Assessing the hidden curriculum for the care of patients with limited english proficiency: An instrument development
Assessing the hidden curriculum for the care of patients with limited english proficiency: An instrument development
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评估英语水平有限的患者护理隐性课程：仪器开发
作者：
A. Green;Claudia Rosu;Tiffany C. Kenison;Chijioke Nze
工作背景：在美国，英语水平有限（LEP）的患者人数不断增加，面临护理质量和安全性差异的风险。医学生护理LEP患者的能力受到隐藏课程（HC）的影响，该课程破坏了学习经验;但迄今为止，还没有办法衡量它。因此，我们设计了一种工具来评估这种HC。研究方法：根据以往定性研究的结果，以及医学生和LEP和心理测量学专家的投入，我们开发了一个23项调查，包括四个领域。我们通过电子邮件将这篇文章发给了美国两所医学院的三年级和四年级学生。我们进行主轴因子分析，以确定该工具的结构效度。仅保留因子负荷≥0.50的项目。结果：我们获得了111份完整的回复。原有23个项目中的22个项目被保留。出现了四个因素/组成部分，它们不支持最初提出的领域。三个因素加载的混合角色建模，学习环境，结构和组织变量，而第四个因素保留了两个角色建模项目。基于因素提取的解决方案，我们重组的工具分为三个领域：角色建模，有效的系统的演示，和LEP患者的结构性障碍的后果（克朗巴赫的α：0.81-0.95，总方差占53.7%）。讨论：结果使我们重新评估领域结构，以创建一个工具，代表学生的看法和背景。我们的仪器，LEP-HC，将允许医学教育工作者调查一个特定的和重要的HC和改善教学与LEP患者的护理。
Background: Patients with limited English proficiency (LEP) are a growing population in the United States at risk for disparities in quality and safety of care. Medical student competency to care for patients with LEP is impacted by a hidden curriculum (HC) that undermines the learning experience; yet to date, there is no way to measure it. Thus, we designed an instrument to assess this HC. Methods: Based on findings from previous qualitative work and input from medical students and experts in LEP and psychometrics, we developed a 23-item survey with four domains. We e-mailed this to 3rd and 4th year students from two medical schools in the US. We conducted principal axis factoring to determine the instrument's construct validity. Only items with a factor loading ≥0.50 were retained. Results: We obtained 111 complete responses. Twenty-two of the 23 original items were retained. Four factors/components emerged, which did not support the original proposed domains. Three factors loaded on a mix of role modeling, and learning environment, structural, and organizational variables, while the fourth factor retained two role modeling items. Based on the factor extraction solution, we restructured the instrument into three domains: role modeling, demonstration of effective systems, and consequences of structural barriers for patients with LEP (Cronbach's alpha: 0.81–0.95, total variance accounted for 53.7%). Discussion: The results led us to reassess the domain structure to create an instrument representing students' perceptions and context. Our instrument, the LEP-HC, will allow medical educators to investigate a specific and important HC and improve teaching about care of patients with LEP.