Center for Palliative Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA.
Test Materials and Development, National Board of Medical Examiners, Philadelphia, Pennsylvania, USA; Palliative Care Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
J Pain Symptom Manage. 2018 Sep;56(3):371-378. doi: 10.1016/j.jpainsymman.2018.06.006. Epub 2018 Jun 22.
It is unknown whether the palliative care (PC) content tested in the U.S. Medical Licensing Examination (USMLE) step examinations reflects the consensus-developed PC competencies.
To review the USMLE step examinations to determine whether they test the PC knowledge necessary for graduating medical students and residents applying for licensure.
Eight PC physicians reviewed three complete examination forms and a focused 509-item bundle of multiple-choice questions (MCQs) identified by the USMLE content outline as potentially assessing PC content. Reviewers determined MCQs to be PC items if the patient was seriously ill and PC knowledge was required to answer correctly. PC items' competency domains were determined using reference domains from PC subspecialty consensus competencies.
Reviewers analyzed 1090 MCQs and identified 242 (22%) as PC items. PC items were identified in each step examination. Patients in PC items were mostly males (62.8%), older than 65 years (62%), and diagnosed with cancer (43.6%). Only 6.6% and 6.2%, respectively, had end-stage heart disease or multimorbid illness. Fifty-one percent of PC items addressed ethics (31%) or communication (19.8%), focusing on patient autonomy, surrogate decision makers, or conflict between decision makers. Pain and symptom management was assessed in 28.5% of PC items, and one-third of those addressed addiction or substance use disorder.
We identified PC content in each step examination. However, heart disease and multimorbidity were under-represented in PC items relative to their prevalence. In addition, there was heavy overlap with ethics, a focus on conflict in assessing communication skills, and emphasis on addiction when testing pain management. Our findings highlight opportunities to enhance testing of clinical PC skills essential for all licensed physicians practicing medicine.
尚不清楚美国医师执照考试（USMLE）分步考试中测试的姑息治疗（PC）内容是否反映了共识制定的 PC 能力。
审查 USMLE 分步考试，以确定它们是否测试了即将毕业的医学生和申请执照的住院医师所需的 PC 知识。
八名 PC 医生审查了三份完整的考试试卷和一份由 USMLE 内容大纲确定的 509 项多项选择题（MCQ）重点包，这些 MCQ 可能评估 PC 内容。如果患者病情严重且需要 PC 知识才能正确回答，则审查员将 MCQ 确定为 PC 项目。使用 PC 亚专业共识能力的参考领域确定 PC 项目的能力领域。
审查员分析了 1090 个 MCQ，并确定了 242 个（22%）为 PC 项目。每个分步考试都确定了 PC 项目。PC 项目中的患者主要是男性（62.8%），年龄超过 65 岁（62%），并被诊断患有癌症（43.6%）。只有分别为 6.6%和 6.2%的患者患有终末期心脏病或多种疾病。51%的 PC 项目涉及伦理（31%）或沟通（19.8%），重点是患者自主权、替代决策人或决策者之间的冲突。疼痛和症状管理在 28.5%的 PC 项目中得到评估，其中三分之一的项目涉及成瘾或物质使用障碍。
我们在每个分步考试中都确定了 PC 内容。然而，与心脏病和多种疾病的流行程度相比，它们在 PC 项目中的代表性不足。此外，在评估沟通技巧时，伦理问题存在严重重叠，在测试疼痛管理时，重点是成瘾。我们的研究结果强调了加强对所有执业医生进行临床 PC 技能测试的机会，这些技能对所有执业医生都至关重要。
