Assessment of patient management skills and clinical skills of practising doctors using computer-based case simulations and standardised patients
Assessment of patient management skills and clinical skills of practising doctors using computer-based case simulations and standardised patients
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DOI：
10.1111/j.1365-2929.2004.01907.x
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发表时间：
2004-09-01
影响因子：
6
通讯作者：
Ciccone, A
中科院分区：
文献类型：
--
作者：
Hawkins, R;Gaglione, MM;Ciccone, A
背景对执业医生的标准化评估正在得到越来越多的支持，但理论和后勤问题构成了严重的障碍。为了从经验丰富的医生那里获得基于计算机的病例模拟（CCS）和标准化的基于病人的（SP）方法的参考绩效水平，并评价这些方法在诊断评估中的实用性。设置和参与者研究在军队三级医疗机构进行，主要观察指标：医生完成了8例CCS和8例SP病例，目标是进入该行业的医生。将标准化的患者表现与存档的四年级医学生数据进行比较。结果虽然主治医生和住院医师在CCS和SP病例中表现良好，但所有病例的评分范围很广。来自不同专业或不同经验的参与者之间的得分没有显着差异。在完成CCS和SP测试的参与者（n = 44）中，观察到CCS和SP检查表评分之间存在中度正相关。医生经验与SP自评量表得分呈负相关。而学生与SP花费的时间变化不大的临床任务，医生似乎花更多的时间在沟通/咨询的情况下，比涉及急性/慢性medical problems.Conclusion的情况下，基于计算机的情况下模拟和标准化的基于病人的评估可能是有用的一部分，多模式的程序来评估执业医生。需要对SP标准制定和评分方法进行进一步研究。根据这种性质的评估确定一系列业绩的经验可能性应得到优先考虑。
CONTEXT Standardised assessments of practising doctors are receiving growing support, but theoretical and logistical issues pose serious obstacles.OBJECTIVES To obtain reference performance levels from experienced doctors on computer-based case simulation (CCS) and standardised patient-based (SP) methods, and to evaluate the utility of these methods in diagnostic assessment.SETTING AND PARTICIPANTS The study was carried out at a military tertiary care facility and involved 54 residents and credentialed staff from the emergency medicine, general surgery and internal medicine departments.MAIN OUTCOME MEASURES Doctors completed 8 CCS and 8 SP cases targeted at doctors entering the profession. Standardised patient performances were compared to archived Year 4 medical student data.RESULTS While staff doctors and residents performed well on both CCS and SP cases, a wide range of scores was exhibited on all cases. There were no significant differences between the scores of participants from differing specialties or of varying experience. Among participants who completed both CCS and SP testing (n = 44), a moderate positive correlation between CCS and SP checklist scores was observed. There was a negative correlation between doctor experience and SP checklist scores. Whereas the time students spent with SPs varied little with clinical task, doctors appeared to spend more time on communication/counselling cases than on cases involving acute/chronic medical problems.CONCLUSION Computer-based case simulations and standardised patient-based assessments may be useful as part of a multimodal programme to evaluate practising doctors. Additional study is needed on SP standard setting and scoring methods. Establishing empirical likelihoods for a range of performances on assessments of this character should receive priority.