Defining core competencies in transfusion medicine for resident physicians: A multi-specialty Delphi consensus study

Anesthesiology Resident Knowledge of Transfusion Medicine: Results From the Anesthesiology Transfusion Education Study

BACKGROUND

Transfusion of blood products is a common practice in anesthesiology. Inadequate transfusion medicine knowledge may lead to inappropriate transfusion practices and patient risk. Using a validated assessment tool modified for anesthesiology, we conducted a survey of anesthesiology residents in the United States to assess transfusion medicine knowledge.

METHODS

A validated transfusion medicine examination and accompanying survey were forwarded by program directors to residents for anonymous completion on May 5 and closed on June 30, 2021. The outcome of interest was the mean examination score. Secondary areas of interest were performance by year of training and previous educational experience in transfusion reported by the trainees. Rasch analysis was performed on the examination quality and individual question performance. Kruskal-Wallis H tests were used to identify differences between mean scores. Post hoc comparisons were used to assess specific pairwise differences between mean test scores by survey variable.

RESULTS

Four hundred twenty-three anesthesiology residents in 37 programs completed the examination. The mean score was 45.5% ± 12.6%. There was a significant difference in mean cumulative examination scores between different resident training levels ( P < 0.001). There was a significant difference in scores between clinical anesthesia (CA)-1 and CA-2 residents ( P = 0.011) and CA-1 and CA-3 residents ( P = 0.012). No significant difference in examination scores was observed between CA-2 and CA-3 residents ( P = 0.95). All these subgroups scored below 50% on the examination. Significant differences between the residency training programs and cumulative scores were identified ( P < 0.001).

CONCLUSIONS

This examination highlights gaps in transfusion medicine knowledge within US anesthesiology residents. Targeted education may improve knowledge in this area and patient care.

Study on a job competence evaluation system for resident physicians (including integrated postgraduates) receiving standardized training

BACKGROUND

Standardized training for resident physicians is the primary form of postgraduate medical education, and it plays a pivotal role in healthcare safety and industry stability. Currently, it has garnered significant attention from healthcare institutions.

METHODS

By conducting a comprehensive literature review and a Delphi consultation in June 2022 for which 40 experts in clinical medicine, public health, and other related fields in China were invited. The indicators were adjusted according to the results of the consultation, and the final indicator weights were determined through an analytic hierarchy process.

RESULTS

The response rate was 100%, and the expert authority coefficient was 0.879. The consistency among the experts on the tertiary indicators, as measured by Kendall's W, was 0.675 (χ2 = 42.516, p < 0.001). Based on the results of the expert consultation, a job competence evaluation system for resident physicians (including integrated postgraduates) receiving standardized training was established, which included 6 primary indicators, 18 secondary indicators, and 116 tertiary indicators. The weights for the primary indicators, namely professional quality, skills and knowledge, patient care, communication and collaboration, teaching skills, and lifelong learning, were 0.313, 0.248, 0.181, 0.083, 0.066, and 0.110, respectively. The top three secondary indicators in terms of combined weights were clinical skills (0.122), professional ethics (0.120), and professional dedication (0.109). The three tertiary indicators with the highest scores were "maintains collaboration with peers and colleagues in patient treatment," "has clinical thinking skills, makes diagnosis and treatment decisions based on analysis of evidence, and has the ability to administer suitable treatments," and "abides by laws and discipline and refuses to seek personal gains in medical practice"; their combined weights were 0.035, 0.028, and 0.027, respectively.

CONCLUSION

This study has established a concrete, objective, and quantifiable competency assessment index system for standardized training of clinical resident physicians (including integrated postgraduates). This system provides a foundation for the quantitative evaluation of the competency of clinical resident physicians (including integrated postgraduates) undergoing standardized training.

Transfusion medicine curricular content for general pediatricians and pediatric subspecialists: A national multi-specialty Delphi consensus study

BACKGROUND

Although pediatric residents frequently order blood products, transfusion medicine (TM) education is both limited and unstandardized during postgraduate training. Using Delphi methodology, this study aimed to identify and prioritize which pediatric TM curricular topics are most important to inform postgraduate training in TM for general pediatricians and pediatric subspecialists.

METHODS

A national panel of experts iteratively rated potential curricular topics, on a 5-point scale, to determine their priority for inclusion within a TM curriculum. After each round, responses were analyzed. Topics receiving a mean rating <3/5 were removed from subsequent rounds and remaining topics were resent to the panel for further ratings until consensus was achieved, defined as Cronbach α ≥ 0.95. At conclusion of the Delphi process, topics rated ≥4/5 were considered core curricular topics, while topics rated ≥3 to <4 were considered extended topics.

RESULTS

Forty-five TM experts from 17 Canadian institutions and 12 subspecialties completed the first Delphi round and 31 completed the second. Fifty-seven potential curricular topics were generated from a systematic literature review and Delphi panelists. Two survey rounds were completed before consensus was achieved. Seventy-three topics in six domains reached consensus: 31 core curricular topics and 42 extended topics. There were no significant differences in ratings between TM and non-TM specialists.

DISCUSSION

A multispecialty Delphi panel reached consensus in identification of curricular topics for pediatric resident physicians. These results set the stage to develop a pediatric TM curriculum that will be foundational for pediatric trainees to enhance learning and improve transfusion safety.

Core competencies for a biomedical laboratory scientist - a Delphi study

BACKGROUND

After completing university education, biomedical laboratory scientists work in clinical laboratories, in biomedical research laboratories, in biotech, and in pharmaceutical companies. Laboratory diagnostics have undergone rapid development over the recent years, with the pace showing no signs of abatement. This rapid development challenges the competence of the staff and will most certainly influence the education of future staff. This study aimed to examine what was considered the necessary competencies needed to pursue a career as a biomedical laboratory scientist.

METHODS

A modified Delphi technique was used, with the panel of experts expressing their views in a series of three questionnaire. Consensus was defined as the point which 75 % or more of the panel participants agreed that a particular competency was necessary.

RESULTS

The study highlights the perceived importance of mostly generic competencies that relate to quality, quality assurance, and accuracy, as well as different aspects of safety, respect, trustworthiness (towards patients/clients and colleagues), and communication skills. The results also stress the significance of self-awareness and professionality.

CONCLUSIONS

We identified important competencies for biomedical laboratory scientists. Together with complementary information from other sources, i.e., guidelines, laws, and scientific publications, the competencies identified can be used as learning outcomes in a competency-based education to provide students with all the competencies needed to work as professional biomedical laboratory scientists.

Development and validation of the safe transfusion assessment tool

BACKGROUND

Given the prevalence and risks of blood transfusion, it is essential that trainees and practicing clinicians have a thorough understanding of relevant transfusion medicine competencies. The aim of this research was to develop and gather validity evidence for an instrument to assess knowledge of core transfusion-related competencies.

METHODS

We developed the safe transfusion assessment tool (STAT) using a multistep process. Initially, 20 core competencies in transfusion medicine were identified through a consensus-driven Delphi process. Learning objectives and assessment items pertinent to each competency were created. Next, a 13-item assessment tool was piloted with multidisciplinary experts and trainees. Multiple iterative revisions were made based on feedback. Finally, the 12-item STAT was administered to 100 participants of varying training level and specialty to establish validity, difficulty and item discrimination indices, and perceived utility.

RESULTS

Analysis of instrument item difficulty and item discrimination indices demonstrated the ability of the STAT to assess essential knowledge in transfusion medicine relevant to trainees and clinicians in multiple programs and practice settings. Eight of twelve items discriminated between learners with varying degrees of expertise. Hundred percent of students and trainees rated the STAT as Extremely Helpful or Somewhat Helpful and the majority planned to utilize the answer guide as a study aid.

CONCLUSION

The STAT is a concise, valid, and reliable knowledge assessment tool that may be used by researchers and educators to augment transfusion medicine curricula (www.safetransfusion.ucsf.edu). Scores can help inform departments on areas in which trainees require additional support and areas of potential educational interventions.