Department of Medicine, 8395Walter Reed National Military Medical Center, Bethesda, MD, USA.
Department of Medicine, 3998Brooke Army Medical Center, San Antonio, TX, USA.
Perit Dial Int. 2021 Sep;41(5):472-479. doi: 10.1177/08968608211000542. Epub 2021 Mar 29.
Peritoneal dialysis (PD) management is a fundamental nephrology skill, especially with the recent emphasis on home dialysis. We report a prospective multicentre cohort study of a formative objective structured clinical examination (OSCE) assessing competence in managing PD-associated bacterial peritonitis, using the unified model of construct validity.
The OSCE was developed by the principal investigators and reviewed by two subject matter experts. The test committee (eight nephrologists and one PD nurse) assessed test item difficulty/relevance and determined passing score. There were 22 test items (7 evidence-based/standard-of-care questions). Passing score was 16/22 (73%). No item had median relevance less than 'important', and all were easy to medium difficulty. Content validity index was 0.91. Preliminary validation (16 board-certified volunteers): mean score was 19 ± 2, with 94% (15/16) passing. Kappa = 0.85 [95% confidence interval (CI) 0.77-0.94]. Cronbach's = 0.70.
Eighty-seven fellows (16 programmes) were tested; 67% passed. Fellows scored significantly less than validators: 17 ± 3 versus 19 ± 2, < 0.001 [95% CI 1.2-3.6]. Eighty-six per cent of evidence-based/standard-of-care questions were answered correctly by validators versus 54% by fellows; < 0.001. Ninety-three per cent of fellows recognized that sufficient criteria were present to diagnose peritonitis, but only 17% correctly indicated all three. Seventy-seven per cent recognized peritonitis-associated ultrafiltration failure, but only 17% prescribed 21 days of antibiotic treatment for gram-negative peritonitis. Eighty-five per cent of fellows surveyed agreed/strongly agreed that the OSCE was useful in self-assessing proficiency. Second-year in-training examination and OSCE scores were positively correlated (Pearson's = 0.57, < 0.00).
The OSCE may be used to formatively assess fellow proficiency in managing PD-associated peritonitis.
腹膜透析（PD）管理是一项基本的肾病学技能，尤其是在最近强调家庭透析的情况下。我们报告了一项前瞻性多中心队列研究，该研究使用统一的建构效度模型评估了一项针对 PD 相关细菌性腹膜炎管理的形成性客观结构化临床考试（OSCE）的能力。
OSCE 由主要研究者开发，并由两位主题专家审查。测试委员会（八位肾脏病专家和一位 PD 护士）评估了测试项目的难度/相关性，并确定了及格分数。共有 22 个测试项目（7 个基于证据/标准护理的问题）。及格分数为 16/22（73%）。没有一个项目的相关性中位数低于“重要”，所有项目的难度都为中等偏易。内容效度指数为 0.91。初步验证（16 名已获得委员会认证的志愿者）：平均得分为 19 ± 2，通过率为 94%（15/16）。Kappa = 0.85 [95%置信区间（CI）0.77-0.94]。Cronbach's = 0.70。
87 名研究员（16 个项目）接受了测试；67%的人通过了。研究员的得分明显低于验证者：17 ± 3 与 19 ± 2，<0.001 [95%置信区间 1.2-3.6]。验证者正确回答了 86%的基于证据/标准护理的问题，而研究员的正确回答率为 54%；<0.001。93%的研究员认为存在足够的标准来诊断腹膜炎，但只有 17%的人正确指出了所有三个标准。77%的人认识到腹膜炎相关超滤失败，但只有 17%的人开了 21 天的抗生素治疗革兰氏阴性腹膜炎。85%的接受调查的研究员同意/强烈同意 OSCE 有助于自我评估熟练程度。第二年住院医师培训考试和 OSCE 分数呈正相关（Pearson's = 0.57，<0.00）。
OSCE 可用于形成性评估研究员在管理 PD 相关腹膜炎方面的熟练程度。
Zotero 插件