Brazilian Version of the ACE (Assessing Competencies in Evidence-Based Medicine) Tool: a Validation Study

Maia, Ferdinand Gilbert Saraiva da Silva; Souza, Ana Karenina Carvalho de; Simas, Breno Carvalho Cirne de; Lopes, Isadora Soares; Bezerra, Maria Paula Ribeiro Dantas; Diniz, Rosiane Viana Zuza

doi:10.1590/1981-5271v46.3-20220081.ING

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Revista Brasileira de Educação Médica

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ORIGINAL ARTICLE • Rev. bras. educ. med. 46 (03) • 2022 • https://doi.org/10.1590/1981-5271v46.3-20220081.ING copy

Brazilian Version of the ACE (Assessing Competencies in Evidence-Based Medicine) Tool: a Validation Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Introduction:

The ACE (Assessing Competencies in Evidence-Based Medicine) Tool is a recently developed questionnaire to assess competencies in Evidence-Based Medicine. The aim of this study is to validate the Brazilian version of ACE Tool.

Methods:

This is a cross-sectional validation study carried out in two phases. In the first phase, the questionnaire was translated. In the second phase, the questionnaire was applied to undergraduate students and teachers/preceptors of the medical course. The evaluated properties were internal validity, consistency and reliability.

Results:

76 medical undergraduate students and 12 teachers/preceptors were included. The mean of teachers/preceptors was significantly higher than that of students (10.25±1.71 vs 8.73±1.80, mean difference of 1.52, 95%CI 0.47-2.57, p=0.005), demonstrating construct validity. The Brazilian version of the ACE Tool obtained adequate internal consistency (Cronbach’s alpha = 0.61) and reliability (item-total correlation ≥ 0.15 in 14 of the 15 items).

Conclusion:

The Brazilian version of the ACE Tool shows acceptable psychometric properties and can be used as an instrument to assess competencies for Evidence-Based Medicine in Brazilian medical students.

Key words:
Medical Education; Validation Study; Evidence-Based Medicine

Fazendo uma pergunta passível de resposta	Sim	Não
1. Todos os elementos PICO estão descritos no cenário do paciente?
2. A questão construída após o cenário produz uma pergunta objetiva e direcionada?
Buscando na literatura
3. A estratégia de busca (a ser utilizada no Medline) encontrará estudos relevantes relacionados à pergunta?
4. A estratégia de pesquisa utiliza descritores em saúde (MeSH/DeCS), palavras-chave e operadores booleanos de forma co/rreta e efetiva?
Avaliando a evidência
5. Há informações suficientes para determinar a representatividade dos pacientes do estudo?
6. O método de alocação dos participantes para a intervenção/exposição e a comparação foi adequado?
7. Alguma forma de ajuste foi necessária?
8. Todos os participantes estavam cegos para o tratamento/exposição?
9. Todos os pesquisadores estavam cegos para o tratamento/exposição?
10. Todos os avaliadores dos desfechos estavam cegos para o tratamento/exposição?
11. Todos os pacientes foram analisados nos grupos para os quais foram randomizados?
Aplicando a evidência
12. O paciente do cenário compartilha características/circunstâncias semelhantes às dos participantes no estudo?
13. O tratamento/terapia é factível no contexto do cenário clínico proposto?
14. Todos os desfechos relevantes foram considerados?
15. Os benefícios do tratamento/terapia superam os potenciais danos e custos?

Item	Step	Difficulty index	Item-total correlation
1	Clinical question	63%	0.28
2	Clinical question	28.4%	0.15
3	Research in literature	77.3%	0.36
4	Research in literature	62.5%	0.18
5	Critical analysis	67%	0.36
6	Critical analysis	15.9%	0.28
7	Critical analysis	51.1%	-0.03
8	Critical analysis	97.7%	0.23
9	Critical analysis	80.7%	0.33
10	Critical analysis	67%	0.20
11	Critical analysis	30.7%	0.16
12	Integration	86.4%	0.21
13	Integration	69.3%	0.29
14	Integration	55.7%	0.36
15	Integration	44.3%	0.27

Property	Test Used	Acceptable Results	Translated version performance
Content Validity	Expert’s opinion	Assesses steps 1-4 of evidence-based practice	Acceptable
Index of Item Difficulty	Percentage of correct answers	Wide range allows implementation in different groups of participants	Ranged from 15.9% to 99.7%
Internal Consistency	Cronbach's alpha	A Cronbach’s alpha of 0.6-0.7 is considered acceptable; 0.7-0.9 is considered good and >0.9 is considered excellent	Cronbach’s alpha of 0.61
Internal Reliability	Item-Total Correlation (CIT)	CIT ≥ 0.15 is considered acceptable	≥ 0.15 for all items except item 7 (-0.03)
Construct validity	Comparison between means of groups with different levels of knowledge	Significant difference between teachers/preceptors and students	On a 15-point scale, the students’ mean was 8.73 and the teachers' mean was 10.25 (p=0.005)

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[1] Chief Editor: Daniela Chiesa. Associate editor: Not assigned.

Ask	Understand the clinical setting and develop a structured question that can be answered.
Search	Build an appropriate search syntax, with descriptors and Boolean operators and identify the appropriate databases.
Appraise	Critically assess the methodology and results of an article, regarding its internal and external validity.
Integrate	Integrate the results of critically evaluated research into the care of a specific patient.
Evaluate	Evaluate changes in one’s current medical practice and identify opportunities for improvement.