距。
