主治医师团队抢救能力的评价与分析

Evaluation and analysis of team rescue capability of attending physicians

目的评价并分析主治医师团队抢救能力,促进主治医师岗位胜任力的培养。方法2020年,以《2015年美国心脏协会心肺复苏及心血管急救指南》和医师胜任力框架中对领导者角色的定义为基础制订评价指标,运用胜任力导向的医学教育和客观结构化临床考试设计评价流程和内容,由主治医师带领1名住院医师和1名护士组成的团队实施抢救,以此考核方式对北京大学第一医院77名晋升满3年至4年的主治医师的团队抢救能力进行评价和分析。结果主治医师的操作技能评分[74.7(66.7,80.3)]高于领导能力评分[56.3(50.7,69.0)分],内科系统操作技能评分[78.9(75.6,86.7)分]高于外科系统[67.2(62.6,75.5)分],差异均具有统计学意义(均P<0.01);领导能力评分内科系统主治医师[64.7(50.7,73.7)分]比外科系统[53.3(49.7,60.7)]高,差异无统计学意义(P=0.07)。结论评价指标对团队抢救能力的评价基本客观,主治医师的领导能力有待提高,需要加强领导能力培养的探讨,同时加强外科系统主治医师操作技能的培养。

Objective To evaluate and to analyze the rescue capacity of attending physician team and to promote the the competence buidling of attending physicians.Methods In 2020,the 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation(CPR)and Emergency Cardiovascular Care(ECC)and the definition of leader in the physician competence framework were used as a basis for developing evaluation index.Using the competency evaluation of medical education and the Objective structured clinical examination(OSCE)to guide evaluation process development and content design,which were applied to evaluate and analyze the team rescue capacity of 77 attending physicians who have been promoted to the position for 3 or 4 years in Peking University First Hospital.The rescue team includes an attending physician,a resident and a nurse.Results The operational skill score of attending physicians[74.7(66.7,80.3)]was higher than that of leadership[56.3(50.7,69.0)],the operational skill score of internal medicine group[78.9(75.6,86.7)]was higher than that of surgical group[67.2(62.6,75.5)],the differences were all statistically significant(all P<0.01).Leadership capacity score of attending physicians in the internal medical group[64.7(50.7,73.7)]was higher than that in the surgical group[53.3(49.7,60.7)],but the difference was not statistically significant(P=0.07).Conclusions The evaluation index of team rescue capacity is basically objective.The leadership capacity of attending physicians needs to be improved,and the cultivation of leadership ability needs to be strengthened with multiple approaches.At the same time it is necessary to strengthen the discussion on the cultivation of operational skills of attending surgeons in the surgical system.