IntroductionThis study seeks to explore validity and reliability evidence for core residency entrustable professional activities (CR-EPAs) that were developed by Peking University First Hospital (PKUFH) in 2020.MethodsA prospective cohort study was conducted in PKUFH. Trainers (raters) assessed pediatric residents on CR-EPAs over 1 academic year, bi-annually. Critical components within a validity evidence framework were examined: response process (rater perceptions), the internal structure (reliability and contributions of different variance sources), and consequences (potential use of a cutoff score).ResultsIn total, 37 residents were enrolled, and 111 and 99 trainers’ ratings were collected in Fall 2020 and Spring 2021, respectively. For rater perceptions, all the raters considered CR-EPAs highly operational and convenient. In all ratings, individual EPAs correlate with total EPA moderately, with Spearman correlation coefficients spanning from 0.805 to 0.919. EPA 2 (select and interpret the auxiliary examinations), EPA 5 (prepare and complete medical documents), EPA 6 (provide an oral presentation of a case or a clinical encounter), and EPA 7 (identify and manage the general clinical conditions) were EPAs correlated with other EPAs significantly. The results of the generalizability theory indicated that the variability due to residents is the highest (nearly 78.5%), leading to a large size of the reliability estimates. The matching results indicate that the lowest error locates at 5.933.ConclusionThe rating showed good validity and reliability. The ratings were reliable based on G-theory. CR-EPAs have a magnificent internal structure and have promising consequences. Our results indicate that CR-EPAs are a robust assessment tool in workplace-based training in a carefully designed setting.

Objective:To assess the reliability of the clinical fundamental skills test for standardized competence test for clinical medicine undergraduates and provide an empirical basis for improving the quality of the test.Methods:A generalizability theory was employed to examine the scores of 7 322 examinees who completed the clinical fundamental skills test for BSc in 2020. According to the test design, examinees, stations and items were included in the analysis. The percentage of variance for each facet was calculated to identify the main sources affecting test reliability. Generalizability (G) coefficient and phi index were calculated to analyze the reliability of the test. Based on the scores of examinees who completed the same items in the test, different G coefficients and phi indices were obtained to explore the optimization of the test reliability by adjusting the number of items and stations.Results:The results from the generalizability theory showed that the percentage of variance for items was 70.0%~76.0%, the percentage of variance for stations was 17.6%~24.4%, and the percentage of variance for examinees was 0.3%~0.8%. G coefficients for the test ranged from 0.502 to 0.717, and phi indices ranged from 0.052 to 0.223. When one item was added, G coefficient increased by 0.002 and phi index increased by 0.002. When five items were added, G coefficient increased by 0.007 and phi index increased by 0.004. When one station was added, G coefficient increased by 0.025, and phi index increased by 0.010. When two stations were added, G coefficient increased by 0.045 and phi index increased by 0.017.Conclusions:There is still room for improving the quality of clinical fundamental skills test. The stations and items are the main sources affecting the test reliability. The test reliability can be improved by increasing the number of stations and items, but the time and the cost of stations and items need to be considered in a comprehensive manner.

Quantifying the severity of neurological disorders, such as attention-deficit/hyperactivity disorder (ADHD), is encouraged in practice. To explore the methodological properties of data-driven classification, this study aimed to develop computerized adaptive testing (CAT) based on Bayesian networks to classify ADHD symptom severity for individual subjects efficiently. The Current Symptoms Scale was used to build an ADHD symptom severity classifier in a sample of 892 college students, and the CAT making use of information gains from conditional probabilities of the Bayesian network was evaluated through a simulation study. The results showed that distributing 8 out of 18 items on average to an individual subject would result in 85% classification accuracy, supporting the adaption of surveying ADHD to digital platforms demanding much-shortened scales. The severity classifier based on Bayesian networks can assist diagnostic tasks via a data-driven mechanism. Further, integrating CAT into the classifier can shorten the scale while maintain acceptable measurement quality. The ADHD symptoms were used in the paper; however, the proposed method applies to other psychological symptoms as well. The impact and limitations of the CAT for ADHD were discussed, and several suggestions for future research were provided.

Objective:Entrustable professional activities (EPAs) applied for residency training consisting of 15 EPAs was developed by Peking University First Hospital (PKUFH) in 2020. A pilot study was implemented with PKUFH Pediatric Residency Program aiming for its efficacy and to orient clinical training.Methods:Totally 55 residents who joined PKUFH Pediatric Residency Program from July 2020 to December 2020 were enrolled with some clinical trainers. The self-assessment and trainer's assessment was conducted. An 8-scale supervision scale was used and Kruskal Wallis test was applied for comparing the self-assessment and trainer's assessment. Mann-Whitney U test was conducted to compare the assessment results from different residents.Results:The scores of both trainer-assessment and self-assessment by the trainees score increase year by year in each EPAs. Post-graduate year 5 (PGY5)residents showed highest supervision level, with the highest trainer-assessment in EPA 11(7.3±0.7) and highest self-assessment in EPA10(7.5±0.5). A good discrimination between each group in all EPAs items (Kruskal-Wallis test, P<0.05) was found. A significant difference (Bonferroni P correction, P<0.0125) was found between second year and first year residents except EPA10 (Obtain informed consent for tests and or procedure). No significant difference was found between in groups. All residents showed a low assessment score in EPA4 (making a medical decision), EPA8 (recognize a patient requiring urgent or emergent care and initiate evaluation and management) and EPA15 (public health events management). Conclusions:EPAs are feasible in the assessment of pediatric residents. Specialized training on medical decision making, critical care and public health events should be strengthened in order to fill the gap found in this research.

目的:探究心理干预联合面部护理对寻常型痤疮患者的护理效果和情绪影响作用.方法:在我院随机选取90例于2019年8月-2020年1月收治的寻常型痤疮患者作为研究对象,随机分为对照组(45例)和观察组(45例),对照组患者进行常规护理,对观察组患者进行心理干预联合面部护理,最后采用SAS量表和SDS量表比较两组患者的情绪变化,再对两组患者的护理满意度、痤疮愈合时间进行比较.结果:观察组患者的SAS、SDS量表评分均低于对照组,观察组患者的护理满意度高于对照组满意度,且观察组患者的痤疮恢复时间少于对照组.结论:对寻常型痤疮患者实施心理干预联合面部护理可以有效缩短患者的治疗时间,促进皮肤的康复,这样可以缓解患者的不良情绪,提高患者的护理满意度,在临床具有积极意义.