改良迷你临床演练方法在口腔正畸科考核中的初步应用

Application of improved mini⁃clinical evaluation exercise in clinical assessment of orthodontists

目的探讨将Tweed分析法与迷你临床演练(Mini⁃CEX)相结合,建立适用于口腔正畸专科的临床考核方案的效果。方法通过将Mini⁃CEX方法与正畸学Tweed分析表进行结合,并补充细化评分表,从而建立了一种新型口腔正畸学教学考核方法,称为改良Mini⁃CEX考核。于2019年9月,从上海交通大学医学院附属第九人民医院口腔正畸科随机选取6名在培口腔专科培训医师作为考生,对考生进行改良Mini⁃CEX考核,由5名正畸专家对其表现进行打分。应用SPSS 21.0软件对打分结果进行统计,计算肯德尔和谐系数(W)并进行显著性检验。结果不同考官在评价同一考生时,考官间的打分具有显著的一致性(W1=0.742,P1=0.001;W2=0.666,P2=0.003;W3=0.720,P3=0.001;W4=0.628,P4=0.004;W5=0.555,P5=0.011;W6=0.330,P6=0.1293)。在医疗面谈、体格检查、临床判断、卫生教育、组织效能和整体表现6项,打分具有显著的一致性(W1=0.620,P1=0.008;W2=0.588,P2=0.012;W3=0.885,P3<0.001;W4=0.625,P4=0.008;W5=0.835,P5=0.001;W6=0.930,P6<0.001),仅人文关怀一项未通过一致性检验(W=0.147,P=0.598)。结论改良Mini⁃CEX具有标准程序,建立明确的得分细节,可以考核全面、获得公正客观,在不同考官间具有良好一致性,适用于当前口腔正畸学的考核与评价。

Objective This study aimed to establish a clinical evaluation system for orthodontics candidates via combining Tweed analysis with mini⁃clinical evaluation exercise(Mini⁃CEX),and examine its effect in clinical assessment.Methods By combining the Mini⁃CEX method with Tweed analysis and supplementing the detailed scoring table,a new type of orthodontics teaching assessment method was established,which was called the modified Mini⁃CEX assessment.In September 2019,six in⁃trained dental resident doctors were randomly selected as candidates from the Department of Orthodontics,Shanghai Ninth People′s Hospital.They were enrolled in the improved Mini⁃CEX clinical assessment,and their performance were evaluated by five senior orthodontic doctors.The obtained data were statistically analyzed by SPSS 21.0 software using Kendall′s coefficient of concordance test.Results The scores of five candidates exhibited a significant consistency among the examiners(W1=0.742,P1=0.001;W2=0.666,P2=0.003;W3=0.720,P3=0.001;W4=0.628,P4=0.004;W5=0.555,P5=0.011;W6=0.330,P6=0.1293).All evaluation scores were significantly consistent in the following aspects:medical interview,physical examination,clinical judgment,health education,organizational effectiveness and overall performance(W1=0.620,P1=0.008;W2=0.588,P2=0.012;W3=0.885,P3<0.001;W4=0.625,P4=0.008;W5=0.835,P5=0.001;W6=0.930,P6<0.001).The only aspect which failed in the consistency test was humanistic care(W=0.147,P=0.598).Conclusions The improved Mini⁃CEX assessment was a convenient,comprehensive,fair and objective method which had good consistency among different examiners.Therefore,this method was expected to be applied to the clinical assessment of orthodontics.