Preiksaitis Carl, Beshar Isabel, Dobiesz Valerie, Frisch Stacey, Henkel Andrea, Rider Ashley, Saxena Monica, Gisondi Michael A
Department of Emergency Medicine Stanford School of Medicine Stanford California USA.
Department of Obstetrics and Gynecology Stanford School of Medicine Stanford California USA.
AEM Educ Train. 2024 Nov 27;8(6):e11043. doi: 10.1002/aet2.11043. eCollection 2024 Dec.
Many patients first learn of a pregnancy in the emergency department (ED). However, limited ED physician knowledge in pregnancy disclosure and options counseling may contribute to challenges in patient care and potential missed opportunities for timely access to reproductive care. No standardized instruments exist to teach or assess this important communication skill for the ED physicians. This study aimed to develop and collect validity evidence for a checklist for effective pregnancy disclosure and options counseling by ED physicians in an environment with unrestricted access to comprehensive reproductive care.
A prospective checklist creation and validity evidence collection study was conducted, involving literature review, expert input through a modified Delphi process, and pilot testing with ED faculty and residents at an urban academic medical center. We structured the validity evidence collection process using Messick's criteria for construct validity, addressing content, response process, internal structure, and relations to other variables. Data analysis focused on collecting validity evidence, including inter-rater reliability and participant performance assessment based on faculty or resident status.
The study resulted in a final 17-item checklist for pregnancy disclosure and options counseling in the ED. Pilot testing with 20 participants (eight faculty members and 12 residents) revealed high overall inter-rater reliability with almost perfect agreement (kappa = 0.81) and acceptable internal consistency (Cronbach's alpha = 0.88). Checklist scores showed no significant difference across standardized patients, indicating consistency. Faculty members outperformed residents, suggesting concurrent validity based on levels of clinical experience.
Preliminary validity evidence supports the use of this novel checklist to assess physician competency in pregnancy disclosure and options counseling in the ED. Given the frequency of new pregnancy encounters in the ED and the dynamic changes to pregnant patients' reproductive rights, enhancing physician education in these areas is critical for optimizing patient care and autonomy.
许多患者首次得知自己怀孕是在急诊科（ED）。然而，急诊科医生在妊娠告知及选择咨询方面的知识有限，这可能给患者护理带来挑战，并可能错失及时获得生殖保健的机会。目前尚无标准化工具用于教导或评估急诊科医生这项重要的沟通技能。本研究旨在开发一份用于急诊科医生有效进行妊娠告知及选择咨询的清单，并收集其效度证据，该环境可不受限制地获得全面的生殖保健服务。
开展了一项前瞻性清单创建及效度证据收集研究，包括文献综述、通过改良德尔菲法获取专家意见，以及在一家城市学术医疗中心对急诊科教员和住院医师进行预试验。我们使用梅西克的结构效度标准构建效度证据收集过程，涉及内容、反应过程、内部结构以及与其他变量的关系。数据分析重点在于收集效度证据，包括评分者间信度以及基于教员或住院医师身份的参与者表现评估。
该研究得出了一份最终包含17项内容的急诊科妊娠告知及选择咨询清单。对20名参与者（8名教员和12名住院医师）进行的预试验显示，评分者间总体信度较高，几乎完全一致（kappa = 0.81），内部一致性可接受（克朗巴哈系数α = 0.88）。清单得分在标准化患者中无显著差异，表明具有一致性。教员的表现优于住院医师，表明基于临床经验水平具有同时效度。
初步效度证据支持使用这份新颖的清单来评估急诊科医生在妊娠告知及选择咨询方面的能力。鉴于急诊科新接诊妊娠患者的频率以及妊娠患者生殖权利的动态变化，加强这些领域的医生教育对于优化患者护理和自主权至关重要。
