Using unannounced standardized patients to assess residents' competency in asthma severity classification
Using unannounced standardized patients to assess residents' competency in asthma severity classification
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DOI：
10.1016/j.ambp.2007.11.004
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发表时间：
2008-03-01
期刊：
影响因子：
--
通讯作者：
Reznik, Marina
中科院分区：
文献类型：
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作者：
Ozuah, Philip O.;Reznik, Marina
目的。-本研究的目的是检验这样的假设：教育干预将提高儿科住院医生使用未公布的标准化患者 (SP) 评估的哮喘严重程度分类的能力。方法。-六名 SP 接受培训，分别代表轻度间歇性、轻度持续性、中度持续性和重度持续性哮喘。对照组的数据是在 2002-2003 年获得的。 2003-2004年，干预后，从干预组收集数据。干预措施包括教学课程和发布哮喘严重程度分类的标准。在授课期间，教师获得了住院医生 (N = 12) 关于严重程度分类的承诺。教职员工和住院医师对 SP 的存在视而不见。每个SP的指定严重性被用作判定标准。将居民的严重程度分级与判定标准进行比较。为了测试干预后能力是否有所改善，我们通过干预组与对照组以及受试者内对照比较来比较居民的表现。双变量分析测试了分类变量比例的差异。结果-分析了 50 次居民 SP 遭遇。在识别持续性哮喘方面，干预组在各个训练级别上的表现均显着优于对照组：研究生第 3 年（PGY3，100% vs 71%）、PGY2（71% vs 50%）和 PGY1（50% vs 43%）。他们在确定持续性哮喘的亚分类方面也表现明显更好：PGY3（87% vs 40%）、PGY2（67% vs 33%）和 PGY1（50% vs 33%）。所有患者的 P < .05。同样，对于受试者内对照比较，干预后居民在持续性哮喘的识别和细分方面的表现明显优于基线时的相同居民。结论：教育干预导致居民在哮喘严重程度分类方面的能力显着提高。
Objective.-The aim of this study was to test the hypothesis that an educational intervention would increase the competency of pediatric residents in classifying asthma severity as assessed using unannounced standardized patients (SPs).Methods.-Six SPs were trained to represent mild-intermittent, mild-persistent, moderate-persistent, and severe-persistent asthma. Data from a control group were obtained in 2002-2003. In 2003-2004, after an intervention, data were collected from an intervention group. The intervention consisted of a didactic session and posting the criteria for asthma severity classification. During precepting, faculty obtained a commitment from residents (N = 12) regarding the severity classification. Faculty and residents were blinded to the presence of SPs. The assigned severity of each SP was used as the criterion standard. Residents' severity classification was compared with the criterion standard. To test whether competency improved postintervention, we compared residents' performance by using intervention group versus control group and within-subject control comparisons. Bivariate analyses tested differences in proportions of categorical variables.Results.-Fifty resident-SP encounters were analyzed. The intervention group performed significantly better than controls at each level of training in identifying persistent asthma: postgraduate year 3 (PGY3, 100% vs 71 %), PGY2 (71 % vs 50%), and PGY1 (50% vs 43%). They also performed significantly better in determining subclassifications of persistent asthma: PGY3 (87% vs 40%), PGY2 (67% vs 33%), and PGY1 (50% vs 33%). All had P < .05. Similarly, for within-subject control comparison, residents performed significantly better postintervention at identification and subclassification of persistent asthma than did the same residents at baseline.Conclusions.-An educational intervention resulted in significant improvements in the competency of residents in asthma severity classification.