住院医师规范化培训中引入Mini-CEX的实践

Research and practice on Mini-CEX in standardized training for residents

目的观察对住院医师规范化培训部分学员使用Mini-CEX进行临床教学的效果。方法选取我院2015级住培学员40名,随机分为对照组和实验组,每组20人。2015年10月至2018年4月,对照组采用传统教学;实验组在传统教学基础上结合Mini-CEX活动,实验组每人在每个轮转科室至少进行2次Mini-CEX。毕业时应用改良的Mini-CEX评分量表、病例答辩和OSCE三种考核方法对两组学员进行测评。针对实施过Mini-CEX的教师和学员分别发放问卷,进行满意度调查。采用SPSS18.0对数据进行统计分析,组间比较采用独立样本t检验,组内前后比较采用配对样本t检验。结果Mini-CEX测评显示,两组学员各项临床能力毕业成绩均高于入学成绩,实验组学员毕业成绩优于对照组,实验组学员成绩提高分数大于对照组提高分数,差异均有统计学意义(P<0.05)。病例答辩显示,实验组学员平均成绩为(81.16±3.75)分,优于对照组的(70.13±3.88)分,差异有统计学意义(t=-9.140,P=0.000)。OSCE考核显示,实验组平均总分为(96.300±4.681),优于对照组的(91.775±3.227)分,差异有统计学意义(t=-3.559,P=0.001)。共发放调查问卷80份,其中教师40份、学员40份,结果显示教师满意率达95.0%、学员满意率达92.5%。结论Mini-CEX应用于住院医师规范化培训临床带教中,有利于提高学员的临床思维、医患沟通和人文关怀能力。

Objective To observe whether Mini-Clinical Evaluation Exercise (Mini-CEX) is effective and feasible for improving the clinical competency of residents receiving standardized training. Methods 40 residents receiving standardized training in the Second Affiliated Hospital of Amy Medical university were randomly divided into control group and experimental group, with 20 trainees in each group. From October 2015 to April 2018, the experimental group was trained by the traditional teaching methods combined with Mini-CEX, and the other was trained by traditional teaching method. At least 2 Mini-CEX were conducted for each trainee of the experimental group in each department. The Mini-CEX, defense of case report and OSCE evaluation were carried out to assess the clinical competence of residents after the standardized training. Satisfaction surveys were conducted for teachers and students who had used Mini-CEX. SPSS 18.0 was used to analyze the data. Independent samples t test was used for inter-group comparison and paired sample t test was used for intra-group comparison. P<0.05 was statistically significant. Results Mini-CEX showed that the scores of the two groups in the clinical competence assessment were improved;the scores of the experimental group were higher than those of the control group, and the improvement in scores of experimental group was higher than that of the control group (the differences were statistically significant, P<0.05). The average score of defense of case report of the experimental group was (81.16±3.75), while that of the control group was (70.13±3.88)(t=-9.140, P=0.000). The average total score of OSCE evaluation of the experimental group was (96.300±4.681), while that of the control group was (91.775±3.227)(t=-3.559, P=0.001). Satisfaction rate of teachers and students were 95.0% and 92.5% respectively. Conlusion Mini-CEX can improve the clinical competence of residents receiving standardized training.