Prehosp Emerg Care. 2021 Mar-Apr;25(2):196-204. doi: 10.1080/10903127.2020.1750743. Epub 2020 May 1.
The chaotic and complex nature of delivering patient care in the prehospital setting complicates the provision of real-time formative feedback to paramedic students. Although the use of simulations is widespread in emergency medical services (EMS) education, a high degree of variability precludes consistent performance assessment in EMS. The objective of this study was to define and validate key domains required to evaluate paramedic prehospital performance. We conducted a two-phase study that combined focus group and Delphi methodology. Participants were purposefully selected to attain diverse panels regarding sex, race, ethnicity, professional roles, levels of education, geographical area, and experience as a paramedic and educator. In Phase I, a panel of 11 subject matter experts (SMEs) were tasked with identifying the essential domains to be evaluated in a paramedic performance assessment. In Phase II, another panel of 11 SMEs and a four-round modified Delphi method with 28 paramedic program directors were used to validate the domains identified in Phase I. The first focus group identified and achieved consensus on five domains: (1) effective communication, (2) scene management, (3) patient assessment, (4) patient management, and (5) professional behavior. These domains were validated by the second focus group. The first round of the Delphi process generated 64 content domains, which were reduced to nine unique content domains via thematic analysis. These nine content domains fit well within the broader domains identified by the focus groups with one specific area, critical thinking and reasoning, being listed in two key areas based on the definitions of the focus group domains of patient assessment and patient management. The content domains identified in this study provide EMS educators a theoretical framework for designing the performance assessment of newly trained professionals in the prehospital setting.
在院前环境中提供患者护理的混乱和复杂性质使向护理人员学生提供实时形成性反馈变得复杂。尽管模拟在紧急医疗服务（EMS）教育中广泛使用，但高度的可变性排除了在 EMS 中进行一致的绩效评估。本研究的目的是定义和验证评估护理人员院前表现所需的关键领域。我们进行了一项两阶段的研究，结合了焦点小组和 Delphi 方法。参与者是有目的地选择的，以获得关于性别、种族、民族、专业角色、教育水平、地理区域以及作为护理人员和教育者的经验的不同小组。在第一阶段，一个由 11 名主题专家（SME）组成的小组负责确定在护理人员绩效评估中要评估的基本领域。在第二阶段，另一个由 11 名 SME 和 28 名护理计划主任组成的四轮修改后的 Delphi 方法用于验证第一阶段确定的领域。第一组重点小组确定并达成共识的五个领域为：（1）有效沟通，（2）现场管理，（3）患者评估，（4）患者管理和（5）专业行为。这五个领域得到了第二组重点小组的验证。德尔福法第一轮生成了 64 个内容领域，通过主题分析将其减少到九个独特的内容领域。这九个内容领域与焦点小组确定的更广泛领域非常吻合，其中一个特定领域，即批判性思维和推理，根据焦点小组患者评估和患者管理领域的定义，被列为两个关键领域之一。本研究中确定的内容领域为 EMS 教育者提供了一个理论框架，用于设计新培训的专业人员在院前环境中的绩效评估。
