小型临床演练评量在社区全科师资培训中的效果评价

Short-term training workshop of mini-clinical evaluation exercise for community general practitioner trainers

目的 通过对社区全科师资进行短期小型临床演练评量（mini-CEX）应用培训,了解在社区带教中开展mini-CEX的需求与可行性,探索mini-CEX在临床教学中的应用与推广.方法 2012年9月对36名社区全科师资进行为期半天的集中培训,培训前后采用问卷调查了解对mini-CEX认知情况及培训需求；通过对观察示范录像后的评分进行分析,评价培训效果.结果 培训前47％（17/36）的社区师资曾听到过mini-CEX并了解评分表；42％（15/36）了解mini-CEX的实施步骤但没有师资曾用过mini-CEX;全部师资均希望了解“如何实施mini-CEX”.培训后绝大多数师资对mini-CEX的7项考核标准及实施反馈达到完全理解或基本理解.对示范录像的评分显示,7项标准中仅1项的9分制正确率接近50％,5项的等级评分正确率在50％以上；两者比较有4项标准的正确率差异存在统计学意义（均P＜0.01）.结论 社区师资认同mini-CEX在住院医师临床能力评估方面的优势,有较强的使用意愿.短期集中培训具有一定效果,在此基础上还应进行评分者培训,并在实际应用中加强经验交流与反馈.

Objective To assess the effect of short-term training workshop of mini clinical evaluation exercise （mini-CEX） for community general practitioner （GP） trainers.Methods Thirty six community GP trainers received half-day training workshop of mini-CEX on September 2012.The GP trainers were interviewed with questionnaire before and after the training program and their video scores were analyzed.Results 47％ （17/36） of GP trainers knew of and briefly understood mini-CEX before the training.42％ （15/36） of them had a rough idea of how to use it but nobody had used it before.All of these trainers hoped to know how to carry out mini-CEX.The vast majority of GP trainers completely or basically understood the standards of evaluation for 7 items of mini-CEX after the training.The accurate rate of 1 iten was close to 50％ in 9-point scale and 5 items exceeded 50％ in 3-rank system.There was significant difference in accurate rates of 4 items between two scoring system （all P ＜ 0.01）.Conclusions Community GP trainers recognize the advantage of mini-CEX and have intention to apply it for evaluation of clinical skills in training.The results of short-term intensive workshop are satisfactory,but more training for rating system and practice are necessary.