Department of Plastic Surgery, Herlev and Gentofte University Hospital, Herlev Ringvej 75, Herlev, 2730, Copenhagen, Denmark.
Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark.
Arch Dermatol Res. 2021 May;313(4):235-243. doi: 10.1007/s00403-020-02097-8. Epub 2020 Jun 28.
Differentiating between benign and malignant skin lesions can be very difficult and should only be done by sufficiently trained and skilled clinicians. To our knowledge there are no validated tests for reliable assessments of clinicians' ability to perform skin cancer diagnostics. To develop and gather validity evidence for a test in skin cancer diagnostics, a multiple-choice questionnaire (MCQ) was developed based on informal interviews with seven content experts from five skin cancer centers in Denmark. Validity evidence for the test was gathered from May until July 2019 using Messick's validity framework (content, response process, internal structure, relationship to other variables and consequences). Item content was revised through a Delphi-like review process and then piloted on 36 medical students and 136 doctors using a standardized response process. Results enabled an analysis of the internal structure and relationship to other variables of the test. Finally, the contrasting groups method was used to investigate the test's consequences (pass-fail standard). The initial 90-item MCQ was reduced to 40 items during the Delphi-like review process. Item analysis revealed that 25 of the 40 selected items were level I-III quality items with a high internal consistency (Cronbach's α = 0.83) and highly significant (P ≤ 0.0001) differences in test scores between participants with different occupations or levels of experience. A pass-fail standard of 12 (48%) correct answers was established using the contrasting groups' method. The skin cancer diagnostics MCQ developed in this study can be used for reliable assessments of clinicians' competencies.
区分良性和恶性皮肤病变可能非常困难，只有经过充分培训和熟练的临床医生才能做到。据我们所知，目前还没有经过验证的测试可以可靠地评估临床医生进行皮肤癌诊断的能力。为了开发和收集皮肤癌诊断测试的有效性证据，我们根据丹麦五个皮肤癌中心的七名内容专家的非正式访谈，开发了一个多项选择题（MCQ）测试。该测试的有效性证据是在 2019 年 5 月至 7 月期间使用 Messick 的有效性框架（内容、反应过程、内部结构、与其他变量的关系和后果）收集的。通过类似 Delphi 的审查过程修订了项目内容，然后在 36 名医学生和 136 名医生中进行了试点，使用标准化的反应过程。结果使我们能够分析测试的内部结构和与其他变量的关系。最后，使用对比组方法研究了测试的后果（通过-失败标准）。在类似 Delphi 的审查过程中，最初的 90 项 MCQ 减少到 40 项。项目分析表明，40 个选定项目中有 25 个是 I-III 级质量项目，具有较高的内部一致性（Cronbach's α=0.83），并且具有不同职业或经验水平的参与者之间的测试成绩差异具有高度显著性（P≤0.0001）。使用对比组方法建立了 12（48%）个正确答案的通过-失败标准。本研究开发的皮肤癌诊断 MCQ 可用于可靠评估临床医生的能力。
