The Seventh Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China.
Guangdong Academy for Medical Simulation (GAMS), Guangzhou, China.
BMC Med Educ. 2023 Nov 23;23(1):897. doi: 10.1186/s12909-023-04861-6.
Abdominal palpation is an essential examination to diagnose various digestive system diseases. This study aimed to develop an objective and standardized test based on abdominal palpation simulators, and establish a credible pass/fail standard of basic competency.
Two tests were designed using the newly developed Jucheng abdominal palpation simulator (test 1) and the AbSim simulator (test 2), respectively. Validity evidence for both tests was gathered according to Messick's contemporary framework by using experts to define test content and then administering the tests in a highly standardized way to participants of different experience. Different simulator setups modified by the built-in software were selected from hepatomegaly, splenomegaly, positive McBurney's sign plus rebound tenderness, gallbladder tenderness (Murphy's sign), pancreas tenderness, and a normal setup without pathologies, with six sets used in test 1 and five sets used in test 2. Different novices and experienced were included in the tests, and test 1 was also administered to an intermediate group. Scores and test time were collected and analyzed statistically.
The internal consistency reliability of test 1 and test 2 showed low Cronbach's alphas of 0.35 and -0.41, respectively. Cronbach's alpha for palpation time across cases were 0.65 for test 1 and 0.76 for test 2. There was no statistical difference in total time spent and total scores among the three groups in test 1 (P-values (ANOVA) were 0.53 and 0.35 respectively), nor between novices and experienced groups in test 2 (P-values (t-test) were 0.13 and 1.0 respectively). It was not relevant to try to establish pass/fail standards due to the low reliability and lack of discriminatory ability of the tests.
It was not possible to measure abdominal palpation skills in a valid way using either of the two standardized, simulation-based tests in our study. Assessment of the patient's abdomen using palpation is a challenging clinical skill that is difficult to simulate as it highly relies on tactile sensations and adequate responsiveness from the patients.
腹部触诊是诊断各种消化系统疾病的基本检查方法。本研究旨在基于腹部触诊模拟器开发一种客观且标准化的测试，并建立一个可靠的通过/不通过的基本能力标准。
使用新开发的聚成腹部触诊模拟器（测试 1）和 AbSim 模拟器（测试 2）分别设计了两项测试。根据 Messick 的当代框架，通过专家定义测试内容并以高度标准化的方式向具有不同经验的参与者进行测试，收集了这两项测试的有效性证据。从肝肿大、脾肿大、阳性 McBurney 征加反跳痛、胆囊触痛（Murphy 征）、胰腺触痛和正常无病变设置中，通过内置软件修改了不同的模拟器设置，测试 1 中使用了 6 个设置，测试 2 中使用了 5 个设置。在测试中纳入了不同的新手和有经验者，并且还对测试 1 进行了中级组的测试。收集和分析了分数和测试时间的统计数据。
测试 1 和测试 2 的内部一致性可靠性显示，Cronbach 的阿尔法系数分别为 0.35 和-0.41，较低。测试 1 中针对病例的触诊时间的 Cronbach 的阿尔法系数为 0.65，测试 2 中为 0.76。在测试 1 中，三个组之间的总用时和总分数之间没有统计学差异（ANOVA 的 P 值分别为 0.53 和 0.35），测试 2 中新手和有经验者之间也没有统计学差异（t 检验的 P 值分别为 0.13 和 1.0）。由于测试的可靠性低且缺乏区分能力，因此尝试建立通过/不通过标准是不相关的。
在我们的研究中，使用这两种标准化的基于模拟的测试中的任何一种都无法有效地测量腹部触诊技能。使用触诊评估患者的腹部是一项具有挑战性的临床技能，因为它高度依赖于触觉和患者的充分反应，因此很难模拟。
