Borracci RA, Alvarez-Gallesio JM, Ciambrone G, Mezzadri NA

Idioma: Ingles.
Referencias bibliográficas: 38
Paginas: 416-422
Archivo PDF: 240.99 Kb.

RESUMEN

Objetivo: Evaluar cómo los médicos en formación (juniors) perciben su propio desempeño quirúrgico en comparación con la calificación otorgada por sus instructores (seniors) según un modelo de curva de aprendizaje. Métodos: Entre abril y junio de 2018 se realizó un estudio prospectivo en un hospital comunitario. Para evaluar cómo los médicos juniors estimaban su propio desempeño, 48 residentes/becarios de especialidades quirúrgicas eligieron una entre seis opciones excluyentes en una escala entre «novicio» y «experto automático». Además, cinco cirujanos que supervisaban a los residentes/becarios dieron sus propias opiniones sobre el nivel de desempeño de cada médico encuestado, usando las mismas categorías. Se realizó un análisis de concordancia para comparar las habilidades autopercibidas y el desempeño real según lo estimado por los cirujanos seniors. Resultados: Cuarenta y siete juniors y 50 seniors completaron la encuesta. El 51% sobrestimó y el 17% subestimó su ubicación en la curva de aprendizaje con respecto a los observadores externos (p = 0.025). El grado promedio de acuerdo entre seniors fue del 50%. La comparación entre la autopercepción de los juniors con respecto a sus observadores seniors mostró una con-cordancia pobre (kappa = 0.494; intervalo de confianza del 95% [IC 95%]: 0.359-0.631; p ‹ 0.0001; sesgo promedio de Bland-Altman: 0.40; IC 95%: 0.11-0.70). Conclusiones:La mitad de los residentes/fellows sobrestimó, y uno de cada seis subestimó, su verdadera ubicación en la curva de aprendizaje en comparación a la opinión de los seniors. Un mejor conocimiento de la existencia de este sesgo de estimación del propio desempeño podría redundar en una mejor confiabilidad del juicio médico.

REFERENCIAS (EN ESTE ARTÍCULO)

1. Roland D, Matheson D, Coats T, Martin G. A qualitative study of self-evaluation of junior doctor performance: is perceived safeness a more useful metric than confidence and competence? BMJ Open. 2015;5:e008521.

2. Pallier G, Wilkinson R, Danthiir V, Kleitman S, Knezevic G, Stankov L, et al. The role of individual differences in the accuracy of confidence judgments. J Gen Psychol. 2002;129:257-99.

3. Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L, et al. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA. 2006; 296:1094-102.

4. Barnsley L, Lyon PM, Ralston SJ, Hibbert EJ, Cunningham I, Gordon FC, et al. Clinical skills in junior medical officers: a comparison of self-reported confidence and observed competence. Med Educ. 2004;38:358-67.

5. Coberly L, Goldenhar LM. Ready or not, here they come: acting interns experience and perceived competency performing basic medical procedures. J Gen Intern Med. 2007;22:491-4.

6. Jones A, McArdle PJ, O’Neill PA. How well prepared are graduates for the role of pre-registration house officer? A comparison of the perceptions of new graduates and educational supervisors. Med Educ. 2001; 35:578-84.

7. Lai NM, Teng CL. Self-perceived competence correlates poorly with objectively measured competence in evidence based medicine among medical students. BMC Med Educ. 2011;11:25.

8. Ward M, MacRae H, Schlachta C, Mamazza J, Poulin E, Reznick R, et al. Resident self-assessment of operative performance. Am J Surg. 2003; 185:521-4.

9. Sidhu RS, Vikis E, Cheifetz R, Phang T. Self-assessment during a 2-day laparoscopic colectomy course: can surgeons judge how well they are learning new skills? Am J Surg. 2006;191:677-81.

10. Sarker SK, Hutchinson R, Chang A, Vincent C, Darzi AW. Self-appraisal hierarchical task analysis of laparoscopic surgery performed by expert surgeons. Surg Endosc. 2006;20:636-40.

11. van Empel PJ, Verdam MG, Huirne JA, Bonjer HJ, Meijerink WJ, Scheele F, et al. Open knot-tying skills: resident skills assessed. J Obstet Gynaecol Res. 2013;39:1030-6.

12. Brewster LP, Risucci DA, Joehl RJ, Littooy FN, Temeck BK, Blair PG, et al. Comparison of resident self-assessments with trained faculty and standardized patient assessments of clinical and technical skills in a structured educational module. Am J Surg. 2008;195:1-4.

13. Pandey VA, Wolfe JH, Black SA, Cairols M, Liapis CD, Bergqvist D, et al. Self-assessment of technical skill in surgery: the need for expert feedback. Ann R Coll Surg Engl. 2008;90:286-90.

14. de Blacam C, O’Keeffe DA, Nugent E, Doherty E, Traynor O. Are residents accurate in their assessments of their own surgical skills? Am J Surg. 2012;204:724-31.

15. Tedesco MM, Pak JJ, Harris EJ Jr. Krummel TM, Dalman RL, Lee JT, et al. Simulation-based endovascular skills assessment: the future of credentialing? J Vasc Surg. 2008;47:1008-1.

16. Hu Y, Tiemann D, Michael Brunt L. Video self-assessment of basic suturing and knot tying skills by novice trainees. J Surg Educ. 2013;70:279‑83.

17. Quick JA, Kudav V, Doty J, Crane M, Bukoski AD, Bennett BJ, et al. Surgical resident technical skill self-evaluation: increased precision with training progression. J Surg Res. 2017;218:144-9.

18. Ganni S, Chmarra MK, Goossens RH, Jakimowicz JJ. Self-assessment in laparoscopic surgical skills training: is it reliable? Surg Endosc. 2017;31:2451-6.

19. Arora S, Miskovic D, Hull L, Moorthy K, Aggarwal R, Johannsson H, et al. Self vs expert assessment of technical and non-technical skills in high fidelity simulation. Am J Surg. 2011;202:500-6.

20. Rizan C, Ansell J, Tilston TW, Warren N, Torkington J. Are general surgeons able to accurately self-assess their level of technical skills? Ann R Coll Surg Engl. 2015;97:549-55.

21. Zevin B. Self versus external assessment for technical tasks in surgery: a narrative review. J Grad Med Educ. 2012;4:417-24.

22. Pusic MV, Boutis K, Hatala R, Cook DA. Learning curves in health professions education. Acad Med. 2015;90:1034-42.

23. Dreyfus SE, Dreyfus HK. A Five-Stage Model of the Mental Activities Involved in Directed Skill Acquisition. Berkeley, California: University of California, Berkeley; 1980.

24. Ericsson K. The acquisition of expert performance as problem solving. In: Davidson J, Sternberg R, editors. The Psychology of Problem Solving. 1st ed. Cambridge, England: Cambridge University Press; 2003. p. 44-83.

25. Ericsson KA. Deliberate practice and acquisition of expert performance: a general overview. Acad Emerg Med. 2008;15:988-94.

26. Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical Epidemiology: a Basic Science for Clinical Medicine. 2nd ed. Boston: Brown and Co.; 1991.

27. Cicchetti DV. Testing the normal approximation and minimal sample size requirements of weighted kappa when the number of categories is large. Appl Psychol Meas. 1981;5:101-4.

28. Morgan PJ, Cleave-Hogg D. Comparison between medical students experience, confidence and competence. Med Educ. 2002;36 534-9.

29. Mitchell RE, Clark PE, Scarpero HM. Assessing the surgical skills of urology residents after preurology general surgery training: the surgical skills learning needs of new urology residents. J Surg Educ. 2011;68:341‑6.

30. Aldave G, Hansen D, Briceño V, Luerssen TG, Jea A. Assessing residents’ operative skills for external ventricular drain placement and shunt surgery in pediatric neurosurgery. J Neurosurg Pediatr. 2017;19:377-83.

31. Moorthy K, Munz Y, Adams S, Pandey V, Darzi A, Imperial College St. Mary’s Hospital Simulation Group. et al. Self-assessment of performance among surgical trainees during simulated procedures in a simulated operating theater. Am J Surg. 2006;192:114-8.

32. Munz Y, Moorthy K, Bann S, Shah J, Ivanova S, Darzi SA, et al. Ceiling effect in technical skills of surgical residents. Am J Surg. 2004;188:294‑300.

33. Bradley KE, Andolsek KM. A pilot study of orthopaedic resident self-assessment using a milestones survey just prior to milestones implementation. Int J Med Educ. 2016;7:11-8.

34. Meyer AN, Payne VL, Meeks DW, Rao R, Singh H. Physicians diagnostic accuracy, confidence, and resource requests: a vignette study. JAMA Intern Med. 2013;173:1952-8.

35. Klayman J, Soll JB, González-Vallejo C, Barlas S. Overconfidence: it depends on how, what, and whom you ask. Organ Behav Hum Decis Process. 1999;79:216-47.

36. Koriat A, Sheffer L, Ma’ayan H. Comparing objective and subjective learning curves: judgments of learning exhibit increased underconfidence with practice. J Exp Psychol Gen. 2002;131:147-62.

37. Finn B, Metcalfe J. The role of memory for past test in the underconfidence with practice effect. J Exp Psychol Learn Mem Cogn. 2007; 33:238‑44.

38. Eva KW, Regehr G. Exploring the divergence between self-assessment and self-monitoring. Adv Health Sci Educ Theory Pract. 2011;16:311-29.