Construção e validação de um guia para o treinamento de habilidades clínicas

Abstract

Introduction: In 2001, the Ministry of Health (MS) and the Ministry of Education (MEC) created the National Curricular Guidelines for the Medical Course (DCN) to improve health education. This led to the implementation of active learning methodologies, which encourage students' active participation and the development of autonomy. In this context, the use of skills training as a teaching strategy in skill laboratories and clinical simulation provides students with the opportunity to make mistakes and learn from them, adjust patterns, and identify weaknesses, thereby contributing to safety and decision-making in proposed practices. Objective: To create and validate a guide for use in clinical skills training. Method: A methodological study consisting of four stages: definition of objectives, literature review, content development, and guide validation. The study was approved by the ethics committee and included 18 expert judges. Results: A guide was developed, structured into five dimensions: 1) Identification; 2) Characterization of competencies and skills; 3) Human and material resources; 4) Content; 5) Evaluation; and 6) Complementary information. The sample predominantly consisted of male experts aged 35-39 years. In terms of professional background, 44.4% (n=8) were nurses and 44.4% (n=8) were doctors. Most participants held specialist and master's degrees, with 50% (n=9) also having a PhD. In the analysis of indices related to "Identification," the representativeness of the items was high, with overall values of 0.90 for IVC and IVF, and 0.81 for CVC. Regarding importance, the items were evaluated as extremely relevant, with values of 0.95 for IVC and IVF and 0.85 for CVC. The clarity of the items was also well-rated, with values of 0.96 for IVC and IVF, and 0.87 for CVC. Reliability indices (ICC) ranged from 0.751 (good) to 0.856 (very good), indicating good to excellent consistency in the measurements. For the factor "Characterization of competencies and skills," the representativeness was also high, with values of 0.90 for IVC and IVF, and 0.85 for CVC. Importance was considered very high, with an overall value of 0.99, and the clarity of the items was rated 0.97, demonstrating high clarity. For the "Human and material resources" factor, representativeness was good, with values of 0.92 for IVC and IVF, and 0.83 for CVC. The representativeness for the "Content" factor was very good, with values of 0.96 for IVC and IVF, and 0.90 for CVC. Importance was also high, with values of 0.99 for IVC and IVF, and 0.93 for CVC. The internal reliability of the items was excellent, with an ICC of 0.945 and Cronbach's Alpha of 0.945. Data for the "Evaluation" factor showed good consistency in terms of representativeness, importance, clarity, and factor belonging. On the other hand, the items for the "Complementary information" factor showed significant inconsistencies. Representativeness was very low, with an ICC of 0.181 and Cronbach's Alpha of 0.176, suggesting that these items may not be adequately aligned with the proposed evaluation. Importance was also low (ICC = 0.386; Cronbach's Alpha = 0.376), though with slight improvement compared to representativeness. For clarity, the indices (ICC = 0.761; Cronbach's Alpha = 0.767) showed moderate consistency, while factor belonging showed good consistency (ICC = 0.790; Cronbach's Alpha = 0.790), indicating better alignment and adequacy of the items. These results suggest that the guide demonstrates high quality and reliability in the fundamental dimensions, although the "Complementary information" factor requires adjustments to improve its consistency and alignment with the training objectives. Conclusion: The validated guide meets the quality and standardization requirements for teaching medical skills, demonstrating high reliability and alignment with pedagogical objectives.