学历对外科住院医师规范化培训临床技能结业考核结果影响的探讨

Influence of academic degree on the result of clinical skill completion examination of standardized training for surgical residents

目的 分析学历因素对外科住院医师规范化培训临床技能结业考核结果的影响,为制定不同学历外科住院医师的培训方案提供参考.方法 2016年10月至2018年10月,选取2014年至2016年北京市1 387名外科住院医师(以下简称为学员)规范化培训临床技能结业考核成绩为研究对象,根据学员在报名考试时的最高学历分为本科、硕士研究生和博士研究生3组,采用方差分析、卡方检验、logistics回归分析等方法进行回顾性分析,比较3组学员在7站临床技能考核中不同模块的考核成绩及通过率,分析学历对考核成绩的影响.结果 本科组学员通过率为63.9% (345/540),硕士研究生组学员通过率为74.1%(341/460),博士研究生组学员通过率为75.7% (293/387),其差异具有统计学意义(P<0.01).硕士研究生组和博士研究生组学员的通过率均高于本科组学员,其差异均具有统计学意义(均P<0.01).硕士研究生组和博士研究生组学员的通过率差异无统计学意义(P=0.604).多因素方差分析显示,本科组、硕士研究生组和博士研究生组学员在辅助检查[(73.90±8.25)分比(75.76±8.86)分比(77.26±8.25)分]、医疗文书[(69.71±22.85)分比(66.86±23.19)分比(72.17±23.40)分]、病例分析[(83.82±10.18)分比(83.43±8.14)分比(85.18±7.84)分]、人文沟通[(87.62±8.05)分比(87.57±7.31)分比(89.63±6.48)分]等模块的成绩,其差异均具有统计学意义(均P<0.01);在病历书写[(84.51±9.17)分比(85.09±7.97)分比(85.08±8.76)分]和外科操作[(87.08±9.04)分比(85.96±7.81)分比(86.37±7.75)分]等模块的成绩,其差异无统计学意义(P>0.05).结论 不同学历外科住院医师的规范化培训方案应有所区别;博士研究生学员在培训设计上应以补齐外科操作等短板为主,可以适当减免轮转培训年限;硕士研究生学员不宜减免轮转年限,其培训计划应当更加侧重补短板;本科学员需要按照培训大纲要求进行全程系统的临床训练.

Objective To analyze the influence of different academic qualifications on the results of standardized training graduation exam of surgical residents,and to put forward corresponding suggestions for formulating training plans for surgical residents.Methods From 2014 to 2016,1387 surgical residents in Beijing were selected as the subjects for the study,and the related factors were analyzed retrospectively.According to the highest academic qualifications obtained by the candidates in the examination,the candidates are divided into bachelor group,master group and doctor group.Using the methods of difference analysis,chi-square test and logistic regression analysis,the scores of different modules of the 7-station and the passing rates of the three groups of candidates in clinical skill examination are compared.Results Among 1387 candidates,540 were in the bachelor group,460 were in the master group and 387 were in the doctor group.There was a significant difference about passing rate among bachelor group 63.9%(345/540),master group 74.2%(341/460)and doctor group 75.7%(293/387)(P<0.01).Among them,the pass rate of master and doctor candidates was higher than that of bachelor candidates,and the difference were statistically significant(All P<0.01).There was no significant difference in the pass rate between the candidates with master and doctor degree(P>0.05).Multivariate ANOVA analysis showed that among bachelor group,master group and doctor group,the scores of assistant examinations[(73.90±8.25)vs(75.76±8.86)vs(77.26±8.25)],medical documents[(69.71±22.85)vs(66.86±23.19)vs(72.17±23.40)],case analysis[(83.82±10.18)vs(83.43±8.14)vs(85.18±7.84)],humanistic communication[(87.62±8.05)vs(87.86±23.19)vs(72.17±23.40)]have significant differences(All P<0.01),There were no significant differences in the scores of the medical record writing[(84.51±9.17)vs(85.09±7.97)vs(85.08±8.76)]and surgical operation modules[(87.08±9.04)vs(85.96±7.81)vs(86.37±7.75)](P>0.05).Conclusions The standardized training programs of surgical residents with different degrees should be different.In terms of training design,doctor degree students should mainly fill in the shortcomings such as surgical operation,and the training period of rotation can be reduced or exempted.The rotation period for master degree students should not be reduced,however,their traning plan should focus more on filling in the shortcomings.Bachelor degree students should conduct systematic clinical training in accordance with the training program.