Kassebaum D G, Cutler E R, Eaglen R H
Division of Medical School Standards and Assessment, Association of American Medical College (AAMC), Washington, D.C., USA.
Acad Med. 1998 May;73(5):550-64. doi: 10.1097/00001888-199805000-00027.
In late 1997, the authors conducted a national survey of communities of interest about the importance and clarity of 44 accreditation standards applied to teaching, learning, and evaluation in medical schools by the Liaison Committee on Medical Education (LCME). Questionnaires were mailed to deans and educational administrators at U.S. medical schools; current LCME members and surveyors and those who had served during the preceding five years; a random selection of residency program directors drawn from both general practice and speciality disciplines; sample groups of medical students and residents; and a cohort of practicing physicians not affiliated with academic medical institutions. Altogether 1,659 questionnaires were mailed, and 701 responses were received (42%). The recipients were asked to use a five-point Likert scale to rate each of the 44 standards both for its perceived importance as an indicator of the quality of undergraduate medical education and for the clarity with which the standard's intent was conveyed. Although the mean ratings of importance all fell in the "moderately important" and "highly important" areas across the respondent groups, the ratings divided into three groups, semantically and statistically. At the high end for importance are standards dealing with fundamental qualities of students, instruction, and the structuring of resources. At the low end of the importance scale are standards dealing largely with matters of process. The ratings for clarity were systematically lower than the ratings for importance, and in some cases the rating for clarity were even more widely discrepant with the ratings for importance. Individual comments by respondents about certain standards were critical of their complicated construction and of confusion about their meaning and measures of compliance. One or more of these hallmarks--being rated of lower importance or clarity, and being the target of criticism by survey respondents--distinguished most of the standards that earlier study had shown are often neglected by surveyors. The predictive validity of each of a number of standards was examined by testing the association between the standard (or its derivative) and outcomes expressed in annual student and school questionnaires and compiled in databases of the Association of American Medical Colleges and the American Medical Association. The result was a mixed bag, confounded by the absence of specific dimensions of many accreditation standards (independent variables) and the lack of discriminating measures of outcome (dependent variables). Nevertheless, the LCME's accreditation standards are believed to be important by those most affected by them. And beyond validating that medical accreditation is guided by relevant standards for teaching, learning, and evaluation, the results of this study point to ways by which the process can be made more precise and useful.
1997年末，作者针对医学教育联络委员会（LCME）应用于医学院校教学、学习及评估的44项认证标准的重要性和清晰度，开展了一项面向相关利益群体的全国性调查。调查问卷被邮寄给美国医学院校的院长及教育管理人员；现任LCME成员、调查员以及前五年内曾任职的人员；从全科及专科领域随机抽取的住院医师培训项目主任；医学生和住院医师样本组；以及一批与学术性医疗机构无关联的执业医师。共邮寄了1659份调查问卷，收到701份回复（回复率42%）。要求受访者使用五点李克特量表，对44项标准中每一项作为本科医学教育质量指标的重要性以及标准意图传达的清晰度进行评分。尽管各受访者群体对重要性的平均评分均落在“中等重要”和“高度重要”区间，但从语义和统计角度来看，评分分为三组。在重要性方面处于高端的是涉及学生基本素质、教学及资源配置的标准。在重要性量表低端的是主要涉及过程事项的标准。清晰度评分系统性地低于重要性评分，在某些情况下，清晰度评分与重要性评分的差异甚至更大。受访者对某些标准的个人评论批评了其复杂的结构以及对其含义和合规衡量标准的混淆。这些特征中的一个或多个——被评为重要性或清晰度较低，且成为调查受访者批评的对象——区分了大多数早期研究表明调查员经常忽视的标准。通过测试标准（或其衍生标准）与美国医学院协会和美国医学协会数据库中年度学生及学校调查问卷所表达的结果之间的关联，对多项标准的预测效度进行了检验。结果好坏参半，许多认证标准（自变量）缺乏具体维度以及结果（因变量）缺乏区分性衡量标准使情况变得复杂。然而，那些受其影响最大的人认为LCME的认证标准很重要。除了验证医学认证以教学、学习和评估的相关标准为指导外，本研究结果还指出了使该过程更加精确和有用的方法。
