客观结构化临床考试在第一年外科住院医师规范化培训中的持续改进研究

Research on continuous improvement of objective structured clinical examination in standardized training of postgraduate year 1 surgery residents

目的动态评价北京大学第一医院外科学校第一年外科住院医师规范化培训的效果，并评价改进以后的客观结构化临床考试（objective structured clinical examination，OSCE）的效能和合理性。方法根据2015年度OSCE考核结果改进2016年度OSCE考站设计及内容。采用SPSS22．0软件测算各考站的难度、区分度、信度，考站间进行相关性分析。比较2015年度和2016年度住院医师OSCE考核结果。结果2016年度住院医师OSCE考核平均成绩为（72．98±4．93）分；本次OSCE考核整体难度为0．730，整体区分度为0．683，整体信度为0．453。第四站和第五站难度中等，第一站、第二站和第六站难度较小；各站的区分度均大于0．400；第六站信度偏低；第一站与第六站间，第二站与第四站间，第二站与第六站间存在中等程度相关，其余各站间无明显相关性。2016年度腹腔镜模拟器基础技能考核成绩明显低于2015年度，但信度明显提高；2016年度不规则创面清创缝合术成绩明显高于2015年度。结论通过持续改进的OSCE考核，能够有效地评价北京大学第一医院外科学校第一年外科住院医师规范化培训效果，循序渐进地提高培训效果。

Objective To evaluate dynamically the outcome of the standardized training of postgraduate year 1 surgery residents at surgical school. To investigate the effectiveness and rationality of the improved objective structured clinical examination （OSCE）. Methods According to the results of OSCE in 2015, the design and content of OSCE＇ s stations were improved in 2016. The difficulty, discrimination and reliability of each station were calculated, and the correlation between each station was analyzed by SPSS 22.0. In addition, the results of OSCE＇ s in 2016 were compared to that in 2015. Results The average OSCE score was （72. 98 ± 4. 93）. The difficulty of total stations was 0. 730. The distinction was 0. 683 and the reliability was 0. 453. The first, second and sixth station were lowest difficulty, and the fourth and fifth station was moderate difficulty. Each station＇ s discrimination was more than 0. 400. The reliability of the sixth station was low. There were moderate correlation between the first station and the sixth station, the second station and the fourth station, as well as the second station and the sixth station. But there was no significant correlation between other stations. The scores of laparoscopic simulator basic skills in 2016 were significantly lower than that in 2015, but the station＇ s reliability was higher in 2016. The scores of irregular wound debridement and suture in 2016 were significant higher than that in 2015. Conclusions Through the continuous improvement of OSCE, surgical school evaluates effectively the outcome of the standardized training of postgraduate year 1 surgery residents and improve the training effect step by step.