Residency and Fellowship Education, American Physical Therapy Association, Alexandria, Virginia, USA.
Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA.
Phys Ther. 2022 May 5;102(5). doi: 10.1093/ptj/pzac019.
The objective of this study was to develop generic domains of competence (DoC) with associated competencies and milestones for physical therapist residency education. This work was intended to culminate in establishing validity evidence to support a competency-based assessment instrument that could be used by residency programs to evaluate resident achievement of the competencies, regardless of specialty area.
Employing the modified Delphi method, a residency education work group developed an evaluation instrument that included 7 DoC and 31 associated competencies with 6 milestones as rating scales for each competency. The instrument was distributed to mentors and residents in accredited physical therapist residency programs to establish validity evidence. Evaluations (measured by milestones) and demographics were collected at 3 time points (program entry, midterm, and final). Scores across these time points were compared using Kruskal-Wallis tests. Reliability was assessed with kappa statistics (interrater reliability) and alpha reliability coefficients (internal consistency). Construct validity was examined using confirmatory factor analysis via structural equation modeling.
Overall, 237 mentors and 228 residents completed 824 evaluations (460 by mentors and 364 resident self-evaluations) across the time points. Scores significantly increased from entry through final time points. The interrater reliability of the associated behaviors ranged from moderate to substantial agreement (κ = 0.417-0.774). The internal consistency was high for all DoC at every time point (α reliability coefficients = .881-.955 for entry, .857-.925 for midterm, and .824-.902 for final). After confirmatory factor analysis with structural equation modeling was performed, a model that included 7 DoC and 20 associated competencies was proposed.
The residency assessment instrument developed demonstrates interrater reliability and validity evidence and therefore supports competency-based assessment of resident clinical performance across specialty areas. Additionally, the instrument aligns the physical therapy profession with other professions, such as medicine, dentistry, and pharmacy, that have transitioned to competency-based education.
This study outlines the benefits of moving to competency-based education for physical therapist residents, using a sound evaluation tool that evaluates residents across specialty areas. The instrument will allow for transition to competency-based education in physical therapist residency education programs.
本研究旨在为物理治疗住院医师教育制定通用能力领域（DoC）及其相关能力和里程碑。这项工作旨在最终建立有效性证据，以支持一种基于能力的评估工具，该工具可被住院医师计划用于评估住院医师在各个专业领域的能力水平。
采用改良 Delphi 法，住院医师教育工作组制定了一种评估工具，该工具包括 7 个能力领域和 31 个相关能力，以及每个能力的 6 个里程碑作为评分量表。该工具分发给认可的物理治疗住院医师教育计划的导师和住院医师，以建立有效性证据。在 3 个时间点（项目开始、中期和最终）收集评估（以里程碑衡量）和人口统计学数据。使用 Kruskal-Wallis 检验比较这些时间点的分数。使用kappa 统计量（评分者间可靠性）和 alpha 可靠性系数（内部一致性）评估可靠性。使用结构方程建模的验证性因子分析来检验结构有效性。
总体而言，237 名导师和 228 名住院医师在所有时间点完成了 824 次评估（460 次由导师进行，364 次由住院医师自我评估）。分数从开始到最终显著增加。相关行为的评分者间一致性从中等到高度一致（κ=0.417-0.774）。在每个时间点，所有能力领域的内部一致性都很高（α可靠性系数在开始时为.881-.955，中期为.857-.925，最终为.824-.902）。在进行结构方程建模的验证性因子分析后，提出了一个包含 7 个能力领域和 20 个相关能力的模型。
所开发的住院医师评估工具具有评分者间可靠性和有效性证据，因此支持跨专业领域的基于能力的住院医师临床表现评估。此外，该工具使物理治疗专业与医学、牙科和药学等已过渡到基于能力的教育的其他专业保持一致。
本研究概述了物理治疗住院医师向基于能力的教育转变的好处，使用了一种评估住院医师在各个专业领域的能力的健全评估工具。该工具将允许物理治疗住院医师教育计划过渡到基于能力的教育。
