Waldauf Petr, Rubulotta Francesca, Sitzwohl Christian, Elbers Paul, Girbes Armand, Saha Rajnish, Marsh Brian, Kumar Ravindra, Maggiorini Marco, Duška František
Kralovske Vinohrady University Hospital and Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic.
Department of Professional Development, ESICM, Brussels, Belgium.
J Intensive Care Soc. 2017 Nov;18(4):294-299. doi: 10.1177/1751143717712623. Epub 2017 Jul 5.
The oral part of European Diploma in Intensive Care diploma examinations changed in 2013 into an objective structured clinical examination-type exam. This step was undertaken to provide a fair and reproducible clinical exam. All candidates face identical questions with predefined correct answers simultaneously in seven high throughput exam centres on the same day. We describe the factors that are associated with success in part 2 European Diploma in Intensive Care exam.
We prospectively collected self-reported data from all candidates sitting European Diploma in Intensive Care part 2 in 2015, namely demographics, professional background and attendance to a European Diploma in Intensive Care part 2 or generic objective structured clinical examination preparatory courses. After testing association with success (with cutoff at p < 0.10) and co-linearity of these factors as independent variables, we performed a multivariate logistical analysis, with binary exam outcome (pass/fail) as the dependent variable. Structural equation modelling was used to gain further insight into relations among determinants of success in the oral part of the European Diploma in Intensive Care.
Out of 427 candidates sitting the exam, completed data from 341 (80%) were available for analysis. The following candidates' factors were associated with increased chance of success: English as native language (odds ratio 4.3 (95% CI 1.7-10.7)), use of Patient-centred Acute Care Training e-learning programme module (odds ratios 2.0 (1.2-3.3)), working in an EU country (odds ratios 2.5 (1.5-4.3)), and better results in the written part of the European Diploma in Intensive Care (for each additional SD of 6.1 points odds ratios 1.9 (1.4-2.4)). Chance of success in the European Diploma in Intensive Care 2 decreased with increased candidates 'age (for each additional SD of 5.5 years odds ratios 0.67 (0.51-0.87)). Exam centres (7 in total) could be clustered into 3 groups with similar success rates. There were significant differences in exam outcomes among these 3 groups of exam centres even after adjustment to known candidates' factors (G1 vs G2 odds ratios 2.4 (1.4-4.1); G1 vs G3 odds ratios 9.7 (4.0-23.1) and G2 vs G3 odds ratios 3.9 (1.7-9.2)). A short data collection period (only one year) and 20% of missing candidates' data are the main limitations of this study.
Younger age, English as native language, better results in written part of the exam, working at a European country and the use of PACT for preparation, were factors associated with success in the oral part of the European Diploma in Intensive Care exam. Despite the limitations of this study, the differences in outcome among the exam centres will need further investigation.
欧洲重症监护文凭考试的口试部分于2013年改为客观结构化临床考试类型。采取这一步骤是为了提供一个公平且可重复的临床考试。所有考生在同一天于七个高吞吐量考试中心同时面对相同的问题，这些问题有预先确定的正确答案。我们描述了与欧洲重症监护文凭考试第二部分成功相关的因素。
我们前瞻性地收集了2015年参加欧洲重症监护文凭考试第二部分的所有考生的自我报告数据，即人口统计学、专业背景以及是否参加过欧洲重症监护文凭考试第二部分或通用客观结构化临床考试预备课程。在测试这些因素与成功的关联（截断值为p<0.10）以及这些因素作为自变量的共线性之后，我们进行了多变量逻辑分析，将二元考试结果（通过/未通过）作为因变量。使用结构方程模型来进一步深入了解欧洲重症监护文凭口试部分成功的决定因素之间的关系。
在参加考试的427名考生中，有341名（80%）的完整数据可供分析。以下考生因素与成功几率增加相关：以英语为母语（优势比4.3（95%置信区间1.7 - 10.7））、使用以患者为中心的急性护理培训电子学习计划模块（优势比2.0（1.2 - 3.3））、在欧盟国家工作（优势比2.5（1.5 - 4.3））以及在欧洲重症监护文凭笔试部分取得更好成绩（每增加6.1分的标准差，优势比1.9（1.4 - 2.））。欧洲重症监护文凭考试2的成功几率随着考生年龄的增加而降低（每增加5.5岁的标准差，优势比0.67（0.51 - 0.87））。考试中心（总共7个）可分为3组，成功率相似。即使在根据已知的考生因素进行调整后，这3组考试中心的考试结果仍存在显著差异（G1与G2的优势比2.4（1.4 - 4.1）；G1与G3的优势比9.7（4.0 - 23.1）以及G2与G3的优势比3.9（1.7 - 9.2））。数据收集期短（仅一年）以及20%的考生数据缺失是本研究的主要局限性。
年龄较小、以英语为母语、考试笔试部分成绩较好、在欧洲国家工作以及使用PACT进行备考，是与欧洲重症监护文凭考试口试部分成功相关的因素。尽管本研究存在局限性，但考试中心之间结果的差异仍需进一步调查。
