Internationally, internal medicine residents have poor transfusion medicine knowledge and would welcome additional training. The especially limited knowledge of transfusion reactions suggests an initial area for focused training. This study not only represents the largest international assessment of transfusion medicine knowledge, but also serves as a model for rigorous, collaborative research in medical education.

BACKGROUND:There is evidence that physicians lack adequate transfusion medicine knowledge. To design needs-based educational interventions to address this gap, a validated assessment tool is required. Previously published exams have not been created or validated using rigorous psychometric methods. STUDY DESIGN AND METHODS:A modified Delphi method was used to achieve consensus regarding the essential knowledge and skills for physicians who transfuse blood products. To ensure content validity, members of an international organization of transfusion medicine experts (Biomedical Excellence for Safer Transfusion [BEST] Collaborative) participated in the exam design process. An exam, based on the most highly rated topics, was created and administered to individuals with a priori expected basic, intermediate, and expert levels of transfusion medicine knowledge. Rasch analysis, a psychometric technique used in highstakes medical licensure and board testing, was used to determine exam accuracy and precision. RESULTS: Thirty-six topics achieved ratings sufficient to be considered for inclusion in the exam (content validity index > 0.8). A 23-question exam was administered to 49 individuals. Mean scores for individuals with expected basic, intermediate, and expert knowledge were 42, 62, and 82%, respectively (p < 0.0001). The exam achieved good fit with the Rasch model. CONCLUSION: A validated exam has now been created to accurately assess transfusion medicine knowledge. This exam can be used to determine knowledge deficits and assist in the design of curricula to improve blood product utilization.A number of studies have shown a high rate of inappropriate blood product use.1-3 These findings are likely in part due to inadequate knowledge of transfusion medicine. 4 While medical schools have transfusion medicine curricula, the amount of time spent teaching this material can vary greatly. 5,6 In one study from the United States, while 83% of the 86 surveyed administrators reported that their school had transfusion medicine lectures, almost half of this teaching amounted to only 1 or 2 hours.5 Only 29% reported small group sessions related to transfusion medicine. In addition, there are no published data that have determined the efficacy of these different curricula.A validated transfusion medicine exam would enable a better assessment of educational methods, trainee knowledge, and areas for improvement. While transfusion medicine exams have been published, they were not designed or validated using accepted psychometric techniques. [7][8][9][10] As noted in an editorial on the development of one of the more recent of these exams, "several critical points about the experimental design and conduct of the study raise questions about the quality of the results and/or data and whether all conclusions and recommendations are truly warranted."11 In this study, we used MATERIALS AND METHODS Identifying topics for the examExam content was determined using a modified Delphi method that is a structured approach for achieving consensu...

It is our recommendation that (1) every training program develop a formal educational strategy for management training, (2) greater opportunity and visibility be afforded for peer-reviewed publications on management topics in mainstream pathology literature, and (3) pathology milestones-oriented tools be developed to assist program directors and their trainees in developing this necessary knowledge and skills.