Hennen B K
J Med Educ. 1984 Jun;59(6):487-93. doi: 10.1097/00001888-198406000-00005.
Recent studies on clinical problem-solving show that a considerable proportion of the problem-solving strategy employed by doctors and medical students is "case specific" or "system specific." Such studies have failed to consider adequately the starting place of the problem-solving process, that is, the inherent complexity of the problem being considered. In presenting clinical problems to students and writing problem-solving skills assessments, educators have demonstrated no quantifiable ways of grading the complexity of the clinical problems they select for instruction or examination purposes. The author in this study reports on the development and application of a complexity index to 29 clinical problems used in a new graduate curriculum. The index uses five components of problem complexity: symptoms, physical signs and investigations, socioeconomic and behavioral factors, diagnoses, and management plans. A test has been made of its interrater reliability between two observers applying it independently in one application. Trials to establish the validity of the complexity index with various criterion groups of physicians and educators are discussed. Suggestions for further refinement of such an index and its application in research in the quality of care and in medical education are offered.
近期关于临床问题解决的研究表明，医生和医学生所采用的相当一部分问题解决策略是“针对具体病例”或“针对具体系统”的。此类研究未能充分考虑问题解决过程的起始点，即所考虑问题的内在复杂性。在向学生呈现临床问题以及编写问题解决技能评估时，教育工作者尚未展示出对他们为教学或考试目的所选临床问题的复杂性进行量化评分的方法。本研究的作者报告了一种复杂性指数在新研究生课程中使用的29个临床问题上的开发与应用情况。该指数使用问题复杂性的五个组成部分：症状、体征与检查、社会经济和行为因素、诊断以及管理计划。在一次应用中，已对两名独立应用该指数的观察者之间的评分者间信度进行了测试。文中讨论了与不同标准组的医生和教育工作者一起建立复杂性指数有效性的试验。还提供了关于进一步完善此类指数及其在医疗质量研究和医学教育中的应用的建议。
