迷你临床演练评估视频工作室培训方式对观察者评分变异的影响

Effect of mini-CEX video workshop training on the evaluation variation of trainee

目的 目前国内外将迷你临床演练评估（mini-CEX）广泛使用于医学生临床技能学习的过程评估之中.这一评价方法基于学生的实际表现,其评估和反馈为一对一形式,观察者多由高年资医师承担.由于不同的观察者之间认知和水平的差异,观察者之间的评分一致性是目前mini-cex考核亟需解决的问题.方法 本文通过使用目前mini-cex常用的视频工作室培训方式,观察了标准考核录像培训对于初次接触mini-cex考核方式的临床医师评分一致性的影响.使用目前通行的视频工作室方式培训初次接触mini-cex考核医师共22人,均为任主治医师3年以上临床医师.评分结果使用秩和检验.结果 经过2次标准考核录像培训,观察者对于mini-cex量表相对客观项目“医学面谈技巧”项目评分一致性有显著改善,P=0.003,“体格检查技巧”评分一致性有所改善,但无显著性（P=0.069）.而相对主观项目（人道关怀/临床判断/组织能力/总体临床能力）评分一致性则无显著影响.结论 初次接触mini-CEX考核方式的观察者通过2轮次视频工作室培训后,对于客观评价项目一致性有显著影响,但对于主观评价项目评分一致性没有影响.需要进一步研究以提高评价一致性.

Aim Mini-CEX is used in the evaluation process of medical students＇ clinical training.This evaluation method is workplace-based direct assessments of students＇ performance.The observers of mini-cex are usually senior physicians.How to minimize inter-accessor scoring variation is crucial in the practice of mini-CEX.Method by using video-workshop training model,the inter-accessor scoring variations between first-contact trainees were accessed.Data were analyzed with rank-sum test.Results 22 first-contact physicians （with ＞ 3 years＇ experience of attendant doctor） underwent standard videoworkshop mini-CEX training program.After 2 rounds of video demonstration,significant difference in scoring variation was found in objective item as ＂Medical interviewing skills＂,P=0.003.An insignificant increase in physical examination skills was also noticed （P=0.069）.No significant differences were found in other subjective scoring items （professional/clinical judgment/organization/overall clinical skills）.Conclusion video-work shop training with 2 round of standard video demo could reduce the inter-accessor variation in objective scoring item,but had no significant effects on the subjective scoring items.