National Registry of Emergency Medical Technicians, Columbus, OH, USA.
Division of Epidemiology, The Ohio State University College of Public Health, Columbus, OH, USA.
BMC Med Educ. 2024 Nov 21;24(1):1341. doi: 10.1186/s12909-024-06282-5.
For emergency medical services (EMS) clinicians, clinical judgment is a higher-order construct that encompasses the initial thought process (clinical reasoning) that assists clinicians in reaching conclusions (clinical decision making). Current theoretical frameworks of clinical judgment contain other higher order constructs (e.g., leadership, communication) which may play a significant role in delivery of care. It is unknown whether this definition of clinical judgment includes additional higher order constructs of leadership and communication. The goal of this evaluation was to determine whether leadership and communication overlap and are subsumed under the larger construct of clinical judgment.
Focus groups of experts in prehospital paramedic and advanced emergency medical technician levels of certification were recruited to generate tasks and their associated knowledge, skills, and abilities (KSAs) in for the domains of clinical judgment, communication, and leadership. These tasks and KSAs were then evaluated for commonality between the domains to evaluate whether communication and leadership are incorporated within clinical judgment.
Task-KSA matrices were generated by focus groups for each domain and evaluated by certification level. There were no differences by certification level in the tasks-KSA matrices for the domains. A total of 77 tasks were identified, comprised of 392 KSAs across three domains (9 sub-domains). An analysis of commonality of tasks between the domains of communication and leadership with clinical judgment demonstrated that 61% of communication tasks were similar to the identified clinical judgment tasks. Similarly, in leadership, clinical judgment had a total of 79% commonality overall.
Clinical judgment was found to be a higher order construct that overlaps with and incorporates the domains of leadership and communication in the theoretical framework of EMS clinical judgment. This study provides validity evidence for the proposed clinical judgment theoretical framework. Future work should focus on pilot evaluations in simulated settings for building additional construct validity.
对于急救医疗服务（EMS）临床医生来说，临床判断是一种更高阶的结构，它包含了帮助临床医生得出结论的初始思维过程（临床推理）（临床决策）。临床判断的当前理论框架包含了其他更高阶的结构（例如领导力、沟通），这些结构可能在提供医疗服务方面发挥着重要作用。目前尚不清楚这个临床判断的定义是否包含领导力和沟通等其他更高阶的结构。本评估的目的是确定领导力和沟通是否重叠，并包含在更大的临床判断结构中。
招募了具有院前护理人员和高级急救医疗技术员认证水平的专家焦点小组，以生成临床判断、沟通和领导力领域的任务及其相关的知识、技能和能力（KSAs）。然后，对这些任务和 KSAs 进行了评估，以确定它们在领域之间是否存在共性，从而评估沟通和领导力是否包含在临床判断中。
焦点小组为每个领域生成了任务-KSA 矩阵，并按认证级别进行了评估。三个领域（9 个子领域）的任务-KSA 矩阵在认证级别上没有差异。共确定了 77 项任务，包含 392 项 KSAs。对沟通和领导力领域与临床判断之间任务的共性进行分析表明，沟通任务中有 61%与确定的临床判断任务相似。同样，在领导力领域，临床判断总体上有 79%的共性。
临床判断被发现是一种更高阶的结构，它与领导力和沟通领域重叠，并包含在 EMS 临床判断的理论框架中。本研究为提出的临床判断理论框架提供了有效性证据。未来的工作应侧重于在模拟环境中进行试点评估，以建立更多的结构有效性。
