The metric of medical education
The metric of medical education
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医学教育的衡量标准
DOI：
10.1046/j.1365-2923.2002.01304.x
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发表时间：
2002
影响因子：
6
通讯作者：
J. Spencer
中科院分区：
文献类型：
--
作者：
B. Jolly;J. Spencer
为什么要写一个关于测量的系列？在过去十年中，在评估医疗保健专业人员的临床能力方面取得了重大进展。从历史上看，这些进步的一个主要刺激因素是20多年前哈登和格里森发表的一篇论文，该论文描述了长期病例是一种低效的评估方法，可以通过客观结构化临床检查（OSCE）有效地补充。随后，模拟病人被证明是一种可行的方法来控制许多测试情况。在美国和欧洲，专业知识都在发展，使用新的数值技术，如泛化理论和拉希标度，来提高测量人类能力的精度。1984年的第一届剑桥会议促进了传统（以判断为导向）和心理测量测试程序的综合，其中一个典型的例子是关键特征测试背后的雏形思想。总之，这些事件开启了对临床能力心理测量学重新产生兴趣的道路。这项工作在美国、荷兰、加拿大和澳大利亚得到了热烈的发展。然而，医学总委员会在1990年代后期对医学院进行的一轮访问中最近进行的一项调查和观察突出表明，联合王国在检查的技术方面仍然存在缺陷。与世界各地的同事交谈表明，尽管有卓越的中心和许多良好的实践，但许多国家的情况与英国没有什么不同；一些医学院、委员会和研究生机构在评估技术方面取得了进展，而另一些则远远落后。不一致或不连贯是常见的。最近，就连《英国医学杂志》（British Medical Journal）也表现出两极分化的倾向，就这个长病例发表了两篇社论，给出了截然不同的观点，既不引用也不承认对方的观点。这显然是一个问题。
Why a series on measurement? Over the last decade significant advances have been made in the assessment of clinical competence of healthcare professionals. Historically, one major stimulus to these advances was the publication, over 20 years ago, of a paper by Harden and Gleeson describing how the long case was an inefficient method of assessment and could usefully be supplemented by the objective structured clinical examination (OSCE). Subsequently, simulated patients were shown to be a feasible method of controlling many testing situations. Expertise was developing in both the USA and in Europe on using new numerical techniques, such as generalizability theory and Rasch scaling, to improve the precision of measurement of human capacities. The First Cambridge Conference, in 1984, catalysed the synthesis of traditional (judgement oriented) and psychometric testing procedures, one portentous example being the embryonic idea behind key features testing. In sum, these events opened the way to a renewed interest in the psychometrics of clinical competence. This work was enthusiastically developed in the USA, the Netherlands, Canada and Australia. However, a recent survey and observations made by the General Medical Council during its round of visits to medical schools in the late 1990s highlighted continuing deficiencies in the technical aspects of examinations in the UK. Conversations with colleagues worldwide suggest that, although there are centres of excellence and much good practice, the situation in many countries is not unlike that in the UK; some medical schools, boards and postgraduate institutions have forged ahead with developments in assessment techniques while others still lag far behind. Inconsistency or incoherence is common. Recently, even the British Medical Journal has shown bipolar tendencies, with two editorials on the long case , giving contrasting perspectives, with neither quoting or acknowledging the other. There is clearly a problem.