Klein Matthew R, Schmitz Zachary P, Adler Mark D, Salzman David H
Department of Emergency Medicine Northwestern University Feinberg School of Medicine Chicago IL USA.
the Department of Pediatrics Northwestern University Feinberg School of Medicine Chicago IL USA.
AEM Educ Train. 2021 Jan 6;5(3):e10566. doi: 10.1002/aet2.10566. eCollection 2021 Jul.
Temporary transvenous cardiac pacing (TVP) is a potentially lifesaving intervention included in the list of essential core procedures for emergency medicine (EM) training; however, opportunities to perform TVP during residency cannot be guaranteed. EM graduates report feeling subjectively underprepared for this procedure, but objective performance data are lacking. Checklist-based simulated assessment is an increasing focus of competency-based medical education, particularly for invasive procedures like TVP. The objectives of this paper were as follows: first, to enlist a multidisciplinary team of experts to create an assessment tool for TVP using best practices in checklist development; second, to determine the reliability of checklist scoring; and third, to assess EM residents' baseline ability to perform TVP using a dedicated task trainer.
This study was conducted at a single 4-year EM residency. A panel of emergency physicians and cardiologists designed a TVP checklist using a modified Delphi approach. After consensus was achieved on a final checklist, EM residents were assessed using a dedicated TVP task trainer. Inter-rater reliability was determined using Cohen's kappa coefficient. Resident performance was determined by number of correctly performed checklist items.
The expert panel achieved consensus on a 30-item checklist after three rounds of revisions. The Cohen's kappa coefficient for the overall checklist score was 0.87, with individual checklist items ranging from 0.63 to 1.00. In total, 58 residents were assessed with a mean score of 13.5 of 30 checklist items. Scores increased with each year of training.
This study details the rigorous development of a TVP checklist designed by a multidisciplinary team of experts. Checklist scores demonstrated strong inter-rater reliability. The overall poor performance of this cohort suggests the current approach to TVP training does not provide sufficient preparation for EM residents. Competency-based techniques, such as simulation-based mastery learning, should be explored.
临时经静脉心脏起搏（TVP）是急诊医学（EM）培训核心基本程序清单中一项可能挽救生命的干预措施；然而，住院医师培训期间进行TVP的机会无法得到保证。急诊医学专业毕业生主观上感觉对该操作准备不足，但缺乏客观的操作数据。基于清单的模拟评估日益成为以能力为基础的医学教育的重点，尤其是对于像TVP这样的侵入性操作。本文的目的如下：第一，招募一个多学科专家团队，利用清单开发的最佳实践方法创建一个TVP评估工具；第二，确定清单评分的可靠性；第三，使用专门的任务训练器评估急诊医学住院医师进行TVP的基线能力。
本研究在一个为期4年的急诊医学住院医师培训项目中进行。一组急诊医师和心脏病专家采用改良的德尔菲法设计了一份TVP清单。在最终清单达成共识后，使用专门的TVP任务训练器对急诊医学住院医师进行评估。使用科恩kappa系数确定评分者间信度。住院医师的操作表现通过正确完成的清单项目数量来确定。
经过三轮修订，专家小组就一份包含30项内容的清单达成共识。整个清单评分的科恩kappa系数为0.87，各个清单项目的系数范围为0.63至1.00。总共对58名住院医师进行了评估，30项清单项目的平均得分为13.5分。分数随着培训年份的增加而提高。
本研究详细介绍了由多学科专家团队精心开发的TVP清单。清单评分显示出很强的评分者间信度。该队列总体表现不佳表明，目前的TVP培训方法未能为急诊医学住院医师提供充分的准备。应探索基于能力的技术，如基于模拟的掌握学习。
