Loochtan Aaron I, Spector Andrew R, Sinha Saurabh R, Lerner David P
Department of Neurology, Duke University Medical Center, Durham, NC.
Department of Neurology, Lahey Hospital and Medical Center, Burlington, MA.
Neurologist. 2019 Mar;24(2):53-55. doi: 10.1097/NRL.0000000000000217.
Neurological emergencies comprise much of neurology residency, but there may be a lack of clinical experience. For our program, oral examinations have been used to assess resident readiness for additional clinical independence. In this study, we examined the perceptions of learners and examiners of oral case examinations.
Six attending physicians administered case-based oral examinations to 8 trainees. Each case involved a chief complaint and progressed through a clinical encounter. Following the examination, each attending physician and trainee completed an online 5-point Likert scale survey of content and educational value. Statistical analysis of point assignment based on Likert scale responses was performed.
Six attendings (100% response) and 7 trainees (87.5% response) completed the assessment. The trainees assessed all 6 cases. Residents had negative responses for 3 cases with specific concern in "feedback" and "learning experience." Residents responded with less positive response than attendings for "The case is easy to understand and progressed in a logical fashion" (3.90 for residents vs. 4.83 attendings; P=0.015) and "The case complexity is appropriate for level of training" (4.14 vs. 4.83; P=0.033). Attendings noted better understanding of trainees thought processes following oral examinations. Trainees noted feedback as the most useful component of case-based assessments.
Case-based assessment in neurology training allows for rapid evaluation of trainees' abilities to critically think. There is general agreement from attendings and trainees that case-based assessment is a useful and positive learning tool. The responses from this survey are being used to modify the cases for future examinations.
神经科急症在神经科住院医师培训中占了很大一部分，但可能缺乏临床经验。在我们的培训项目中，一直通过口试来评估住院医师是否准备好获得更多临床独立性。在本研究中，我们调查了学习者和考官对口试病例考试的看法。
6名主治医师对8名学员进行基于病例的口试。每个病例都有一个主要诉求，并贯穿整个临床诊疗过程。考试结束后，每位主治医师和学员都完成了一项关于内容和教育价值的在线5级李克特量表调查。对基于李克特量表回答的评分进行了统计分析。
6名主治医师（100%回复率）和7名学员（87.5%回复率）完成了评估。学员们评估了所有6个病例。住院医师对3个病例给出了负面反馈，特别关注“反馈”和“学习体验”。在“病例易于理解且逻辑连贯”（住院医师评分为3.90，主治医师评分为4.83；P=0.015）和“病例复杂性与培训水平相适应”（4.14对4.83；P=0.033）方面，住院医师的积极反馈少于主治医师。主治医师指出，口试后对学员的思维过程有了更好的理解。学员们指出，反馈是基于病例评估中最有用的部分。
神经科培训中的基于病例的评估能够快速评估学员的批判性思维能力。主治医师和学员普遍认为基于病例的评估是一种有用且积极的学习工具。本次调查的结果正被用于修改未来考试的病例。
