外科医师非手术临床技能评分标准中导师评价的研究

Tutor evaluation on the scoring criterion for non-technical skills in surgeons

目的非手术技能(non-technical skills,NTS)是考察外科医师综合素质的必需条目之一。本研究提出C-NTS的概念,即基于情景化(如病史采集)和录像的非手术临床技能的评分标准,并验证其实际操作效果。方法研究对象分为导师组和学员组;导师组含三甲医院胃肠外科高年资主治医师4人,均为男性,博士学历;学员组随机选择2018年同科室4名外科基地轮转医生,男性2人,女性2人。导师在培训讨论前后分别参照标准对同一匿名视频评分。应用SPSS 22.0,采用单因素方差分析比较组间及组内评分差异,用Kendall协和系数检验评分一致性。结果导师接受培训前后,其评分的Kendall协和系数由0.425增长为0.853,后者同时提示差异有统计学意义(P=0.017),证实了培训的有效性。结论C-NTS初步解决了非手术临床技能考核同质化的难点。若组织临床导师展开C-NTS相应讨论及接受培训,可能有利于临床实际教学和评价中节省时间与人力。

Objective Non-technical skills(NTS)are necessary to evaluate the comprehensive quality of surgeons.In this study,we proposed the concept of C-NTS,a scoring criterion for NTS based on real scenarios(for example,history taking)and video recording,and verified its practical application effects.Methods Study objects were divided into the tutor group and the student group.The tutor group contained four senior attending physicians in gastrointestinal surgery department of one tertiary hospital(all male with doctor degree).The student group had four rotating surgeons who were randomly selected from the same department in 2018(two males and two females).Before and after the training,the tutor rated the same anonymous video by C-NTS.One-factor analysis of variance was used to compare the differences between and within the groups,and Kendall concordant coefficient was used to test the consistency by SPSS 22.0.Results After the tutor receiving training,Kendall concordant coefficient was increased from 0.425 to 0.853 and the latter suggested the difference had statistical significance(P=0.017),which confirmed the effectiveness of the training.Conclusion C-NTS has preliminarily solved the difficulty of homogenization of NTS assessment.Relevant C-NTS discussions and trainings for clinical tutors may be beneficial to save time and manpower in clinical teaching and evaluation.