基于模拟的临床评估确定澳大利亚物理治疗实践的最低能力要求：一项交叉试验。

Simulation-based clinical assessment identifies threshold competence to practise physiotherapy in Australia: a crossover trial.

作者信息

Moss Penny, Barnett-Harris Anton, Lee Darren, Gupta Kriti, Pritchard Shane, Sievers Natalie, Te Maxine, Blackstock Felicity

机构信息

Australian Physiotherapy Council, Richmond, Australia.

Physiotherapy, School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.

出版信息

Adv Simul (Lond). 2022 Jul 27;7(1):21. doi: 10.1186/s41077-022-00215-2.

DOI:10.1186/s41077-022-00215-2

PMID:35897084

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9327219/

Abstract

BACKGROUND

Although evidence exists for the efficacy of high-fidelity simulation as an educational tool, there is limited evidence for its application in high-stakes professional threshold competency assessment. An alternative model of simulation-based assessment was developed by the Australian Physiotherapy Council (APC), using purpose-written standardised patients, mapped to the appropriate threshold level. The aim of this two-phase study was to investigate whether simulation-based clinical assessments resulted in equivalent outcomes to standard, real-life assessments for overseas-trained physiotherapists seeking registration to practice in Australia.

METHODS

A randomised crossover trial comparing simulation-based assessment to real-life assessment was completed. Participants were internationally trained physiotherapists applying for registration to practice in Australia, voluntarily recruited from the Australian Physiotherapy Council (APC) assessment waiting list: study 1 n = 25, study 2 n = 144. Study 1 participants completed usual APC real-life assessments in 3 practice areas, completed on different days at APC partner healthcare facilities. Participants also underwent 3 practice area-matched simulation-based assessments, completed on the same day at purpose-designed simulation facilities. Study 2 participants completed 3 simulation-based assessments and 1 real-life assessment that was randomly allocated for order and practice area. Assessment of competency followed the standard APC procedure of 90-minute examinations using The Moderated Assessment Form (MAF).

RESULTS

The overall pass rate was higher for real-life assessments in both studies: study 1, 50% versus 42.7%; study 2, 55.6% versus 44.4%. Chi-square analysis showed a high to moderate level of exact matching of pass/fail grades across all assessments: study 1, 73.4% (p < 0.001); study 2, 58.3% (p = 0.027). Binary logistic regression showed that the best predictors of real-life pass/fail grade were simulation-based MAF pass/fail grade (study 1, OR 7.86 p < 0.001; study 2, OR 2.037, p = 0.038) and simulation-based total MAF score (study 1, OR 1.464 p < 0.001; study 2, OR 1.234, p = 0.001).

CONCLUSION

Simulation-based assessment is a significant predictor of clinical performance and can be used to successfully identify high stakes threshold competence to practice physiotherapy in Australia.

摘要

背景

尽管有证据表明高保真模拟作为一种教育工具是有效的，但在高风险专业门槛能力评估中的应用证据有限。澳大利亚理疗理事会（APC）开发了一种基于模拟的评估替代模型，使用专门编写的标准化患者，并映射到适当的门槛水平。这项两阶段研究的目的是调查对于寻求在澳大利亚注册执业的海外培训理疗师，基于模拟的临床评估是否能产生与标准的现实生活评估等效的结果。

方法

完成了一项将基于模拟的评估与现实生活评估进行比较的随机交叉试验。参与者是申请在澳大利亚注册执业的国际培训理疗师，从澳大利亚理疗理事会（APC）评估等候名单中自愿招募：研究1，n = 25；研究2，n = 144。研究1的参与者在3个实践领域完成了常规的APC现实生活评估，在APC合作医疗设施的不同日期进行。参与者还在专门设计的模拟设施同一天完成了3个与实践领域匹配的基于模拟的评估。研究2的参与者完成了3个基于模拟的评估和1个现实生活评估，其顺序和实践领域是随机分配的。能力评估遵循APC的标准程序，使用《适度评估表》（MAF）进行90分钟的考试。

结果

在两项研究中，现实生活评估的总体通过率都更高：研究1，50%对42.7%；研究2，55.6%对44.4%。卡方分析显示，所有评估中通过/失败等级的精确匹配程度较高至中等：研究1，73.4%（p < 0.001）；研究2，58.3%（p = 0.027）。二元逻辑回归显示，现实生活通过/失败等级的最佳预测因素是基于模拟的MAF通过/失败等级（研究1，OR 7.86，p < 0.001；研究2，OR = 2.037, p = 0.038）和基于模拟的MAF总分（研究1，OR 1.464，p < 0.001；研究2，OR 1.234，p = 0.001）。