精神科住院医师“五站式”客观结构化临床考核评分标准的信度分析

Reliability analysis of five-station objective structured clinical assessment criteria for psychiatric residents

目的:探讨精神科住院医师"五站式"客观结构化临床考核(OSCE)的3个站点评分表的信度。方法:以广东省第三期精神科住院医生培训师资培训班115名学员为对象,先由指导老师针对OSCE中第二站"临床技能站"、第三站"临床思维站"、第五站"临床沟通站"评分标准逐项讲解和分析;然后安排广州市惠爱医院二年级住培医师对真实住院患者进行上述3个站点的现场测试,现场师资培训班学员对住培医师进行评分;其中学员对住培医师"临床沟通站"分别在指导老师现场讲解后及实例演练后进行两次评分,分析各次评分的组内一致性。结果:学员对住培医师"临床技能站"、"临床思维站"的现场评分一致性的组内相关系数(ICC)分别为0.988、1.000;"临床沟通站"现场讲解后及实例演练后两次评分ICC分别为0.990及0.998。结论:经培训的学员对精神科住院医师"五站式"OSCE考核评分一致性高,联合实例演练后再评分的组内一致性更好。

Objective:To explore the reliability of three sites evaluation scales of objective structured clinical examination(OSCE)for psychiatric residents.Method:One hundred and fifteen students from the third psychiatric teacher training course were included.First of all,trainees were explained and analyzed by welltrained instructors according to the evaluation scales of the second station"clinical skills station",the third station"clinical thinking station"and the fifth station"clinical communication station".Then,the second grade resident physicians of Guangzhou Huiai Hospital were arranged to conduct the field tests of the above three sites for the real inpatients,and the on-site trainees scored them.After the completion of grading,trainees’scoring scales were collected on site to analyze the consistency of grading in the three sites.In addition,the fifth station"clinical communication station"required on-site trainees to conduct case drills in groups after receiving the onsite explanation and guidance from the instructor.After the completion of the drill,all the trainees and the instructor will conduct the evaluation of a resident physician in the fifth station together and give a score,so as to analyze the scoring consistency after the joint training and the drill.Results:Intra-class correlation coefficient(ICC)was calculated with statistic software and it showed high consistency among different assessors after training in all three stations including"clinical kills","clinical thinking"and"clinical communication"with ICC equal 0.988,1.000 and 0.990 respectively.ICC of"clinical communication station"was 0.998 after the joint practice,which was higher than that before the practice.Conclusion:It is further verified that the scoring criteria of the five-station assessment for psychiatric residents are highly consistent after training,and the re-grader can improve the intra-group consistency of clinical communication stations after joint practice.