背景:准确的自我评估对于医生的专业发展至关重要。关于麻醉里程碑自我评估准确性的数据很少。这项研究的目的是调查居民自我评估和教师对麻醉学里程碑的评估之间的差异以及相关因素。
方法:这是一项在一所普通大学附属医院进行的横断面研究。我们包括在里程碑评估时在研究生二年级和三年级参加标准化住院医师培训计划的麻醉住院医师。我们要求临床能力委员会教师和麻醉住院医师自己对能力进行评估,在2023年1月和2024年1月使用中文版本的麻醉学里程碑。主要结果是自我评估和教师评估之间的差异,通过从每个亚能力的自我评估分数中减去教师评估分数来计算。
结果:分别在2023年和2024年对46名和42名居民进行了评估。自我评估的总和得分显着高于教师的评分[平均值(标准化偏差):120.39(32.41)与114.44(23.71),配对t检验P=0.008],组内相关系数为0.55[95%置信区间(CI):0.31至0.70]。Bland-Altman图显示患者护理中的严重高估(偏倚0.32,95%CI:0.05至0.60),基于实践的学习和改进(偏差0.45,95%CI:0.07至0.84),和专业性(偏差0.37,95%CI:0.02至0.72)。具有硕士学位的居民的评分(平均差:-1.06,95%CI:-1.80至-0.32,P=0.005)和博士学位(平均差:-1.14,95%CI:-1.91至-0.38,P=0.003)比具有学士学位的居民更接近教师评估。与病人护理相比,在广义估计方程逻辑回归模型中,自我评分和能力评分在医学知识(均差:-0.18,95%CI:-0.35~-0.02,P=0.031)和人际交往能力(均差:-0.41,95%CI:-0.64~-0.19,P<0.001)方面的差异较小.
结论:这项研究表明,居民倾向于高估自己,强调需要提高里程碑自我评估的准确性。自我评估和教师评估之间的差异与居民的学位和能力领域有关。
BACKGROUND: Accurate self-assessment is crucial for the professional development of physicians. There has been sparse data on the accuracy of self-assessments on Anesthesiology Milestones. The aim of this study was to investigate the differences between resident self-assessments and faculty-assessments on Anesthesiology Milestones and the associated factors.
METHODS: This was a cross-sectional study conducted in a general tertiary university-affiliated hospital. We included anesthesia residents who were enrolled in the standardized residency training program in postgraduate year two and three at the time of the Milestone evaluation. We requested evaluations of competencies from both the Clinical Competency Committee faculty and the anesthesia residents themselves, utilizing the Chinese version of Anesthesiology Milestones in January 2023 and January 2024. The primary outcome was the differences between self- and faculty-assessments, calculated by subtracting the faculty-rated score from the self-rated score on each subcompetency.
RESULTS: A total of 46 and 42 residents were evaluated in year 2023 and 2024, respectively. The self-rated sum score was significantly higher than that rated by faculty [mean (standardized deviation): 120.39 (32.41) vs. 114.44 (23.71), P = 0.008 in paired t test] with an intraclass correlation coefficient of 0.55 [95% confidence interval (CI): 0.31 to 0.70]. The Bland-Altman plots revealed significant overestimation in patient care (bias 0.32, 95% CI: 0.05 to 0.60), practice-based learning and improvement (bias 0.45, 95% CI: 0.07 to 0.84), and professionalism (bias 0.37, 95% CI: 0.02 to 0.72). Ratings from residents with master\'s degrees (mean difference: -1.06, 95% CI: -1.80 to -0.32, P = 0.005) and doctorate degrees (mean difference: -1.14, 95% CI: -1.91 to -0.38, P = 0.003) were closer to the faculty-assessments than residents with bachelor\'s degrees. Compared with patient care, the differences between self- and faculty- rated scores were smaller in medical knowledge (mean difference: -0.18, 95% CI: -0.35 to -0.02, P = 0.031) and interpersonal and communication skills (mean difference: -0.41, 95% CI: -0.64 to -0.19, P < 0.001) in the generalized estimating equation logistic regression model.
CONCLUSIONS: This study revealed that residents tended to overestimate themselves, emphasizing the need to improve the accuracy of Milestones self-assessment. The differences between self- and faculty-assessments were associated with residents\' degrees and domains of competency.