我们如何评估梅奥诊所内科住院医师的适应力和坚韧精神？一项纵向效度研究，包括与医学知识、职业素养和临床能力的相关性。
How do we assess resilience and grit among internal medicine residents at the Mayo Clinic? A longitudinal validity study including correlations with medical knowledge, professionalism and clinical performance.
作者信息
Alahdab Fares, Halvorsen Andrew J, Mandrekar Jayawant N, Vaa Brianna E, Montori Victor M, West Colin P, Murad M Hassan, Beckman Thomas J
机构信息
Mayo Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
Office of Educational Innovations, Internal Medicine Residency Program, Mayo Clinic, Rochester, Minnesota, USA.
出版信息
BMJ Open. 2020 Dec 15;10(12):e040699. doi: 10.1136/bmjopen-2020-040699.
BACKGROUND
There has been limited research on the positive aspects of physician wellness and to our knowledge there have been no validity studies on measures of resilience and grit among internal medicine (IM) residents.
OBJECTIVES
To investigate the validity of resilience (10 items Connor-Davidson Resilience Scale (CD-RISC 10)) and grit (Short Grit Scale (GRIT-S)) scores among IM residents at a large academic centre, and assess potential associations with previously validated measures of medical knowledge, clinical performance and professionalism.
METHODS
We evaluated CD-RISC 10 and GRIT-S instrument scores among IM residents at the Mayo Clinic Rochester, Minnesota between July 2017 and June 2019. We analysed dimensionality, internal consistency reliability and criterion validity in terms of relationships between resilience and grit, with standardised measures of residents' medical knowledge (in-training examination (ITE)), clinical performance (faculty and peer evaluations and Mini-Clinical Evaluation Examination (mini-CEX)) and professionalism/dutifulness (conference attendance and evaluation completion).
RESULTS
A total of 213 out of 253 (84.2%) survey-eligible IM residents provided both CD-RISC 10 and GRIT-S survey responses. Internal consistency reliability (Cronbach alpha) was excellent for CD-RISC 10 (0.93) and GRIT-S (0.82) overall, and for the GRIT subscales of consistency of interest (0.84) and perseverance of effort (0.71). CD-RISC 10 scores were negatively associated with ITE percentile (β=-3.4, 95% CI -6.2 to -0.5, p=0.02) and mini-CEX (β=-0.2, 95% CI -0.5 to -0.02, p=0.03). GRIT-S scores were positively associated with evaluation completion percentage (β=2.51, 95% CI 0.35 to 4.67, p=0.02) and conference attendance (β=2.70, 95% CI 0.11 to 5.29, p=0.04).
CONCLUSIONS
This study revealed favourable validity evidence for CD-RISC 10 and GRIT-S among IM residents. Residents demonstrated resilience within a competitive training environment despite less favourable test performance and grittiness that was manifested by completing tasks. This initial validity study provides a foundation for further research on resilience and grit among physicians in training.
背景
关于医生健康的积极方面的研究有限，据我们所知，尚未有针对内科住院医师复原力和毅力测量方法的效度研究。
目的
在一个大型学术中心调查内科住院医师中复原力（10项Connor-Davidson复原力量表（CD-RISC 10））和毅力（简短毅力量表（GRIT-S））得分的效度，并评估与先前验证的医学知识、临床能力和职业素养测量方法之间的潜在关联。
方法
我们在2017年7月至2019年6月期间评估了明尼苏达州罗切斯特市梅奥诊所内科住院医师的CD-RISC 10和GRIT-S量表得分。我们从复原力和毅力之间的关系、住院医师医学知识的标准化测量（在职考试（ITE））、临床能力（教员和同行评估以及迷你临床评估考试（mini-CEX））和职业素养/尽责性（会议出席率和评估完成情况）方面分析了维度、内部一致性信度和效标效度。
结果
253名符合调查条件的内科住院医师中，共有213名（84.2%）提供了CD-RISC 10和GRIT-S的调查回复。CD-RISC 10（0.93）和GRIT-S（0.82）总体的内部一致性信度（Cronbach α）很好，兴趣一致性（0.84）和努力坚持性（0.71）的GRIT子量表也是如此。CD-RISC 10得分与ITE百分位（β=-3.4，95%CI -6.2至-0.5，p=0.02）和mini-CEX（β=-0.2，95%CI -0.5至-0.02，p=0.03）呈负相关。GRIT-S得分与评估完成率（β=2.51，95%CI 0.35至4.67，p=0.02）和会议出席率（β=2.70，95%CI 0.11至5.29，p=0.04）呈正相关。
结论
本研究揭示了CD-RISC 10和GRIT-S在内科住院医师中的良好效度证据。住院医师在竞争激烈的培训环境中展现出了复原力，尽管考试成绩不太理想，并且通过完成任务表现出了毅力。这项初步的效度研究为进一步研究培训中的医生的复原力和毅力奠定了基础。
Zotero 插件