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      The dialysis orders objective structured clinical examination (OSCE): a formative assessment for nephrology fellows

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          Abstract

          Background

          Few quantitative nephrology-specific simulations assess fellow competency. We describe the development and initial validation of a formative objective structured clinical examination (OSCE) assessing fellow competence in ordering acute dialysis.

          Methods

          The three test scenarios were acute continuous renal replacement therapy, chronic dialysis initiation in moderate uremia and acute dialysis in end-stage renal disease-associated hyperkalemia. The test committee included five academic nephrologists and four clinically practicing nephrologists outside of academia. There were 49 test items (58 points). A passing score was 46/58 points. No item had median relevance less than ‘important’. The content validity index was 0.91. Ninety-five percent of positive-point items were easy–medium difficulty. Preliminary validation was by 10 board-certified volunteers, not test committee members, a median of 3.5 years from graduation. The mean score was 49 [95% confidence interval (CI) 46–51], κ = 0.68 (95% CI 0.59–0.77), Cronbach’s α = 0.84.

          Results

          We subsequently administered the test to 25 fellows. The mean score was 44 (95% CI 43–45); 36% passed the test. Fellows scored significantly less than validators (P < 0.001). Of evidence-based questions, 72% were answered correctly by validators and 54% by fellows (P = 0.018). Fellows and validators scored least well on the acute hyperkalemia question. In self-assessing proficiency, 71% of fellows surveyed agreed or strongly agreed that the OSCE was useful.

          Conclusions

          The OSCE may be used to formatively assess fellow proficiency in three common areas of acute dialysis practice. Further validation studies are in progress.

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          Most cited references 13

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          Construct validity in psychological tests.

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            Recalculation of the Critical Values for Lawshe's Content Validity Ratio

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              Modifiable practices associated with sudden death among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study.

              Sudden death is common in hemodialysis patients, but whether modifiable practices affect the risk of sudden death remains unclear.
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                Author and article information

                Journal
                Clin Kidney J
                Clin Kidney J
                ckj
                Clinical Kidney Journal
                Oxford University Press
                2048-8505
                2048-8513
                April 2018
                23 August 2017
                : 11
                : 2
                : 149-155
                Affiliations
                [1 ]Nephrology Division, Walter Reed National Military Medical Center, Bethesda, MD, USA
                [2 ]Nephrology Division, Medical University of South Carolina, Charleston, SC, USA
                [3 ]Nephrology Division, Portsmouth Naval Medical Center, Portsmouth, VA, USA
                [4 ]Department of Renal Diseases and Hypertension, University of Colorado, Denver, CO, USA
                [5 ]Department of Internal Medicine, Baptist Memorial Hospital, Golden Triangle, Columbus, MS, USA
                [6 ]Nephrology Associates, Fairfax, VA, USA
                [7 ]Nephrology Division, University of Wisconsin, Madison, WI, USA
                [8 ]Nephrology Associates, Mercy Regional Medical Center, Durango, CO, USA
                Author notes
                Correspondence and offprint requests to: Christina M. Yuan; E-mail: christina.m.yuan.civ@ 123456mail.mil
                Article
                sfx082
                10.1093/ckj/sfx082
                5887504
                Published by Oxford University Press on behalf of ERA EDTA, 2017.

                This work is written by US Government employees and is in the public domain in the US.

                Page count
                Pages: 7
                Product
                Categories
                Education

                Nephrology

                objective structured clinical examination, dialysis, nephrology, fellowship, education, testing

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