Toward meaningful evaluation of clinical competence: The rote of direct observation in clerkship ratings
Toward meaningful evaluation of clinical competence: The rote of direct observation in clerkship ratings
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DOI：
10.1097/00001888-200410001-00007
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发表时间：
2004-10-01
影响因子：
7.4
通讯作者：
Yudkowsky, R
中科院分区：
文献类型：
--
作者：
Hasnain, M;Connell, KJ;Yudkowsky, R
问题陈述和目的。缺乏教师的直接观察可能会影响对临床能力的有意义的判断。本研究的目的是探讨直接观察法对家庭医学助理员临床表现评分信度和效度依据的影响。在16项评估工具上对家庭医学书记员(n=172)进行评分的导师记录了每个评分的数据来源：笔记回顾、病例讨论和/或直接观察。计算平均数据来源得分，并将其分为低、中或高三类，高分组包括最直接的观察。分析了数据来源对评价者间一致性的影响，以及助理临床分数(CCS)与国家法医委员会(NBME(R))科目考试和四年标准化患者临床能力考试(M4CCE)分数之间的关联。评分者之间的信度随着数据来源的增加而增加；对于低、中、高组，组内相关系数分别为0.29、0.50和0.74。高分组CCS与NBME评分呈显著正相关(r=.311，p=.054)，与M4CCE呈显著正相关(r=.423，p=.009)。当更直接的观察被包括在内作为助理等级的基础时，临床能力的可靠性和有效性证据被增强。
Problem Statement and Purpose. The lack of direct observation by faculty may affect meaningful judgments of clinical competence. The purpose of this study was to explore the influence of direct observation on reliability and validity evidence for family medicine clerkship ratings of clinical performance.Method. Preceptors rating family medicine clerks (n = 172) on a 16-item evaluation instrument noted the data-source for each rating: note review, case discussion, and/or direct observation. Mean data-source scores were computed and categorized as low, medium or high, with the high-score group including the most direct observation. Analyses examined the influence of data-source on interrater agreement and associations between clerkship clinical scores (CCS) and scores from the National Board of Medical Examiners (NBME(R)) subject examination as well as a fourth-year standardized patient-based clinical competence examination (M4CCE).Results. Interrater reliability increased as a function of data-source; for the low, medium, and high groups, intraclass correlation coefficients were .29, .50, and .74, respectively. For the high-score group, there were significant positive correlations between CCS and NBME score (r = .311, p = .054); and between CCS and M4CCE (r = .423, p = .009).Conclusion. Reliability and validity evidence for clinical competence is enhanced when more direct observation is included as a basis for clerkship ratings.