Mikhaeil-Demo Yara, Holmboe Eric, Gerard Elizabeth E, Wayne Diane B, Cohen Elaine R, Yamazaki Kenji, Templer Jessica W, Bega Danny, Culler George W, Bhatt Amar B, Shafi Neelofer, Barsuk Jeffrey H
is Assistant Professor, Department of Neurology, Northwestern University, Feinberg School of Medicine.
is Chief Research, Milestone Development, and Evaluation Officer, Accreditation Council for Graduate Medical Education (ACGME).
J Grad Med Educ. 2021 Apr;13(2):223-230. doi: 10.4300/JGME-D-20-00832.1. Epub 2021 Apr 16.
The American Board of Psychiatry and Neurology and the Accreditation Council for Graduate Medical Education (ACGME) developed Milestones that provide a framework for residents' assessment. However, Milestones do not provide a description for how programs should perform assessments.
We evaluated graduating residents' status epilepticus (SE) identification and management skills and how they correlate with ACGME Milestones reported for epilepsy and management/treatment by their program's clinical competency committee (CCC).
We performed a cohort study of graduating neurology residents from 3 academic medical centers in Chicago in 2018. We evaluated residents' skills identifying and managing SE using a simulation-based assessment (26-item checklist). Simulation-based assessment scores were compared to experience (number of SE cases each resident reported identifying and managing during residency), self-confidence in identifying and managing these cases, and their end of residency Milestones assigned by a CCC based on end-of-rotation evaluations.
Sixteen of 21 (76%) eligible residents participated in the study. Average SE checklist score was 15.6 of 26 checklist items correct (60%, SD 12.2%). There were no significant correlations between resident checklist performance and experience or self-confidence. The average participant's level of Milestone for epilepsy and management/treatment was high at 4.3 of 5 (SD 0.4) and 4.4 of 5 (SD 0.4), respectively. There were no significant associations between checklist skills performance and level of Milestone assigned.
Simulated SE skills performance of graduating neurology residents was poor. Our study suggests that end-of-rotation evaluations alone are inadequate for assigning Milestones for high-stakes clinical skills such as identification and management of SE.
美国精神病学与神经病学委员会以及毕业后医学教育认证委员会（ACGME）制定了里程碑，为住院医师评估提供了一个框架。然而，里程碑并未对项目应如何进行评估给出描述。
我们评估了即将毕业的住院医师识别和管理癫痫持续状态（SE）的技能，以及这些技能与他们所在项目的临床能力委员会（CCC）报告的ACGME癫痫及管理/治疗里程碑之间的相关性。
我们对2018年来自芝加哥3家学术医疗中心的即将毕业的神经科住院医师进行了一项队列研究。我们使用基于模拟的评估（26项清单）评估住院医师识别和管理SE的技能。将基于模拟的评估分数与经验（每位住院医师报告在住院期间识别和管理的SE病例数）、识别和管理这些病例的自信心以及他们所在的CCC根据轮转结束评估分配的住院医师培训结束时的里程碑进行比较。
21名符合条件的住院医师中有16名（76%）参与了研究。SE清单平均得分是26项清单项目中的15.6项正确（60%，标准差12.2%）。住院医师清单表现与经验或自信心之间无显著相关性。癫痫及管理/治疗的平均参与者里程碑水平较高，分别为5分中的4.3分（标准差0.4）和5分中的4.4分（标准差0.4）。清单技能表现与分配的里程碑水平之间无显著关联。
即将毕业的神经科住院医师的模拟SE技能表现较差。我们的研究表明，仅靠轮转结束评估不足以分配如SE识别和管理等高风险临床技能的里程碑。
