Evaluación de competencias clínicas y quirúrgicas de una Residencia de Ortopedia y Traumatología Infantil. Utilización del Mini-CEX (Mini-Clinical Evaluation Exercise) y del DOPS (Direct Observation of Procedural Skills) / Evaluation of clinical and surgical proficiency at a residency of child orthopedics and traumatology Use of the Mini-CEX (Mini-Clinical Evaluation Exercise) and DOPS (Direct Observation of Procedural Skills)

RESUMEN

Objetivo: Evaluar competencias profesionales de una residencia de Ortopedia y Traumatología Infantil. Instrumentos pedagógicos utilizados Mini-Clinical Evaluation Exercise (Mini-CEX)y Direct Observation of Procedural Skills (DOPS)para competencias clínicas y quirúrgicas, respectivamente. Ambas evalúan la cúspide de la pirámide de Miller; se precisaron su confiabilidad y validez.materiales y métodos: Estudio observacional prospectivo de una cohorte de seis residentes de primero, segundo y tercer año quienes fueron evaluados por seis docentes en diversos contextos y situaciones reales consultorio externo y de guardia, sala de internación, interconsultas, quirófano y sala de yesos. Resultados: Se realizaron 65 observaciones. Cada residente fue evaluado como media en 10 oportunidades por entre 3 y 6 docentes. Para las variables clínicas, en general, los residentes más antiguos obtuvieron valores sobresalientes y los residentes de primer año, valores satisfactorios. No hubo diferencias significativas para las competencias quirúrgicas globalmente, pero los residentes de tercer año fueron más competentes para resolver situaciones inesperadas. El coeficiente de Cronbach fue superior a 0,90. Conclusiones: Ambos instrumentos de evaluación tuvieron una elevada confiabilidad. El método estadístico permitió individualizar exactamente las fragilidades y fortalezas de la residencia. El coeficiente de Cronbach obtuvo un valor de alto impacto psicométrico. Nivel de Evidencia IV

ABSTRACT

Purpose: To assess professional competencies in a Pediatric Orthopedic and Traumatology Residency Program by the implementation of two performance-assessment instruments Mini-Clinical Evaluation Exercise (Mini-CEX) and Direct Observation of Procedural Skills (DOPS) for clinical and surgical skills. Both tools aim to assess the top of Miller's pyramid, for its reliability and validity. Materials and Methods: Prospective observational cohort study of six medical trainees in the first, second and third year of their residency program (R1-R2-R3) who were randomly assessed by six examiners during their daily training at outpatient clinics, emergency room, inpatients unit, operating room, and plaster room. The statistical analysis was carried out with the Chi-Square and Wilcoxon-Rank paired test for univariate variables. The residents' relationship cohorts were compared using the Kruskal-Wallis test. The reliability of the methodological tool was determined by the psychometric test of Crombach. Alfa was set at ≤ 0.05. Diagnostic study level IV. Results: We performed 65 assessments. Each resident was evaluated 10 times on average by 3 to 6 examiners. The oldest residents had better performances in overall clinical competencies. However, the R1 group achieved satisfactory results whereas the R2-R3 groups had the most outstanding scores. There were no statistical differences in general surgical competencies, but the R3 group was outstanding in cases of unforeseen surgical situations. The Alfa Crombach coefficient was over 0.90. Conclusion: The Mini-CEX, DOPS, and interactive feedback were powerful tools to provide high-quality assessment and were widely accepted by residents and examiners. The statistical analysis allowed us to identify the weaknesses and strengths of the trainees. The Crombach coefficient had a high psychometric impact. Level of Evidence IV