Seto Teresa L, Tabangin Meredith E, Taylor Kathryn K, Josyula Srirama, Vasquez Juan Carlos, Kamath-Rayne Beena D
From the Division of Neonatology (T.LS.); Division of Biostatistics and Epidemiology (M.E.T.), Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Harvard School of Medicine (K.K.T.), Cambridge, MA; The Ohio State University College of Medicine (S.J.), Columbus, OH; Hospital Enrique Aguilar Cerrato (J.C.V.), La Esperanza, Honduras; and Division of Neonatology and Global Health Center (B.D.K.R.), Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Simul Healthc. 2017 Aug;12(4):226-232. doi: 10.1097/SIH.0000000000000224.
Helping Babies Breathe (HBB) is a simulation-based neonatal resuscitation curriculum designed for low-resource settings. At the completion of the workshop, learners complete the following four assessments: a multiple-choice question (MCQ) test, bag-mask ventilation (BMV) checklist, and two objective structured clinical examinations (OSCEs). Objective structured clinical examinations are clinical performance assessments that evaluate learners' skills in simulated scenarios. The aims of this study were (1) to evaluate the validity and reliability of the OSCEs used in the HBB curriculum, (2) to conduct an itemized analysis of the OSCEs to identify specific deficits in knowledge and performance, and to identify areas of improvement for future versions of HBB.
Seventy physicians and nurses completed an HBB workshop conducted in Spanish at a Honduran community hospital. Validity and reliability were examined using an item analysis of item difficulty, discrimination, correlation, and internal consistency/reliability.
Posttest scores were higher for all assessments. Most items on the OSCEs were of low difficulty and low discrimination. Item agreement was lowest for multistep items.
As summative and formative assessments of performance in simulated neonatal resuscitation, the HBB OSCEs are effective because most learners were able to perform the skills correctly after an HBB workshop. On the basis of our results, we recommend changes to future editions of HBB, including the following: simplification of multistep items to single tasks, use of a global rating scale, provision of additional scenarios, and specific instructions to raters on how to grade OSCEs and promote self-reflection to enhance debriefings/feedback. Further validation and study of the OSCEs in the second edition of HBB would enhance their quality and translation into clinical performance.
“帮助婴儿呼吸”（HBB）是一项基于模拟的新生儿复苏课程，专为资源匮乏地区设计。在工作坊结束时，学员要完成以下四项评估：多项选择题（MCQ）测试、面罩通气（BMV）检查表以及两项客观结构化临床考试（OSCE）。客观结构化临床考试是一种临床技能评估，用于评估学员在模拟场景中的技能。本研究的目的是：（1）评估HBB课程中使用的OSCE的有效性和可靠性；（2）对OSCE进行逐项分析，以确定知识和技能方面的具体不足，并为HBB的未来版本确定改进领域。
70名医生和护士在洪都拉斯一家社区医院参加了用西班牙语举办的HBB工作坊。通过对项目难度、区分度、相关性和内部一致性/可靠性进行项目分析，来检验有效性和可靠性。
所有评估的后测分数都更高。OSCE中的大多数项目难度低、区分度也低。多步骤项目的项目一致性最低。
作为模拟新生儿复苏中表现的总结性和形成性评估，HBB的OSCE是有效的，因为大多数学员在参加HBB工作坊后能够正确执行技能。根据我们的结果，我们建议对HBB的未来版本进行如下更改：将多步骤项目简化为单一任务、使用整体评分量表、提供更多场景，以及向评分者提供关于如何对OSCE进行评分和促进自我反思以加强汇报/反馈的具体指导。在HBB第二版中对OSCE进行进一步验证和研究将提高其质量并转化为临床实践表现。
