Division of General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America.
Creighton University School of Law, Omaha, Nebraska, United States of America.
PLoS One. 2020 Feb 7;15(2):e0228450. doi: 10.1371/journal.pone.0228450. eCollection 2020.
This study developed a new Professional Decision-Making in Medicine Measure that assesses the use of effective decision-making strategies: seek help, manage emotions, recognize consequences and rules, and test assumptions and motives. The aim was to develop a content valid measure and obtain initial evidence for construct validity so that the measure could be used in future research or educational assessment.
Clinical scenario-based items were developed based on a review of the literature and interviews with physicians. For each item, respondents are tasked with selecting two responses (out of six plausible options) that they would choose in that situation. Three of the six options reflect a decision-making strategy; these responses are scored as correct. Data were collected from a sample of 318 fourth-year medical students in the United States. They completed a 16-item version of the measure (Form A) and measures of social desirability, moral disengagement, and professionalism attitudes. Professionalism ratings from clerkships were also obtained. A sub-group (n = 63) completed a second 16-item measure (Form B) to pilot test the instrument, as two test forms are useful for pre-posttest designs.
Scores on the new measure indicated that, on average, participants answered 75% of items correctly. Evidence for construct validity included the lack of correlation between scores on the measure and socially desirable responding, negative correlation with moral disengagement, and modest to low correlations with professionalism attitudes. A positive correlation was observed with a clerkship rating focused on professionalism in peer interactions.
These findings demonstrate modest proficiency in the use of decision-making strategies among fourth-year medical students. Additional research using the Professional Decision-Making Measure should explore scores among physicians in various career stages, and the causes and correlates of scores. Educators could utilize the measure to assess courses that teach decision-making strategies.
本研究开发了一种新的医学专业决策衡量标准，用于评估有效决策策略的使用情况：寻求帮助、管理情绪、识别后果和规则，以及检验假设和动机。目的是开发一个具有内容效度的衡量标准，并获得初步的结构效度证据，以便该衡量标准可用于未来的研究或教育评估。
根据文献回顾和对医生的访谈，开发了基于临床情景的项目。对于每个项目，要求受访者从六个可能的选项中选择两个他们会在那种情况下选择的选项。这六个选项中的三个反映了决策策略；这些回答被记为正确。数据来自美国 318 名四年级医学生的样本。他们完成了一个 16 项的衡量标准（A 版），以及社会期望、道德脱离和专业态度的衡量标准。还获得了实习科室的专业评价。一个子组（n=63）完成了第二个 16 项的衡量标准（B 版），以试点测试该工具，因为两个测试形式对于前后测试设计很有用。
新衡量标准的得分表明，平均而言，参与者答对了 75%的题目。结构效度的证据包括衡量标准的得分与社会期望反应之间缺乏相关性，与道德脱离呈负相关，与专业态度呈适度至低度相关。与专注于同伴互动中的专业精神的实习科室评价呈正相关。
这些发现表明，四年级医学生在使用决策策略方面表现出中等水平的熟练程度。使用专业决策衡量标准的进一步研究应探索各种职业阶段的医生的得分，以及得分的原因和相关性。教育者可以利用该衡量标准评估教授决策策略的课程。
