国家命题对全科医师住培结业临床实践能力考核质量提升的分析

赵文宣; 袁胜; 刘莎; 汤小燕; 金雅磊; 马春薇

doi:10.16766/j.cnki.issn.1674-4152.003534

国家命题对全科医师住培结业临床实践能力考核质量提升的分析

doi: 10.16766/j.cnki.issn.1674-4152.003534

武汉大学中南医院全科医学科，湖北武汉 430071

基金项目:

2022年度湖北省卫生健康委临床医学教育教学改革研究项目 HBJG-22D0006

2023年湖北省地方标准制定项目 T-Z-05-2023179

详细信息

通讯作者:
马春薇，E-mail: zn000183@whu.edu.cn

中图分类号: R192.3 R499
计量
- 文章访问数: 38
- HTML全文浏览量: 24
- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2023-10-23
- 网络出版日期: 2024-07-22

Analysis of the national proposition to promote the standardized training quality of general practice residents

Department of General Practice, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China

摘要

摘要: 目的 2023年在全科住院医师规范化培训结业临床实践能力考核中首次采取全国统一命题的考试方式，该命题方式对住院医师临床实践能力水平的考核效果如何，对于住培考核质量提升的影响如何，尚无研究。本文旨在比较国家命题与省级命题方式对全科住院医师规范化培训结业临床实践能力的评估效果，分析国家命题对考核质量提升的促进作用，提出可靠建议。方法收集2022年、2023年湖北省全科住院医师规范化培训结业临床实践能力考核成绩，对考试难度进行分析，并通过问卷收集考生及考官对不同命题方式的建议与反馈。结果 2023年(98.88%)与2022年(98.38%)考核通过率比较差异无统计学意义。2023年基本技能操作考站平均分(19.00±2.34)低于2022年(20.88±2.40)，2023年医患沟通考站平均分(11.78±1.44)低于2022年(13.20±1.09)，2023年总成绩平均分(79.24±6.75)低于2022年(81.86±7.29)，差异均有统计学意义(P＜0.001)。考生与考官对选择住培结业实践考核的组织形式均倾向于全国统一命题统一考核。2023年考题难度系数(0.79)较2022年(0.82)难。结论国家命题能促进全科住院医师规范化培训和考核质量的提升，更加符合目前的住培发展形势。
- 国家命题 /
- 省级命题 /
- 全科 /
- 住院医师规范化培训 /
- 客观结构化临床考核
Abstract: Objective In 2023, the national unified proposition was adopted in the assessment of clinical practice ability after standardized training for general practice residents. There is no research on the effect of this proposition on the assessment of the clinical practice ability level of residents and the impact on the improvement of the quality of resident training. This paper aims to compare the evaluation effect of the national proposition and provincial proposition method on the clinical practice ability of general practice residents in standardized training, analyze the promotion effect of the national proposition on the improvement of assessment quality, and put forward reliable suggestions. Methods The results of the clinical practice ability assessment of standardized training of general practice residents in Hubei Province in 2022 and 2023 were collected, the difficulty of the examination was analyzed, and the suggestions and feedback of candidates and examiners on different proposition methods were collected by questionnaires. Results There was no significant difference in the pass rate between 2023 (98.88%) and 2022 (98.38%). The average score of the basic skills operation test station in 2023 (19.00±2.34) was lower than that in 2022 (20.88±2.40), the average score of the doctor-patient communication test station in 2023 (11.78±1.44) was lower than that in 2022 (13.20±1.09), and the average score of the total score in 2023 (79.24±6.75) was lower than that in 2022 (81.86±7.29), all of which showed significant significance(P < 0.001). Candidates and examiners tend to choose the organizational form of the practical assessment of the national unified proposition assessment. The difficulty coefficient of the 2023 exam (0.79) was more difficult than that of 2022 (0.82). Conclusion The national proposition promotes the improvement of the standardized training and assessment quality of general practice residents, which is more in line with the current development situation of resident training.
- National proposition /
- Provincial propositions /
- General Practice /
- Standardized training for residents /
- Objective structured clinical examination

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表 1 不同年份考生基本情况比较[人数(%)]

Table 1. Comparison of the basic information of the residents[cases (%)]

年份	人数	性别		年龄组			培训基地
年份	人数	男性	女性	低年龄组	中年龄组	高年龄组	省会城市	非省会城市
2022	309	138(97.83)	171(98.83)	174(98.85)	93(100.00)	42(92.86)	151(99.34)	158(97.47)
2023	356	150(98.67)	206(99.03)	222(98.65)	94(98.94)	40(100.00)	192(99.48)	164(98.17)
χ²值		0.430		2.563			1.699
P值		0.512		0.278			0.192
注：低年龄组(24~28岁)、中年龄组(29~33岁)、高年龄组(≥34岁)。表格中数字代表人数(通过率)，通过率=(合格人数÷总人数)×100%。

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表 2 不同年份考生各考站成绩比较(x±s，分)

Table 2. Comparison of the test station results in different years(x±s, points)

年份	人数	基本技能操作	医患沟通	全科接诊	总成绩
2022	309	20.88±2.40	13.20±1.09	47.79±5.66	81.86±7.29
2023	356	19.00±2.34	11.78±1.44	48.46±5.06	79.24±6.75
t值		10.202	14.258	1.616	4.794
P值		＜0.001	＜0.001	0.107	＜0.001

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表 3 考生与考官选择不同考核形式的原因调查[人数(%)]

Table 3. Residents and examiners choose different forms of examination reasons investigation[cases (%)]

内容	国家命题	省级命题
选择住培结业实践考核的组织形式倾向
考生	194(75.19)	64(24.81)
考官	62(60.78)	40(39.22)
考生选择上述考核形式的原因
有利于自己准备考试	128(65.98)	34(53.13)
体现考试的公平性	124(63.92)	31(48.44)
促进不同地区住院医师规范化培训同质化发展	111(57.22)	47(73.44)
其他	5(2.57)	3(4.69)
考官选择上述考核形式的原因
有利于考生应考	38(61.29)	31(77.50)
有利于各地开展结业考核	33(53.23)	32(80.00)
更能体现结业考核的公平性	57(91.94)	22(55.00)
有利于体现不同地区考生的培训水平	38(61.29)	31(77.50)

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表 4 2022年省级命题和2023年国家命题OSCE各考站和总体难度分析

Table 4. 2022 provincial proposition and 2023 national proposition OSCE test station and overall difficulty analysis

考站	2022年			2023年
考站	平均分(x)	满分(w)	难度系数(P)	平均分(x)	满分(w)	难度系数(P)
基本技能操作	20.88	25	0.84	19.00	25	0.76
医患沟通	13.20	15	0.88	11.78	15	0.79
全科接诊	47.79	60	0.80	48.46	60	0.81
总体	81.86	100	0.82	79.24	100	0.79

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