Creación, validación y aplicación de un script concordance test (SCT) para la evaluación del razonamiento clínico en cardiología pediátrica en profesionales con dedicación pediátrica habitual

Resumen

Introduction Nowadays, when doctors complete their Resident Medical Intern program, health professionals with general paediatric assistance are not evaluated on their Paediatric Cardiology knowledge and clinical reasoning Actual unawareness about this knowledge precludes professional retraining directed to solve deficiencies in this collective. Script Concordance Test (SCT), due to its structure and orientation to usual clinical practice, allows getting consistent data through variables analysis and it is applicable to a considerable sample. Surprisingly, it has not been used in Spain for health professionals evaluation so far. Objectives Development, validation and application of an SCT questionnaire for clinical reasoning analysis in paediatric cardiology applied on a population of paediatricians and general practitioners attending children in order to be used as testing method for specific training. Material and methods SCT test development, correction and validation that included demographic and employment data from every evaluated subject for Paediatric Cardiology clinical reasoning evaluation of paediatricians and usual paediatric assistance family doctors. We collected 32 questionnaires from paediatric cardiology specialists, which were used like gold standard to professional's scoring system. The questionnaire was emailed to paediatricians and family doctors from 1st march to 31st may of 2018. We collected 188 and 38 questionnaires respectively. A statistical study was performed included demographic and employment variables from evaluated subjects and achieved scores, to study possible relationship between them. Results We didn't find any statistically significant differences on achieved scores related to evaluated subject gender, paediatric assistance frequency, paediatric assistance experience, paediatric cardiologist accessibility, usual working place and paediatric assistance on-call time. We found statistical significant differences in achieved scores related to evaluated subject qualification, type and duration of Paediatric Cardiology received formation and paediatric cardiology training course taken. We observed the older the professional, the lowest the score in the questionnaire. We detected four paediatricians (2,1 %) and one family doctor (2,6 %) that didn't have adequate Paediatric Cardiology clinical reasoning. Conclusions We developed a 70 questions SCT test that was approved by a Paediatric Cardiology experts committee by judges' criteria, it met reliability criteria and it allowed distinguishing evaluated subject different formative grade. It was accessible, easily correctable, codified and interpretable for investigators. Variables like qualification, training, continuous educational programs and usual working place had greater weight in Paediatric Cardiology clinical reasoning than paediatric assistant experience, paediatric assistant frequency, paediatric cardiologist accessibility or paediatric assistant on call time. Evaluated subject percentage that didn't pass the questionnaire was similar to published scientific literature.