Shewade Hemant Deepak, Jeyashree Kathiresan, Kalaiselvi Selvaraj, Palanivel Chinnakali, Panigrahi Krishna Chandra
Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi.
Department of Community Medicine, Indira Gandhi Medical College and Research Institute, Puducherry.
Adv Med Educ Pract. 2017 Apr 10;8:277-286. doi: 10.2147/AMEP.S123840. eCollection 2017.
A community-based training (CBT) program, where teaching and training are carried out in the community outside of the teaching hospital, is a vital part of undergraduate medical education. Worldwide, there is a shift to competency-based training, and CBT is no exception. We attempted to develop a tool that uses a competency-based approach for assessment of CBT.
Based on a review on competencies, we prepared a preliminary list of major domains with items under each domain. We used the Delphi technique to arrive at a consensus on this assessment tool. The Delphi panel consisted of eight purposively selected experts from the field of community medicine. The panel rated each item for its relevance, sensitivity, specificity, and understandability on a scale of 0-4. Median ratings were calculated at the end of each round and shared with the panel. Consensus was predefined as when 70% of the experts gave a rating of 3 or above for an item under relevance, sensitivity, and specificity. If an item failed to achieve consensus after being rated in 2 consecutive rounds, it was excluded. Anonymity of responses was maintained.
The panel arrived at a consensus at the end of 3 rounds. The final version of the self-assessment tool consisted of 7 domains and 74 items. The domains (number of items) were Public health - epidemiology and research methodology (13), Public health - biostatistics (6), Public health administration at primary health center level (17), Family medicine (24), Cultural competencies (3), Community development and advocacy (2), and Generic competence (9). Each item was given a maximum score of 5 and minimum score of 1.
This is the first study worldwide to develop a tool for competency-based evaluation of CBT in undergraduate medical education. The competencies identified in the 74-item questionnaire may provide the base for development of authentic curricula for CBT.
基于社区的培训（CBT）项目是本科医学教育的重要组成部分，该项目的教学和培训在教学医院以外的社区进行。在全球范围内，医学教育正转向基于能力的培训，CBT也不例外。我们试图开发一种使用基于能力的方法来评估CBT的工具。
基于对能力的综述，我们编制了主要领域的初步清单，每个领域下都有具体项目。我们采用德尔菲技术就该评估工具达成共识。德尔菲小组由八名从社区医学领域有目的地挑选出的专家组成。该小组对每个项目的相关性、敏感性、特异性和可理解性进行0至4分的评分。在每一轮结束时计算中位数评分并反馈给小组。当70%的专家对某个项目在相关性、敏感性和特异性方面给出3分或以上的评分时，即达成共识。如果一个项目在连续两轮评分后未达成共识，则将其排除。回复保持匿名。
该小组在三轮结束时达成了共识。自我评估工具的最终版本包括7个领域和74个项目。这些领域（项目数量）分别是公共卫生 - 流行病学与研究方法（13个）、公共卫生 - 生物统计学（6个）、初级卫生保健中心层面的公共卫生管理（17个）、家庭医学（24个）、文化能力（3个）社区发展与倡导（2个）以及通用能力（9个）。每个项目的最高分为5分，最低分为1分。
这是全球范围内第一项为本科医学教育中基于能力的CBT评估开发工具的研究。这份74项问卷中确定的能力可能为CBT真实课程的开发提供基础。
