Division of Critical Care Medicine (MW Zackoff); Department of Pediatrics, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine (MW Zackoff, FJ Real, D DeBlasio, B Sobolewski, N Unaka, K Jerardi, and M Klein), Ohio.
Division of General and Community Pediatrics (FJ Real, D DeBlasio, JR Spaulding, and M Klein); Department of Pediatrics, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine (MW Zackoff, FJ Real, D DeBlasio, B Sobolewski, N Unaka, K Jerardi, and M Klein), Ohio.
Acad Pediatr. 2019 Aug;19(6):698-702. doi: 10.1016/j.acap.2019.01.011. Epub 2019 Mar 8.
Competency-based training should be paired with objective assessments. To date, there has been limited objective assessment of resident-as-teacher curricula (RATC). We sought to assess the impact of a longitudinal RATC on postgraduate year-1 (PGY1) resident teaching competency using Observed Structured Teaching Encounters (OSTEs) for the skills of 1) brief didactic teaching [DT], 2) feedback [FB], and 3) precepting [PR].
A controlled, prospective, educational study was conducted from May 2015 to June 2016. The RATC consisted of a workshop series with reinforcement of key skills (DT, FB) during clinical rotations. Intervention residents participated in the RATC and completed OSTEs at the beginning and end of the academic year. A control group, PGY1 residents that matriculated the year previously, completed the OSTEs before starting their PGY2 year. OSTEs were reviewed by 2 blinded study personnel. We assessed reliability between raters via intraclass correlation coefficients and differences in OSTE scores via least squared mean differences (LSMD).
In total, 92.5% (n = 37) of eligible control and 100% (n = 41) of eligible intervention residents participated. The OSTEs demonstrated excellent agreement between reviewers (DT: 0.99, FB: 0.89, PR: 0.98). A significant pre-post difference was demonstrated in the intervention group for DT (LSMD [95% confidence interval], 3.14 [2.49-3.79], P < .0001), FB (0.93 [0.49-1.37], P < .0001), and PR (0.64 [0.09-1.18], P < .022). A significant difference between the control and intervention groups was demonstrated for DT (3.00 [2.05-3.96], P < .0001).
Skill-based OSTEs can be used to detect changes in residents' teaching competency and may represent a potential component of programmatic evaluation of resident-as-teacher curricula.
基于能力的培训应该与客观评估相结合。迄今为止，对住院医师作为教师课程（RATC）的客观评估有限。我们旨在使用观察结构化教学评估（OSTE）评估纵向 RATC 对住院医师 1 年级（PGY1）住院医师教学能力的影响，OSTE 评估的技能包括 1）简短的教学方法[DT]，2）反馈[FB]和 3）指导[PR]。
一项从 2015 年 5 月至 2016 年 6 月进行的对照、前瞻性、教育研究。RATC 由一系列讲习班组成，在临床轮转期间强化关键技能（DT、FB）。干预组住院医师参加了 RATC，并在学年开始和结束时完成了 OSTE。对照组是前一年入学的 PGY1 住院医师，在开始 PGY2 之前完成了 OSTE。OSTE 由 2 名盲审研究人员进行审查。我们通过组内相关系数评估评分者之间的可靠性，并通过最小二乘均值差异（LSMD）评估 OSTE 评分的差异。
共有 92.5%（n=37）名符合条件的对照组和 100%（n=41）名符合条件的干预组住院医师参加了研究。OSTE 显示评分者之间具有极好的一致性（DT：0.99，FB：0.89，PR：0.98）。干预组在 DT（LSMD[95%置信区间]，3.14[2.49-3.79]，P<.0001）、FB（0.93[0.49-1.37]，P<.0001）和 PR（0.64[0.09-1.18]，P<.022）方面表现出明显的前后差异。对照组和干预组之间在 DT（3.00[2.05-3.96]，P<.0001）方面表现出显著差异。
基于技能的 OSTE 可用于检测住院医师教学能力的变化，可能是住院医师作为教师课程计划评估的潜在组成部分。
