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首页> 外文期刊>The Journal of Graduate Medical Education >An Objective Structured Clinical Examination to Improve Formative Assessment for Senior Pediatrics Residents
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An Objective Structured Clinical Examination to Improve Formative Assessment for Senior Pediatrics Residents

机译：一种目标结构化临床检查，提高高级儿科居民的形成性评估

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Background? Residency programs are developing new methods to assess resident competence and to improve the quality of formative assessment and feedback to trainees. Simulation is a valuable tool for giving formative feedback to residents.;Objective? To develop an objective structured clinical examination (OSCE) to improve formative assessment of senior pediatrics residents.;Methods? We developed a multistation examination using various simulation formats to assess the skills of senior pediatrics residents in communication and acute resuscitation. We measured several logistical factors (staffing and program costs) to determine the feasibility of such a program.;Results? Thirty-one residents participated in the assessment program over a 3-month period. Residents received formative feedback comparing their performance to both a standard task checklist and to peers' performance. The program required 16 faculty members per session, and had a cost of $624 per resident.;Conclusions? A concentrated assessment program using simulation can be a valuable tool to assess residents' skills in communication and acute resuscitation and provide directed formative feedback. However, such a program requires considerable financial and staffing resources.;Introduction Residency programs must improve the quality and breadth of trainee assessment and feedback to ensure that graduates are prepared for independent practice. Faculty assessments and in-training examination scores are inadequate performance measures when used as a main assessment methodology.1,2 In addition, the Accreditation Council for Graduate Medical Education requires a breadth of trainee assessment with improved measures.3 Pediatrics residency leadership at the Ann & Robert H. Lurie Children's Hospital of Chicago partnered with the kidSTAR Medical Education Program, a team of physicians and nurses with backgrounds in simulation and medical education, to develop a performance-based objective structured clinical examination (OSCE) using various forms of simulation. Our overall aims were to (1) assess clinical skills and provide formative feedback to the individual residents, and (2) determine resident preparation for senior responsibilities. Our objective in this article is to describe the design, implementation, and costs of this formative assessment program.;Methods We used Kern et al's 6-step approach to curriculum development4 to design the assessment program, and we decided that an OSCE format fit our need for performance-based assessment. Needs Assessment We performed a literature search to examine the use of OSCEs for formative purposes with residents. We identified several studies that evaluated how to improve OSCE validity, including combining it with other assessment methods.5–8 Several prior studies have examined the validity of OSCEs as assessment tools in graduate medical education,9–12 but none have used OSCEs to assess resuscitation skills in pediatrics residents. Program leadership expressed an interest in assessing residents as they transitioned to the final year of training with its increased patient care responsibility. Also, this time frame allowed for an opportunity to address any deficiencies identified before graduation. Our goal was to observe residents performing activities that are traditionally not directly supervised, including management of an acutely decompensating patient requiring critical intervention and communication with clinicians and families. We developed a 5-station OSCE. The number was determined by time constraints and the amount of faculty required. Three stations were immersive simulations involving patients with acute decompensation events, including respiratory (bronchiolitis/apnea), cardiac (pulseless ventricular tachycardia), and neurologic (status epilepticus) etiologies. Clinical performance and handoffs were assessed in these stations. A fourth case used a standardized patient to assess communication with a parent. The final case inv
机译：背景？居住计划正在制定评估居民能力的新方法，并提高形成培训人的形成性评估和反馈的质量。模拟是一种有价值的工具，用于向居民提供形成性反馈。;目标？制定客观结构化的临床检查（欧安组织），以改善高级儿科居民的形成性评估。;方法？我们采用各种仿真格式开发了多次考试，以评估通信和急性复苏中高级儿科居民的技能。我们测量了几个后勤因素（人员配置和计划成本），以确定此类计划的可行性。;结果？三十一位居民在3个月内参加了评估计划。居民接受了形成性反馈比较其对标准任务清单和同行性能的表现。该计划每次会议需要16名教师，每居民的费用为624美元。结论？使用模拟的集中评估计划可以是评估居民通信和急性复苏的技能的有价值的工具，并提供指示的形成性反馈。但是，这样的计划需要相当大的财务和人员配置资源。引入居留计划必须提高实习生评估和反馈的质量和广度，以确保为独立实践做好准备。教师评估和培训课程考试得分是绩效措施不足，当用作主要评估方法.1,2此外，研究生医学教育的认证委员会需要一系列与改进措施的实习生评估.3处女士＆Robert H. Lurie儿童医院芝加哥与kidstar医学教育计划，一支医生和护士团队与仿真和医学教育的背景，利用各种形式的模拟开发基于绩效的客观结构临床检查（欧安组织）。我们的整体目标是（1）评估临床技能，并为各个居民提供联系反馈，（2）确定高级责任的居民准备。我们本文的目标是描述该形成性评估计划的设计，实施和成本。;方法我们使用克伦等人的6步方法课程开发4来设计评估计划，我们决定符合欧安组织格式适合我们的需要基于绩效的评估。需求评估我们进行了文献搜索，以检查欧索斯的使用是否与居民的形成目的。我们确定了几项研究，评估了如何提高欧安组织有效性，包括将其与其他评估方法相结合.5-8若干先前研究已经研究了欧索斯的有效性作为毕业生医学教育的评估工具，但没有使用欧式武器来评估儿科居民的复苏技能。方案领导力表达了对居民的转型到培训的最后一年的评估时，表达了令人兴趣的是，随着患者护理责任增加。此外，此时间框架允许有机会解决毕业前识别的任何缺陷。我们的目标是观察居民表演传统上没有直接监督的活动，包括管理急性分拆患者，需要与临床医生和家庭进行关键干预和沟通。我们开发了一个5站欧安组织。该数字由时间限制确定，所需的教师数量确定。三个站是涉及急性失代偿事件的患者的沉浸式模拟，包括呼吸道（支气管炎/呼吸暂停），心脏（无紫外神经性心动过速）和神经系统（状态癫痫症）病因。在这些站中评估了临床表现和切换。第四种案例使用标准化的患者评估与父母的沟通。最终案例inv

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