Wasson Katherine, Adams William H, Berkowitz Kenneth, Danis Marion, Derse Arthur R, Kuczewski Mark G, McCarthy Michael, Parsi Kayhan, Tarzian Anita J
a Neiswanger Institute for Bioethics and Stritch School of Medicine, Loyola University Chicago , Maywood , Illinois , USA.
b Medical Education and Public Health Sciences, Loyola University Chicago Health Sciences Division , Maywood , Illinois , USA.
AJOB Empir Bioeth. 2019 Jul-Sep;10(3):164-172. doi: 10.1080/23294515.2019.1634653. Epub 2019 Jul 11.
The field of clinical ethics is examining ways of determining competency. The Assessing Clinical Ethics Skills (ACES) tool offers a new approach that identifies a range of skills necessary in the conduct of clinical ethics consultation and provides a consistent framework for evaluating these skills. Through a training website, users learn to apply the ACES tool to clinical ethics consultants (CECs) in simulated ethics consultation videos. The aim is to recognize competent and incompetent clinical ethics consultation skills by watching and evaluating a videotaped CEC performance. We report how we set a criterion cut score (i.e., minimally acceptable score) for judging the ability of users of the ACES tool to evaluate simulated CEC performances. A modified Angoff standard-setting procedure was used to establish the cut score for an end-of-life case included on the ACES training website. The standard-setting committee viewed the Futility Case and estimated the probability that a minimally competent CEC would correctly answer each item on the ACES tool. The committee further adjusted these estimates by reviewing data from 31 pilot users of the Futility Case before determining the cut score. Averaging over all 31 items, the proposed proportion correct score for minimal competency was 80%, corresponding to a cut score that is between 24 and 25 points out of 31 possible points. The standard-setting committee subsequently set the minimal competency cut score to 24 points. The cut score for the ACES tool identifies the number of correct responses a user of the ACES tool training website must attain to "pass" and reach minimal competency in recognizing competent and incompetent skills of the CECs in the simulated ethics consultation videos. The application of the cut score to live training of CECs and other areas of practice requires further investigation.
临床伦理领域正在研究确定行为能力的方法。临床伦理技能评估（ACES）工具提供了一种新方法，该方法确定了临床伦理咨询过程中所需的一系列技能，并为评估这些技能提供了一个一致的框架。通过一个培训网站，用户学习将ACES工具应用于模拟伦理咨询视频中的临床伦理顾问（CEC）。目的是通过观看和评估录像中的CEC表现来识别合格和不合格的临床伦理咨询技能。我们报告了我们如何为判断ACES工具用户评估模拟CEC表现的能力设定一个标准分数线（即最低可接受分数）。采用了一种改良的安格夫标准设定程序来确定ACES培训网站上一个临终案例的分数线。标准设定委员会观看了“无效案例”，并估计了一名能力最低合格的CEC正确回答ACES工具上每个项目的概率。在确定分数线之前，委员会通过审查来自31名“无效案例”试点用户的数据进一步调整了这些估计值。对所有31个项目进行平均，最低能力的建议正确得分比例为80%，对应于31个可能分数中24至25分之间的分数线。标准设定委员会随后将最低能力分数线设定为24分。ACES工具的分数线确定了ACES工具培训网站的用户在模拟伦理咨询视频中识别CEC合格和不合格技能时必须获得的正确回答数量，才能“通过”并达到最低能力水平。将分数线应用于CEC的现场培训和其他实践领域需要进一步研究。
