Papp K K, Williams S D, Goldman M H
Surgery. 1984 Jul;96(1):102-8.
Complex cognitive skills, such as interpretation of information and problem solving, are essential for the practice of medicine. Patient management problems (PMPs) are used by both medical school faculty and certifying boards to measure higher-order cognitive skills. This study investigates two questions that relate to PMPs. Whether there is a difference among students in their achievement on PMPs that may be attributed to their clinical experience is examined. In addition, the effect of the order in which PMPs are taken is evaluated. For the purpose of this study, three PMPs were developed measuring three different areas of surgical problem solving. One hundred four third-year medical students who took their surgery clerkship during a 9-month period in 1982 were examined. Students were randomly assigned to one of three rotations for an 8-week period. At the end of the rotation, they each took three PMPs in random order. The multivariate analysis of variance procedure was used to examine the hypothesis of no relationship between clinical rotation and order of completion. The proficiency score for each PMP was considered the dependent variable. There was no difference in performance between groups rotating in different clinical surgical settings (multivariate F (6186) = 0.67; p = 0.67.) This suggests that generalization occurs with patient management and problem-solving skills. Statistically significant differences were found between groups on the basis of the order in which they took the PMPs (multivariate F (6186) = 4.07; p less than 0.001.) There are several plausible explanations for this finding. One explanation is that all three problems were difficult. As a result, students' perceptions about their performance on each problem may have influenced their performance on subsequent problems. Another explanation is that motivation to achieve may have diminished with time. These data suggest that there are basic management skills that may be taught in a variety of surgical experiences. Care must be taken in the use of the PMP as a tool for evaluation so that noneducational factors such as order do not play a role in the results.
复杂的认知技能，如信息解读和问题解决能力，对于医学实践至关重要。医学院教师和认证委员会都使用患者管理问题（PMPs）来衡量高阶认知技能。本研究调查了与PMPs相关的两个问题。研究了学生在PMPs成绩上的差异是否可能归因于他们的临床经验。此外，还评估了PMPs考试顺序的影响。为了本研究的目的，开发了三个PMPs，用于测量手术问题解决的三个不同领域。对1982年在9个月期间参加外科实习的104名三年级医学生进行了检查。学生们被随机分配到三个轮转组中的一组，为期8周。在轮转结束时，他们每人随机顺序参加三个PMPs考试。使用多变量方差分析程序来检验临床轮转与完成顺序之间无关系的假设。每个PMP的熟练程度得分被视为因变量。在不同临床手术环境中轮转的组之间在表现上没有差异（多变量F(6,186)=0.67；p=0.67）。这表明患者管理和问题解决技能具有普遍性。根据学生参加PMPs考试的顺序，发现组间存在统计学上的显著差异（多变量F(6,186)=4.07；p<0.001）。对于这一发现有几种合理的解释。一种解释是所有三个问题都很难。因此，学生对自己在每个问题上表现的看法可能影响了他们在后续问题上的表现。另一种解释是随着时间的推移，取得成绩的动力可能会减弱。这些数据表明，有一些基本的管理技能可以在各种外科手术经验中传授。在将PMP作为评估工具时必须谨慎，以便诸如考试顺序等非教育因素不会对结果产生影响。
