客观结构化临床考试考站设置的改进

Preliminary application of the revised objective structure clinical examination stations

目的探讨改良的客观结构化临床考试（objective structure clinical examination,OSCE）考站设置的可行性及效果。方法选择上海交通大学新华临床医学院2008、2009级临床医学系106名学生为考试对象。分成2组，实验组32名采用改良的OSCE考试；对照组74名采用传统OSCE考试。改良的OSCE考试是在原有OSCE考站设置基础上，对操作部分的考站进行改进，均采用临床病例为题干，要求学生根据题干得出可能的诊断，并进行相应操作。教学结束后，根据两组学生参加上海交通大学医学院OSCE考试的成绩，以及实验组参加全国高等医学院校大学生临床技能大赛情况评估教学结果。相关数据采用独立样本t检验。结果实验组学生认同新的考站设置更贴近临床。实验组学生OSCE考试成绩优于对照组学生，但两组比较差异无统计学意义。实验组32名大学生的测试平均分为（80．50±15．45），而对照组学生的测试平均分为（78．30±17．68）。新的OSCE考站设置有利于学生进行技能大赛培训，新华临床医学院学生连续2年在上海交通大学医学院临床技能大赛中夺冠。结论以案例为基础的OSCE考站设置，更贴近临床教学，更能客观地评价学生临床能力，对医学生综合能力培养具有一定积极作用。

Objective To explore the feasibility and effectiveness of the revised OSCE stations. Methods 106 sstudents of grade 2008 and 2009 from Xinhua clinical medical school of Shanghai Jiaotong University School of Medicine were involved, 32 of whom （experimental group） tool modified OSCE examination and 74 of whom （control group） tool traditional OSCE examination. The revised OSCE exam was the one which on the basis of original OSCE test station setup, improved the operating part of the test stand, adopted clinical cases as stem, asked the students to make possible diagnosis, and perform the corresponding operation. We evaluated the students based on the OSCE scores from the school exam and the overall performances in the national clinical skills competition.Comparison between the two groups was performed by using t test. Results All students who have received the new training methods agreed that it stood closer to the clinical setting. Revised-OSCE trained group of students test scores than traditional OSCE trained group of students,though it didn＇t have statistical significance. Students from the revised-OSCE group had the score of （80.50± 15.45）, while the traditional group had the score of （78.30 ± 17.68）. By taking the revised-OSCE trainings, all the students have improved their clinical skills and two years in a row to win the Shanghai Jiaotong University School of Medicine Clinical Skills Competition. Conclusions Case-based OSCE stations are well accepted. The new OSCE stations are much closer to clinical teaching and can make better objective assessment of students, so it plays a good role in improving medical students＇ overall performances.