外科专业学位硕士研究生和北京市外科住院医师临床技能考核的对比分析

Analysis of clinical competence assessment in the graduation examination for surgical professional degree postgraduates and surgical residents in Beijing

目的：探讨外科专业学位硕士研究生结业临床技能考核方案和存在的问题。方法收集2013年首都医科大学临床外科专业硕士研究生结业临床技能考核方案、成绩及总结报告和2013年北京市外科住院医师临床技能考核方案、成绩及总结报告。采用SPSS 11.5，对两者相同考核项目的成绩及考核通过率分别行t检验和卡方检验。结果2013年，接受首都医科大学外科学临床技能考核的硕士研究生为118人，接受北京市住院医师临床技能考核人员为274人。两者的考核方案存在明显差异，表现为组织机构和考核所涵盖的内容不同。外科专业学位硕士研究生临床技能考核内容缺少沟通能力、辅助检查阅读与分析等；两者在相同项目上也存在细化程度和要求的差异。研究生的病例分析项目得分高于住院医师[（84.60±11.47） vs.（82.18±10.18），P=0.039]；而外科基本操作项目得分低于住院医师[（78.2±14.02） vs.（90.50±6.34），P=0.000]。此外，在病历书写、病例分析、外科操作项目通过率（≥70分）方面，两类人员差异有统计学意义（P＜0.05）。结论外科专业学位硕士研究生临床技能考核方案需与住院医师培训目标相适应，增加沟通能力、实验室检查及影像检查判读的内容；除采用过程评估外，可将多站式客观结构化临床技能考核（objective structured clinical examination，OSCE）作为结业考核形式。

Objective To investigate clinical competence assessment in the graduation examination for surgical professional degree postgraduates and surgical residents in Beijing. Methods Data of clinical competence assessment of graduation examination for surgical postgraduates from Capital Medical University （CMU） and residents from Beijing surgical residency training programs in 2013 were summarized and ana-lyzed. SPSS 11.5 software was used to do t test and chi square test to the corresponding data line. Results There were 118 surgical postgraduates in clinical medicine from CMU and 274 residents from Beijing surgi-cal residency training programs, who attended final clinical competence assessment. There were significant differences between the postgraduate and resident clinical competence assessment system. The differences included their organization in charge of examination and the contents of assessment system. The assessment system of clinical competence for the surgical postgraduates did not involved communication skills, reading and analysis of laboratory tests and imaging investigation. The score of case analysis in the postgraduate group was higher than that in the resident group [（84.6±1.1） vs. （82.2±10.2）, P=0.039], however the score of surgical skill assessment in postgraduate group was significantly lower than that of the resident group [（78.2 ±14.0） vs. （90.5 ±6.3）, P=0.000]. In addition, the rate in the score being higher or equal to 70 of case note, case analysis and surgical skill assessment between postgraduates and residents was significantly different （P〈0.05）. Conclusion Clinical competence assessment system for the surgical postgraduates should be adapted to their training goal. In addition to the process assessment, the objective structured clinical skills examination （OSCE） can be as a reasonable postgraduate graduation examination mode.