McMahon Erin, Jevitt Cecilia, Aronson Barbara
J Midwifery Womens Health. 2018 Mar;63(2):221-226. doi: 10.1111/jmwh.12721. Epub 2018 Mar 13.
Intrapartum emergencies occur infrequently but require a prompt and competent response from the midwife to prevent morbidity and mortality of the woman, fetus, and newborn. Simulation provides the opportunity for student midwives to develop competence in a safe environment. The purpose of this study was to determine the inter-rater reliability of the McMahon Competence Assessment Instrument (MCAI) for use with student midwives during a simulated shoulder dystocia scenario.
A pilot study using a nonprobability convenience sample was used to evaluate the MCAI. Content validity indices were calculated for the individual items and the overall instrument using data from a panel of expert reviewers. Fourteen student midwives consented to be video recorded while participating in a simulated shoulder dystocia scenario. Three faculty raters used the MCAI to evaluate the student performance. These quantitative data were used to determine the inter-rater reliability of the MCAI.
The intraclass correlation coefficient (ICC) was used to assess the inter-rater reliability of MCAI scores between 2 or more raters. The ICC was 0.86 (95% confidence interval, 0.60-0.96). Fleiss's kappa was calculated to determine the inter-rater reliability for individual items. Twenty-three of the 42 items corresponded to excellent strength of agreement.
This study demonstrates a method to determine the inter-rater reliability of a competence assessment instrument to be used with student midwives. Data produced by this study were used to revise and improve the instrument. Additional research will further document the inter-rater reliability and can be used to determine changes in student competence. Valid and reliable methods of assessment will encourage the use of simulation to efficiently develop the competence of student midwives.
分娩期紧急情况虽不常发生，但需要助产士迅速且专业地应对，以预防产妇、胎儿和新生儿出现发病和死亡情况。模拟为助产专业学生提供了在安全环境中培养能力的机会。本研究的目的是确定麦克马洪能力评估工具（MCAI）在模拟肩难产场景中用于评估助产专业学生时的评分者间信度。
采用非概率便利抽样的预试验来评估MCAI。利用专家评审小组的数据计算各个项目及整个工具的内容效度指标。14名助产专业学生在参与模拟肩难产场景时同意被录像。三名教师评分者使用MCAI评估学生的表现。这些定量数据用于确定MCAI的评分者间信度。
组内相关系数（ICC）用于评估两名或更多评分者之间MCAI评分的评分者间信度。ICC为0.86（95%置信区间，0.60 - 0.96）。计算Fleiss's kappa以确定各个项目的评分者间信度。42个项目中有23个项目的一致性强度极佳。
本研究展示了一种确定用于助产专业学生的能力评估工具评分者间信度的方法。本研究产生的数据用于修订和改进该工具。更多研究将进一步记录评分者间信度，并可用于确定学生能力的变化。有效且可靠的评估方法将鼓励使用模拟来高效培养助产专业学生的能力。
