Portfolio在全科医学住院医师培训中应用初探

Application of Portfolio in General Practice Residency Training

目的探索Portfolio在全科医学住院医师培训中的应用,促进住院医师反思性学习,帮助住院医师在实践中不断进步,实现培养目标要求。方法首先,通过问卷法和访谈法了解住院医师对Portfolio应用的看法。然后,在社区基地培训过程中,建立了住院医师Portfolio,并进行形成性评价。采用病历审阅方法评估接诊记录、居民健康档案、个人健康管理报告所体现的相关能力。采用迷你临床演练评估(mini-CEX)方法评价临床综合能力。结果通过建立Portfolio改革了培训和评价方式,引入了形成性评价。住院医师普遍认为Portfolio能有效地提高自主学习、终身学习和批判性思维能力,强化其全科医学临床思维能力和临床综合能力的培养。病历审阅结果显示随着培训过程的不断推进,评分均逐渐提高并达到合格标准。在社区实践基地培训开始和即将结束时两次mini-CEX评分比较,后者高于前者,差异有统计学意义(P<0.01)。结论在全科医学住院医师培训中开发并应用Portfolio有助于促进住院医师的学习、管理和评价,提高培训质量,具有可行性。但Portfolio的设计原则、内容和评价标准还有待于进一步完善,电子版Portfolio有待开发。

Objective To explore the application of Portfolio in general practice residency training,and establish a reflective learning system in order to help residents progress in practice and achieve the training objectives and requirement.Methods First,the questionnaire method and the interview method were used to understand the residents＇ views about a reflective Portfolio.Then,the residents＇ Portfolio was established and formative assessment was conducted during training process in the community teaching base.Medical records review was used to assess the related clinical competencies embodied by admission records,health records and personal health management reports.The mini-CEX method was used to evaluate comprehensive clinical competencies of general practice residents.Results The traditional training and assessing methods were reformed and a formative assessment method was conducted by the establishment of Portfolio.The general practice residents generally agreed that Portfolio could effectively improve the self-learning lifelong learning and critical thinking skills,and could train intensively clinical reasoning skills in general practice and comprehensive clinical competencies.The results of medical records review showed that,with the continuous progress of the training process,the scores of residents had a gradual increase trend and reached the eligibility criteria.The mini-CEX results showed that the scores of residents in the end of community training were higher than at the beginning（P 0.01）.Conclusion The application of Portfolio in general practice residency training could help to promote learning,management and evaluation of the residents and improve the quality of training,and it is feasible.However,the design principle,content and evaluation standard remain to be further improved and E-portfolio needs to be developed.