多样化评价体系在麻醉学住院医师规范化培训中的应用

Application of diversified evaluation methods in standardized training of anesthesiologists

目的探讨多样化评价体系在不同学历麻醉学住院医师规范化培训(以下简称住培)中的应用,为评价其核心胜任力提供参考。方法选取2016年9月至2017年8月在北京协和医院麻醉学住培基地接受住培的58名住院医师为研究对象,根据不同学历将其分为3组。其中,A组为在读麻醉学专业学位硕士研究生共25人,B组为已经获得八年制临床医学专业博士学位的住院医师共14人,C组为已经获得临床医学专业学士学位的住院医师共19人。设计并构建由多项选择题试题库季度考核、轮转病例登记系统、不定期日常临床工作抽样评价、客观结构化临床考试年度考核组成的多样化评价体系,综合分析住院医师各项考核成绩得出住院医师的医学知识、患者照护、职业素养、沟通能力和操作技能等5项核心胜任力成绩和总成绩,并为每名住院医师绘制核心胜任力雷达图,比较3组住院医师的核心胜任力。结果A组、B组和C组住院医师在职业素养[(4.27±0.75)分比(4.55±0.51)分比(4.32±0.67)分]和患者照护能力[(4.00±0.60)分比(4.17±0.64)分比(3.97±0.62)分]方面的差异均无统计学意义(均P>0.05);在医学知识[(4.13±0.36)分比(4.12±0.34)分比(3.72±0.44)分]、沟通能力[(3.71±0.34)分比(4.02±0.24)分比(3.75±0.32)分]、操作技能[(4.15±0.27)分比(4.43±0.17)分比(4.19±0.18)分]和胜任力总成绩[(20.25±1.67)分比(21.29±1.41)分比(19.95±1.38)分]的差异均具有统计学意义(均P<0.05)。分析3组住院医师雷达图的形状特点发现,A组住院医师雷达图最常见沟通能力相对薄弱的类型(共12人);B组住院医师最常见5项核心胜任力均等的类型(共8人);C组住院医师最常见医学知识掌握较差的类型(共8人)。结论多样化评价体系有助于对住院医师核心胜任力的全面评估;不同学历住院医师的各项核心胜任力表现不同,需要针对其不同特点在培训过程中有所侧重。

Objective To study the application of diversified assessment system on standardized training of residents with different degrees in anesthesiology,so as to provide reference for improving their core competence.Methods Fifty-eight residents in anesthesiology department from September 2016 to August 2017 were selected,including 25 clinical graduate students in group A,14 residents with doctoral degree in group B and 19 residents with Bachelor's degree in group C.Designed and built a diversified assessment system consisting of quarterly multiple choice question examinations,clinical work registrations system,irregular daily performance evaluations and annual OSCE clinical skills assessments.The five core competencies including medical knowledge,patient care,professionalism,communication skills and technical skills were evaluated by all these scores,and the radar chart of core competencies is drawn for each resident.Compared the differences of five core competencies among residents in different groups.Results There were no significant differences in the competency of professionalism[(4.27±0.75)vs(4.55±0.51)vs(4.32±0.67)]and patient care[(4.00±0.60)vs(4.17±0.64)vs(3.97±0.62)]among residents in 3 different groups(all P>0.05).There were significant differences in scores of medical knowledge[(4.13±0.36)vs(4.12±0.34)vs(3.72±0.44)],communication ability[(3.71±0.34)vs(4.02±0.24)vs(3.75±0.32)],technical skills[(4.15±0.27)vs(4.43±0.17)vs(4.19±0.18)]and total scores of competencies[(20.25±1.67)vs(21.29±1.41)vs(19.95±1.38)](all P<0.05).By analyzing the shape and characteristics of radar chart of residents with different degrees,it can be found that the relatively weak communication skills of residents in group A is the most common(12 people in group A),in group B,the equal clinical competencies of residents is the most common(8 peoplein group B),the poor medical knowledge in group C is the most common(8 people in group C).Conclusions The diversified evaluation system is helpful for the comprehensive evaluation of the core competence of the standardized trainging residents;the performance of core competencies of residents with different degree is different,which needs to be focused on in the training process according to the different characteristics of the residents.