使用沉浸式模拟评估医学生的非技术技能：哪些是基本要素？

Assessing Medical Students' Nontechnical Skills Using Immersive Simulation: What Are the Essential Components?

机构信息

From the Scottish Centre for Simulation and Clinical Human Factors (E.C.P., V.R.T.), Larbert; The University of Edinburgh (E.C.P., S.E.S., V.R.T.); and NHS Lothian (A.L.H., J.K., V.R.T.), Edinburgh, United Kingdom.

出版信息

Simul Healthc. 2021 Apr 1;16(2):98-104. doi: 10.1097/SIH.0000000000000463.

DOI:10.1097/SIH.0000000000000463

PMID:32649588

Abstract

INTRODUCTION

Nontechnical skills (NTS) have been acknowledged to be important for medical students and can be linked to improved clinical performance. However, existing tools to evaluate these within a simulated setting address only a limited number of NTS. The Medical Students' Nontechnical Skills (Medi-StuNTS) behavioral marker system (BMS) outlines 5 categories of NTS for medical students. This study aimed to seek evidence for completeness and content validity to refine the BMS and to ascertain which NTS are essential for medical students.

METHODS

We asked 128 workshop participants if they felt there were any missing or irrelevant items in Medi-StuNTS system. A subject matter expert panel (n = 10) rated how essential they considered each item in the BMS. An Item-Content Validity Index was calculated for each skill element and the Scale-Content Validity Index was calculated as a measure of content validity of the full system.

RESULTS

Of the workshop participants, 78.9% felt that there were no missing items and 93% felt that there were no irrelevant items. Potentially missing items highlighted were as follows: "working in a hierarchy," "leadership," "awareness of the emotional state of other team members," and "nonverbal communication." Fourteen of 16 skill elements achieved the recommended level for content validity (Item-Content Validity Index ≥ 0.78), and the Scale-Content Validity Index was higher than the acceptable level (≥0.8).

CONCLUSIONS

Evidence for completeness and content validity of Medi-StuNTS has been demonstrated. There is a far wider range of NTS that seem to be essential for medical students than those assessed by tools developed before Medi-StuNTS. Medi-StuNTS provides comprehensive cover of the essential NTS required by medical students, with specific reference to the skill categories "self-awareness" and "escalating care," which do not feature in other tools for assessing NTS in this group.

摘要

简介

非技术技能（NTS）已被认为对医学生很重要，并且可以与改善临床表现相关联。但是，现有的模拟环境中评估这些技能的工具仅能评估有限数量的 NTS。医学生非技术技能（Medi-StuNTS）行为标记系统（BMS）概述了医学生的 5 类 NTS。本研究旨在寻求完整性和内容有效性的证据，以完善 BMS，并确定医学生必需的 NTS。

方法

我们询问了 128 名研讨会参与者，他们是否认为 Medi-StuNTS 系统中存在缺失或不相关的项目。一个主题专家小组（n=10）对 BMS 中的每个项目的重要性进行了评估。为每个技能要素计算了项目内容有效性指数，并且作为系统内容有效性的衡量标准，计算了量表内容有效性指数。

结果

在研讨会参与者中，78.9%的人认为没有缺失的项目，93%的人认为没有不相关的项目。突出显示的潜在缺失项目如下：“在层级中工作”、“领导力”、“意识到其他团队成员的情绪状态”和“非言语沟通”。16 个技能要素中有 14 个达到了内容有效性的推荐水平（项目内容有效性指数≥0.78），并且量表内容有效性指数高于可接受水平（≥0.8）。

结论

Medi-StuNTS 的完整性和内容有效性得到了证明。对于医学生来说，似乎必需的 NTS 范围远远超过了 Medi-StuNTS 之前开发的工具所评估的范围。Medi-StuNTS 提供了医学生必需的基本 NTS 的全面涵盖，特别是参考了“自我意识”和“升级护理”这两个技能类别，这些类别在其他评估医学生 NTS 的工具中并未涉及。