Henriksen Mikael Johannes Vuokko, Wienecke Troels, Thagesen Helle, Jacobsen Rikke Vita Borre, Subhi Yousif, Ringsted Charlotte, Konge Lars
Copenhagen Academy for Medical Education and Simulation, The Capital Region of Denmark, Rigshospitalet section 5404, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
J Gen Intern Med. 2017 Jun;32(6):610-618. doi: 10.1007/s11606-016-3981-y. Epub 2017 Feb 6.
Lumbar puncture is a common procedure in many specialties. The procedure serves to diagnose life-threatening conditions, often requiring rapid performance. However, junior doctors possess uncertainties regarding performing the procedure and frequently perform below expectations. Hence, proper training and assessment of performance is crucial before entering clinical practice.
To develop and collect validity evidence for an assessment tool for lumbar puncture performance, including a standard to determine when trainees are ready for clinical practice.
Development of a new tool, based on clinician interviews and a literature review, was followed by an explorative study to gather validity evidence.
We interviewed 12 clinicians from different specialties. The assessment tool was used to assess 11 doctors at the advanced beginners' level and 18 novices performing the procedure in a simulated, ward-like setting with a standardized patient. Procedural performance was assessed by three content experts. We used generalizability theory to explore reliability. The discriminative ability of the tool was explored by comparing performance scores between the two groups. The contrasting groups method was used to set a pass/fail standard and the consequences of this was explored.
The interviews identified that in addition to the technical aspects of the procedure, non-technical elements involving planning and conducting the procedure are important. Cronbach's alpha = 0.92, Generalizability-coefficient was 0.88 and a Decision-study found one rater was sufficient for low-stakes assessments (G-coefficient 0.71). The discriminative ability was confirmed by a significant difference between the mean scores of novices, 40.9 (SD 6.1) and of advanced beginners, 47.8 (SD 4.0), p = 0.004. A standard of 44.0 was established which was consistent with the raters' global judgments of pass/fail.
We developed and demonstrated strong validity evidence for the lumbar puncture assessment tool. The tool can be used to assess readiness for practice.
腰椎穿刺是许多专科常见的操作。该操作有助于诊断危及生命的疾病，通常需要快速完成。然而，初级医生在进行该操作时存在不确定性，且操作表现常常低于预期。因此，在进入临床实践之前，进行适当的培训和操作评估至关重要。
开发并收集腰椎穿刺操作评估工具的效度证据，包括确定实习生何时准备好进入临床实践的标准。
基于临床医生访谈和文献综述开发一种新工具，随后进行探索性研究以收集效度证据。
我们采访了12名来自不同专科的临床医生。该评估工具用于在模拟病房环境中，对11名处于高级初学者水平的医生和18名新手进行操作评估，患者为标准化病人。由三位内容专家对操作表现进行评估。我们使用概化理论探索可靠性。通过比较两组的表现分数来探索该工具的区分能力。采用对比组方法设定通过/未通过标准，并探讨其后果。
访谈发现，除了操作的技术方面，涉及操作规划和实施的非技术要素也很重要。克朗巴哈系数α = 0.92，概化系数为0.88，决策研究发现一名评分者足以进行低风险评估（G系数0.71）。新手组平均得分40.9（标准差6.1）与高级初学者组平均得分47.8（标准差4.0）之间存在显著差异，证实了区分能力，p = 0.004。确立了44.0的标准，这与评分者对通过/未通过的整体判断一致。
我们开发并证明了腰椎穿刺评估工具具有强有力的效度证据。该工具可用于评估实践准备情况。
