探讨妇产科住院医师模拟分段诊断性刮宫术技能培训与考核评分表的设计

Designing a simulative Dilation & Curettage procedure and an assessment scoring form for obstetrics and gynecology residents

探讨分段诊断性刮宫术(分段诊刮术)手术模型和考核评分系统在妇产科住院医师临床技能培训中的作用。选取2015年1月至2017年9月在北京大学人民医院妇产科住院医师培训基地轮转的43名住院医师,分别进行出科考核和年度考核60人次。考试中,要求住院医师根据所给病例,在女性骨盆模型上完成分段诊刮术,并表述相应的术前、术中和术后处理。考试评分表中包含与手术相关的10个项目,分别为术前3项、术中2项、术后5项。统计各项得分,评出优良、及格、不及格3个级别,以综合判断住院医师对手术的掌握情况。对考试不及格者要求训练后重新考试,直至及格。在各项评分中,无菌操作和病历记录2项不及格比例较高,分别为33.3%和68.3%。另外,在术前准备和知情同意项目中也各有18.3%不及格,其余各项不及格比率<10.0%。具体分析评分表中各个考核项目,找出完成分段诊刮术过程中的不足之处,以增强技能培训中的针对性。模拟分段诊刮术及考核评分系统是检验住院医师对手术掌握情况的一种方法,量化分析手术完成情况对加强住院医师基本手术技能培训和临床思维的培养有积极作用。

This study aims to explore the role of surgical model and assessment scoring system of segmental diagnostic curettage（Dilatation and Curettage, D＆C） in clinical skills training for obstetrics and gynecology residents. At the clinical training center of Peking University People’s Hospital, 43 residents working at the Department of Obstetrics and Gynecology participated in specialty and annual examinations for 60 person-time in total. During the exams, residents were required to perform the D＆C on the female pelvic model and present the corresponding preoperative, intraoperative and postoperative treatments according to a given case with abnormal uterine bleeding. The designed assessment scoring form included 10 items related to the surgery, which were 3 preoperative items, 2 intraoperative items and 5 postoperative items, respectively. Each item was stratified as excellence, pass, and fail in order to comprehensively assess the mastery D＆C procedure of residents. As for the residents who failed the examination, they were required to practice the procedure again until they passed the examination. After analyzing data of all assessment scores, we found that fail rates on two items, sterile working and medical recording, were comparatively high, reaching 33.3% and 68.3%, respectively. In addition, there was a fail rate of 18.3% on items of pre-operation preparation and informed consent. The fail rates of other items were lower than 10.0%. After analyzing the failed items and finding deficiencies on the clinical skills training program, we aim to develop targeted clinical skill training in the future. Simulation of D＆C procedure and the assessment scoring system is a method to evaluate the mastery of this procedure skill for residents, which has a positive effect on strengthening the basic surgical skills and clinical thinking training.