Development and validation of the ACE tool: Assessing medical trainees' competency in evidence based medicine

BACKGROUND: While a variety of instruments have been developed to assess knowledge and skills in evidence based medicine (EBM), few assess all aspects of EBM - including knowledge, skills attitudes and behaviour - or have been psychometrically evaluated. The aim of this study was to develop and validate an instrument that evaluates medical trainees’ competency in EBM across knowledge, skills and attitude. METHODS: The ‘Assessing Competency in EBM’ (ACE) tool was developed by the authors, with content and face validity assessed by expert opinion. A cross-sectional sample of 342 medical trainees representing ‘novice’, ‘intermediate’ and ‘advanced’ EBM trainees were recruited to complete the ACE tool. Construct validity, item difficulty, internal reliability and item discrimination were analysed. RESULTS: We recruited 98 EBM-novice, 108 EBM-intermediate and 136 EBM-advanced participants. A statistically significant difference in the total ACE score was observed and corresponded to the level of training: on a 0-15-point test, the mean ACE scores were 8.6 for EBM-novice; 9.5 for EBM-intermediate; and 10.4 for EBM-advanced (p < 0.0001). Individual item discrimination was excellent (Item Discrimination Index ranging from 0.37 to 0.84), with internal reliability consistent across all but three items (Item Total Correlations were all positive ranging from 0.14 to 0.20). CONCLUSION: The 15-item ACE tool is a reliable and valid instrument to assess medical trainees’ competency in EBM. The ACE tool provides a novel assessment that measures user performance across the four main steps of EBM. To provide a complete suite of instruments to assess EBM competency across various patient scenarios, future refinement of the ACE instrument should include further scenarios across harm, diagnosis and prognosis

Long-term variability of the optical spectra of NGC 4151: II. Evolution of the broad Ha and Hb emission-line profiles

Results of the long-term (11 years, from 1996 to 2006) H$\alpha$ and H$\beta$ line variations of the active galactic nucleus of NGC 4151 are presented. High quality spectra (S/N>50 and R~8A) of H$\alpha$ and H$\beta$ were investigated. We analyzed line profile variations during monitoring period. Comparing the line profiles of H$\alpha$ and H$\beta$, we studied different details (bumps, absorption features) in the line profiles. The variations of the different H$\alpha$ and H$\beta$ line profile segments have been investigated. Also, we analyzed the Balmer decrement for whole line and for line segments. We found that the line profiles were strongly changing during the monitoring period, showing blue and red asymmetries. This indicates a complex BLR geometry of NGC 4151 with, at least, three kinematically distinct regions: one that contributes to the blue line wing, one to the line core and one to the red line wing. Such variation can be caused by an accelerating outflow starting very close to the black hole, where the red part may come from the region {closer to the black hole than the blue part, which is coming} from the region having the highest outflow velocities. Taking into account the fact that the BLR of NGC 4151 has a complex geometry (probably affected by an outflow) and that a portion of the broad line emission seems to have not a pure photoionization origin, one can ask the question whether the study of the BLR by reverberation mapping may be valid in the case of this galaxy.Comment: 24 pages, 18 figures, accepted for publications in A&