title: Internal medicine resident knowledge of transfusion medicine: results from the BEST-TEST international education needs assessment.
abstract: BACKGROUND
  Blood transfusion is the most common hospital procedure performed in the United States. While inadequate physician transfusion medicine knowledge may lead to inappropriate practice, such an educational deficit has not been investigated on an international scale using a validated assessment tool. Identifying specific deficiencies is critical for developing curricula to improve patient care.
  
  
  METHODS
  Rasch analysis, a method used in high-stakes testing, was used to validate an assessment tool consisting of a 23-question survey and a 20-question examination. The assessment tool was administered to internal medicine residents to determine prior training, attitudes, perceived ability, and actual knowledge related to transfusion medicine.
  
  
  RESULTS
  A total of 474 residents at 23 programs in nine countries completed the examination. The overall mean score of correct responses was 45.7% (site range, 32%-56%). The mean score for Postgraduate Year (PGY)1 (43.9%) was significantly lower than for PGY3 (47.1%) and PGY4 (50.6%) residents. Although 89% of residents had participated in obtaining informed consent from a patient for transfusion, residents scored poorly (<25% correct) on questions related to transfusion reactions. The majority of residents (65%) would find additional transfusion medicine training "very" or "extremely" helpful.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Haspel
authors.affiliation: Department of Clinical Pathology, Sunnybrook Health Sciences Centre, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Yulia
authors.initials: Y
authors.lastname: Lin
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Ranjeeta
authors.initials: R
authors.lastname: Mallick
authors.affiliation: Department of Medicine, Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Alan
authors.initials: A
authors.lastname: Tinmouth
authors.affiliation: Department of Hemotherapy and Hemostasis, University Clinic Hospital, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Cid
authors.affiliation: Institute of Clinical Hemostaseology and Transfusion Medicine, Saarland University Hospital, Homburg/Saar, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Eichler
authors.affiliation: Department of Hemotherapy and Hemostasis, University Clinic Hospital, Barcelona, Spain.
authors.forename: Miguel
authors.identifier: http://orcid.org/0000-0003-2593-833X
authors.initials: M
authors.lastname: Lozano
authors.affiliation: Center for Clinical Transfusion Research, Sanquin/LUMC, Leiden, the Netherlands.
authors.forename: Leo
authors.initials: L
authors.lastname: van de Watering
authors.affiliation: American Society for Clinical Pathology (ASCP), Chicago, Illinois.
authors.forename: Patrick B
authors.initials: PB
authors.lastname: Fisher
authors.affiliation: American Society for Clinical Pathology (ASCP), Chicago, Illinois.
authors.forename: Asma
authors.initials: A
authors.lastname: Ali
authors.affiliation: American Society for Clinical Pathology (ASCP), Chicago, Illinois.
authors.forename: Eric
authors.initials: E
authors.lastname: Parks
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D002170:Canada; D002983:Clinical Competence; D003479:Curriculum; D003625:Data Collection; D004521:Educational Measurement; D005060:Europe; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D020380:Needs Assessment; D010820:Physicians / Q000523:psychology*; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D064826:Transfusion Medicine / Q000193:education*; D065227:Transfusion Reaction; D014481:United States