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Design and validation of an assessment tool that measures CA1s' knowledge about general anesthesia for urgent cesarean delivery
Abstract Number: F-35
Abstract Type: Original Research
Teaching novice residents (CA1) the knowledge and skills to perform general anesthesia (GA) for cesarean delivery (CD) requires innovative strategies, as they may never manage such cases in training. As part of a teaching program involving a serious game (SG), we used a multistage design process to create a multiple-choice test as an assessment tool to evaluate CA1’s knowledge related to this scenario at baseline, after SG training, and 3-6 months after training.
First, 3 faculty members created 33 questions (each stem with 1 correct answer and 3 distractors), categorized as: (1) physiologic changes of pregnancy (PCP), (2) pharmacology (PHA), (3) anesthetic implications of pregnancy (AIP), and (4) crisis resource management principles (CRM), based on a validated task list.(1)
A Delphi process (3 rounds) provided content validation. In round 1, experts (N=15 members of SOAP) anonymously rated the questions on a 7-point Likert scale (1 = “I feel this is not important at all”, and 7 = “I feel this is extremely important”). Questions ranked 5 in importance by 70% of experts were retained; 5 questions were eliminated, several were revised and 1 added. In round 2 (N=14), consensus on 29 items was defined as a change of ≤10% in mean priority score for each item and a change of ≤ 5% in the average of absolute-value % changes in individual mean priority scores across all items. Consensus was reached in all except 8 questions. In round 3 (N=14), consensus was reached for 7 of these 8 questions; the underperforming question was kept as a provisional item during pilot testing.
Last, a pilot test evaluating internal consistency, reliability, and convergent validity was conducted with the July 2016 CA1 class (N=26) at another institution, CA2’s (N=17) and attendings (N=10).
Results: Good internal consistency and reliability was demonstrated (α =0.76). Convergent validity coefficients suggested theoretical meaningfulness of the 4 sub-scales: PCP correlated at .65 with PHA, .47 with CRM, and .32 with AIP. PHA correlated with CRM and AIP at .55 and .43, respectively. The correlation between CRM and AIP was .28. The same question underperformed but will be retained as provisional item.
Preliminary evidence indicates the test produces reliable scores to assess CA1’s knowledge related to conduct of GA for emergent CD. Further reliability assessment will be conducted with ongoing use of the tool.
1. Anesthesiology 2006;105:260-6.