Doctors and Numbers: An Assessment of the Critical Risk Interpretation Test
Doctors and Numbers: An Assessment of the Critical Risk Interpretation Test
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DOI：
10.1177/0272989x14558423
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发表时间：
2015-05-01
影响因子：
3.6
通讯作者：
Matlock, Daniel D.
中科院分区：
文献类型：
--
作者：
Caverly, Tanner J.;Prochazka, Allan V.;Matlock, Daniel D.
背景风险解释影响决策。然而，对于临床医生如何解释他们通常遇到的风险数据，没有有效的评估。Objective.建立临床医生风险解读的20项测试的信度和效度。方法.关键风险解释测试（CRIT）测量临床医生的能力：1）基于结果中有意义的差异（例如，疾病特异性对全因死亡率）和时间段（例如，终生与10年死亡率），2）对不同的风险框架保持稳定的解释（例如，相对风险v.绝对风险），以及3）正确解释诊断测试如何改变风险。有658名临床医生和医学实习生参加：116名执业护士（NP）在全国会议上，273名医学生在1个机构，148名居民在2个机构的内科，和121名内科医生在1个机构。参与者在教育会议期间完成了自我管理的纸上测试。17位循证医学专家在线参加了测试，并正式评估了内容的有效性。对18名二年级医学生进行了问卷调查，并在3周后进行了重测，以探讨重测与测试的相关性。结果专家评审支持测试清晰度和内容有效性。因素分析支持CRIT识别至少3个临床医生知识的可分离领域。重测相关性是公平的（组内相关系数= 0.65;标准误= 0.15）。我们的测试分数与其他相关能力的测试相关。平均测试分数各组之间存在差异，既往循证医学培训和经验存在差异（NP为93，医学生为101，居民为101，学术内科医生为103，医生专家为110; P < 0.001）。结论.我们的研究结果为CRIT作为关键风险解释能力的指标的可靠性和有效性提供了支持证据，这是可以接受的，在教育环境中管理是可行的。
Background. Risk interpretation affects decision making. Yet, there is no valid assessment of how clinicians interpret the risk data that they commonly encounter. Objective. To establish the reliability and validity of a 20-item test of clinicians' risk interpretation. Methods. The Critical Risk Interpretation Test (CRIT) measures clinicians' abilities to 1) modify the interpretation based on meaningful differences in the outcome (e.g., disease specific v. all-cause mortality) and time period (e.g., lifetime v. 10-year mortality), 2) maintain a stable interpretation for different risk framings (e.g., relative v. absolute risk), and 3) correctly interpret how diagnostic testing modifies risk. There were 658 clinicians and medical trainees who participated: 116 nurse practitioners (NPs) at a national conference, 273 medical students at 1 institution, 148 residents in internal medicine at 2 institutions, and 121 internists at 1 institution. Participants completed a self-administered paper test during educational conferences. Seventeen evidence-based medicine experts took the test online and formally assessed content validity. Eighteen second-year medical students were recruited to take the test and a retest 3 weeks later to explore test-retest correlation. Results. Expert review supported test clarity and content validity. Factor analysis supported that the CRIT identifies at least 3 separable areas of clinician knowledge. Test-retest correlation was fair (intraclass correlation coefficient = 0.65; standard error = 0.15). Scores on our test correlated with other tests of related abilities. Mean test scores varied among groups, with differences in prior evidence-based medicine training and experience (93 for NPs, 101 for medical students, 101 for residents, 103 for academic internists, and 110 for physician experts; P < 0.001). Conclusions. Our results provide supporting evidence for the reliability and validity of the CRIT as an index of critical risk interpretation abilities, which is acceptable and feasible to administer in an educational setting.