Effects of training in direct observation of medical residents' clinical competence - A randomized trial
Effects of training in direct observation of medical residents' clinical competence - A randomized trial
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DOI：
10.7326/0003-4819-140-11-200406010-00008
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发表时间：
2004-06-01
影响因子：
39.2
通讯作者：
Huot, SJ
中科院分区：
文献类型：
--
作者：
Holmboe, ES;Hawkins, RE;Huot, SJ
背景资料：教师观察居民和学生进行临床技能是必不可少的可靠和有效的评价受训人员。目的：为了评估一个新的多方面的方法，教师发展的有效性，称为直接观察能力培训。设计：控制试验的教师从16个内科住院医师计划使用群集随机设计。设置：学术医疗中心。参与者：40名内科教学人员：干预组17名，对照组23名。测量：完成培训后8个月，教师进行直接观察的舒适度变化，教师对研讨会的满意度，以及教师评级行为的变化。干预：能力工作坊的直接观察结合了教学性的小型讲座、互动小组和录像带评估练习以及与标准化居民和患者的评估技能练习。37名教师（干预组16名，对照组21名）完成了研究。干预组中的大多数教师（14 [88%]）报告说，与对照组教师（4 [19%]）相比，他们对进行直接观察感到更加舒适（P = 0.04），所有干预教师都将培训评为优秀。对于9个录像的临床遭遇，干预组教师在他们对医疗面谈、体检和咨询的评估中比对照组更严格;即使在调整基线评级行为后，医疗面谈和体检评级的差异仍然具有统计学意义。局限性：该研究涉及有限数量的住院医师项目，教师没有对实际住院医师的表现进行评级。直接观察能力培训，教师发展的一个新的多方面的方法，导致有意义的变化，在评级行为和教师的舒适度与临床技能的评价。
Background: Faculty observation of residents and students performing clinical skills is essential for reliable and valid evaluation of trainees.Objective: To evaluate the efficacy of a new multifaceted method of faculty development called direct observation of competence training.Design: Controlled trial of faculty from 16 internal medicine residency programs using a cluster randomization design.Setting: Academic medical centers.Participants: 40 internal medicine teaching faculty members: 17 in the intervention group and 23 in the control group.Measurements: Changes in faculty comfort performing direct observation, faculty satisfaction with workshop, and changes in faculty rating behaviors 8 months after completing the training.Intervention: The direct observation of competence workshop combines didactic mini-lectures, interactive small group and videotape evaluation exercises, and evaluation skill practice with standardized residents and patients.Results: 37 faculty members (16 in the intervention group and 21 in the control group) completed the study. Most of the faculty in the intervention group (14 [88%]) reported that they felt significantly more comfortable performing direct observation compared with control group faculty (4 [19%]) (P = 0.04), and all intervention faculty rated the training as outstanding. For 9 videotaped clinical encounters, intervention group faculty were more stringent than controls in their evaluations of medical interviewing, physical examination, and counseling; differences in ratings for medical interviewing and physical examination remained statistically significant even after adjustment for baseline rating behavior.Limitations: The study involved a limited number of residency programs, and faculty did not rate the performance of actual residents.Conclusion: Direct observation of competence training, a new multifaceted approach to faculty development, leads to meaningful changes in rating behaviors and in faculty comfort with evaluation of clinical skills.