一种新的观察评分工具和一种接触后评分工具在评估医学生内科实习期间临床推理技能的有效性、可靠性和可行性：一项试点研究。

Validity, reliability and feasibility of a new observation rating tool and a post encounter rating tool for the assessment of clinical reasoning skills of medical students during their internal medicine clerkship: a pilot study.

机构信息

Radboud university medical center, Nijmegen, The Netherlands.

出版信息

BMC Med Educ. 2020 Jun 19;20(1):198. doi: 10.1186/s12909-020-02110-8.

DOI:10.1186/s12909-020-02110-8

PMID:32560648

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7304120/

Abstract

BACKGROUND

Systematic assessment of clinical reasoning skills of medical students in clinical practice is very difficult. This is partly caused by the lack of understanding of the fundamental mechanisms underlying the process of clinical reasoning.

METHODS

We previously developed an observation tool to assess the clinical reasoning skills of medical students during clinical practice. This observation tool consists of an 11-item observation rating form (ORT). In the present study we verified the validity, reliability and feasibility of this tool and of an already existing post-encounter rating tool (PERT) in clinical practice among medical students during the internal medicine clerkship.

RESULTS

Six raters each assessed the same 15 student-patient encounters. The internal consistency (Cronbach's alfa) for the (ORT) was 0.87 (0.71-0.84) and the 5-item (PERT) was 0.81 (0.71-0.87). The intraclass-correlation coefficient for single measurements was poor for both the ORT; 0.32 (p < 0.001) as well as the PERT; 0.36 (p < 0.001). The Generalizability study (G-study) and decision study (D-study) showed that 6 raters are required to achieve a G-coefficient of > 0.7 for the ORT and 7 raters for the PERT. The largest sources of variance are the interaction between raters and students. There was a consistent correlation between the ORT and PERT of 0.53 (p = 0.04).

CONCLUSIONS

The ORT and PERT are both feasible, valid and reliable instruments to assess students' clinical reasoning skills in clinical practice.

摘要

背景

系统评估医学生在临床实践中的临床推理技能非常困难。这在一定程度上是由于缺乏对临床推理过程基本机制的理解。

方法

我们之前开发了一种观察工具来评估医学生在临床实践中的临床推理技能。该观察工具由一个 11 项观察评分表（ORT）组成。在本研究中，我们验证了该工具以及已经存在的临床实习中内科实习医学生的事后评估工具（PERT）在临床实践中的有效性、可靠性和可行性。

结果

6 名评估者每人评估了 15 名学生-患者的相遇。（ORT）的内部一致性（Cronbach 的 alpha）为 0.87（0.71-0.84），而 5 项（PERT）为 0.81（0.71-0.87）。ORT 的单测内部一致性系数较差；0.32（p<0.001）以及 PERT；0.36（p<0.001）。单测量的组内相关系数对于 ORT 为 0.32（p<0.001），PERT 为 0.36（p<0.001）。广义研究（G 研究）和决策研究（D 研究）表明，需要 6 名评估者才能获得 ORT 的 G 系数>0.7，而 PERT 则需要 7 名评估者。方差的最大来源是评估者和学生之间的相互作用。ORT 和 PERT 之间存在一致的相关性，相关系数为 0.53（p=0.04）。