Application of objective structured clinical examination in annual assessment of standardised training for residents
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摘要:
目的 通过开展对客观结构化临床考试(objective structured clinical examination, OSCE)在住院医师规范化培训年度考核中应用的研究，指导今后OSCE的试题设置，使试题更规范、合理。 方法 选取参加2020年蚌埠医学院第一附属医院住院医师规范化培训年度考核的内科专业学员2018级62人、2019级64人的考核成绩为研究对象，分别分析OSCE设置的信度、效度、难度、区分度，并比较2个年级学员各站考试分数，讨论OSCE试题设置的合理程度及培训时间对成绩的影响。 结果 OSCE设置的信度选择评价者信度进行分析，结果良好；效度使用内容效度进行评价，效度较高；OSCE试题对于2018级学员的难度在0.55~0.78、总难度为0.72，对于2019级学员的难度在0.49~0.79、总难度为0.67，2个年级的单站难度、总体难度基本达到适宜标准；OSCE试题对于2018级学员的区分度为0.18，对于2019级学员的区分度为0.19，稍嫌不足；比较2个年级学员各站考试分数，2018级学员有5站(共6站)成绩高于2019级学员，差异有统计学意义(P < 0.001)。 结论 本次OSCE考站设置较为合理，可以客观反映学员的培训水平及临床实践能力，考核区分度有上升空间，培训时间与成绩呈正相关。 Abstract:Objective To guide the examination question setting of Objective Structured Clinical Examination (OSCE) in the future and make the examination questions more standardised and reasonable through research on the application of OSCE in the annual assessment of standardised training for residents. Methods The assessment results of 62 internal medicine students in 2018 and 64 in 2019 who participated in the annual assessment of standardized training for residents in the First Affiliated Hospital of Bengbu Medical College in 2020 were selected as the research object. The reliability, validity, difficulty, degree of differentiation of OSCE were respectively analysed. The test scores of students of two grades at each station were compared. The reasonable degree of OSCE test question setting and the impact of training time on their scores were discussed. Results The OSCE reliability selection evaluator was analysed, and the results were good. Validity was evaluated by content validity, which was relatively high. The OSCE tests ranged from 0.55 to 0.78 with a total difficulty of 0.72 for 2018 students, and from 0.49 to 0.79 with a total difficulty of 0.67 for 2019 students. The single-station difficulty and overall difficulty of the two grades basically reached the appropriate standard. The distinction of the OSCE question for the class of 2018 was 0.18, and the distinction for the class of 2019 was 0.19, which was insufficient. By comparing the test scores of students in each station of both grades, there were five stations (a total of six stations) of students in the class of 2018 whose scores were higher than those of students in the class of 2019, and the difference was statistically significant (P < 0.001). Conclusion The OSCE examination station is set reasonably, which can objectively reflect the training level and clinical practice ability of the students, and there is room for improvement in the assessment differentiation. The training time is positively correlated with the results. -
表 1 OSCE内科学专业单站及总体难度统计
站别 2018级 2019级 平均分 单站满分 难度 平均分 单站满分 难度 影像判读 15.0 20 0.75 13.5 20 0.67 体格检查 15.3 20 0.76 14.2 20 0.71 技能操作 15.7 20 0.78 13.9 20 0.69 心肺复苏 11.2 15 0.74 11.8 15 0.79 病史采集 15.2 20 0.76 13.2 20 0.66 病例分析 11.0 20 0.55 9.9 20 0.49 总体难度 0.72 0.67 
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表 2 OCSE内科学专业试题区分度
年级 XH(27%高分组平均分) XL(27%低分组平均分) W(试卷总分) 区分度 2018级 88.19 77.76 115 0.18 2019级 81.24 71.56 115 0.17
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表 3 2018、2019级住培学员考核分数情况(x ±s，分)
年级 人数 影像判读 体格检查 技能操作 心肺复苏 病史采集 病例分析 2018级 62 14.98±1.65 15.27±1.58 15.66±1.69 11.17±1.07 15.16±0.92 11.00±2.16 2019级 64 13.39±2.13 14.12±1.98 13.79±1.43 11.80±0.78 13.21±1.19 9.84±1.67 t值 5.812 4.123 8.651 -4.286 10.963 3.492 P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 0.001
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