基于临床实践中“可疑”活动的测量预测普通实践执照/认证考试表现：一项回顾性队列研究。

Prediction of general practice licensure/certification examination performance by a measure of 'questionable' activities in clinical practice: a retrospective cohort study.

机构信息

School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.

General Practice Training Research Department, Royal Australian College of General Practitioners, Level 1, 20 Mclntosh Drive, Mayfield West, Newcastle, NSW 2304, Australia.

出版信息

Postgrad Med J. 2024 May 18;100(1184):382-390. doi: 10.1093/postmj/qgad147.

DOI:10.1093/postmj/qgad147

PMID:38298001

Abstract

PURPOSE

'Low-value' clinical care and medical services are 'questionable' activities, being more likely to cause harm than good or with disproportionately low benefit relative to cost. This study examined the predictive ability of the QUestionable In Training Clinical Activities Index (QUIT-CAI) for general practice (GP) registrars' (trainees') performance in Australian GP Fellowship examinations (licensure/certification examinations for independent GP).

METHODS

The study was nested in ReCEnT, an ongoing cohort study in which Australian GP registrars document their in-consultation clinical practice. Outcome factors in analyses were individual registrars' scores on the three Fellowship examinations ('AKT', 'KFP', and 'OSCE' examinations) and pass/fail rates during 2012-21. Analyses used univariable and multivariable regression (linear or logistic, as appropriate). The study factor in each analysis was 'QUIT-CAI score percentage'-the percentage of times a registrar performed a QUIT-CAI clinical activity when 'at risk' (i.e. when managing a problem where performing a QUIT-CAI activity was a plausible option).

RESULTS

A total of 1265, 1145, and 553 registrars sat Applied Knowledge Test, Key Features Problem, and Objective Structured Clinical Exam examinations, respectively. On multivariable analysis, higher QUIT-CAI score percentages (more questionable activities) were significantly associated with poorer Applied Knowledge Test scores (P = .001), poorer Key Features Problem scores (P = .003), and poorer Objective Structured Clinical Exam scores (P = .005). QUIT-CAI score percentages predicted Royal Australian College of General Practitioner exam failure [odds ratio 1.06 (95% CI 1.00, 1.12) per 1% increase in QUIT-CAI, P = .043].

CONCLUSION

Performing questionable clinical activities predicted poorer performance in the summative Fellowship examinations, thereby validating these examinations as measures of actual clinical performance (by our measure of clinical performance, which is relevant for a licensure/certification examination).

摘要

目的

“低价值”的临床护理和医疗服务是“有问题的”活动，它们可能弊大于利，或者相对于成本而言，收益不成比例地低。本研究检验了可疑培训临床活动指数（QUIT-CAI）对澳大利亚全科医生研究员（培训生）在澳大利亚全科医生奖学金考试（独立全科医生的执照/认证考试）中的表现的预测能力。

方法

该研究嵌套在 ReCEnT 中，这是一项正在进行的队列研究，其中澳大利亚全科医生研究员记录他们在咨询中的临床实践。分析中的结果因素是个别研究员在三次奖学金考试中的分数（AKT、KFP 和 OSCE 考试）以及 2012-21 年期间的通过/失败率。分析使用了单变量和多变量回归（线性或逻辑，视情况而定）。在每项分析中，研究因素都是“QUIT-CAI 分数百分比”-当研究员在“有风险”时（即管理可能需要进行 QUIT-CAI 活动的问题时）执行 QUIT-CAI 临床活动的次数百分比。

结果

共有 1265、1145 和 553 名研究员分别参加了应用知识测试、关键特征问题和客观结构化临床考试。多变量分析显示，较高的 QUIT-CAI 分数百分比（更多有问题的活动）与应用知识测试成绩较差（P = .001）、关键特征问题成绩较差（P = .003）和客观结构化临床考试成绩较差（P = .005）显著相关。QUIT-CAI 分数百分比预测皇家澳大利亚全科医生学院考试失败[比值比 1.06（95%置信区间 1.00，1.12）每增加 1% QUIT-CAI，P = .043]。