Jansen J J, Berden H J, van der Vleuten C P, Grol R P, Rethans J, Verhoeff C P
Department of General Practice, University of Limburg, Maastricht, The Netherlands.
Resuscitation. 1997 Feb;34(1):35-41. doi: 10.1016/s0300-9572(96)01028-3.
In this study we evaluated the practical performance of 70 general practitioners in cardiopulmonary resuscitation (CPR) before and after instruction and compared checklist-based scores to mechanical recording scores in order to investigate which scoring method is preferable. Both checklist and recording strip-based scores showed significant improvement after instruction, but only 37% were judged proficient according to the American Heart Association standards (checklist scoring), and 47% according to the recording print-based scoring system, while rates judged 97% as satisfactory by general impression. Interrater reliability was highest for the recording print (0.97) and lower for the checklist (0.79), especially for CPR performance (0.56). Comparison of checklist and recording print showed that the checklist was specific but not very sensitive in identifying poor performance for cardiac compression rate, since observers overestimated performance. The correlation for CPR performance between checklist score and recording strip score was low (0.45), indicating that candidates were ranked differently. The correlation between diagnosis and performance score was low for checklist as well as recording print (0.22), indicating that the score on diagnosis was a poor predictor for the score on performance of CPR. These results support the use of the recording manikin as compared with the use of a checklist for formative evaluation of basic life support skills. However, as proficiency in diagnosis and performance in CPR are poorly correlated, assessment of diagnosis using a checklist must be included. Therefore we strongly recommend the combination of assessment by observers using a checklist for diagnostic procedures and the recording strip of the manikin for performance of CPR, as employed in most evaluation schemes.
在本研究中，我们评估了70名全科医生在接受心肺复苏（CPR）指导前后的实际操作表现，并比较了基于检查表的评分与机械记录评分，以探究哪种评分方法更可取。指导后，检查表评分和基于记录条的评分均显示出显著改善，但根据美国心脏协会标准（检查表评分），只有37%的人被判定为熟练，根据基于记录打印的评分系统这一比例为47%，而总体印象判定为满意的比例为97%。评分者间信度在记录打印方面最高（0.97），在检查表方面较低（0.79），尤其是在心肺复苏操作方面（0.56）。检查表与记录打印的比较表明，检查表在识别心脏按压速率不佳表现方面具有特异性，但不太敏感，因为观察者高估了操作表现。检查表评分与记录条评分之间的心肺复苏操作相关性较低（0.45），表明候选人的排名不同。检查表和记录打印的诊断与操作表现评分之间的相关性也较低（0.22），表明诊断评分对心肺复苏操作评分的预测性较差。这些结果支持在基础生命支持技能的形成性评估中使用记录人体模型而非检查表。然而，由于心肺复苏的诊断熟练程度与操作表现相关性较差，必须纳入使用检查表进行诊断评估。因此，我们强烈建议采用大多数评估方案中所采用的方法，即由观察者使用检查表对诊断程序进行评估，并使用人体模型的记录条对心肺复苏操作进行评估。
