客观结构化临床考试(OSCE)在麻醉科住院医师评估中的应用

Application of objective structured clinical examination(OSCE)in the assessment of anesthetic residents

目的针对麻醉学住院医师规范化培训的特点,建立客观结构化临床考试(OSCE)方案并予以实施,探寻评价麻醉学住院医师临床能力的新方案。方法设计OSCE站点(包括考核病例编写、标准化病人培训及各站点评分表编制等);组织2018年、2019年第3年住院医师进行OSCE;根据编制的评分表对住院医师的各站表现进行评分并对各站成绩进行比较。结果OSCE共设置6个站点,分别为模拟口试、气管内插管术、椎管内麻醉穿刺术、深静脉置管术、心肺复苏术及麻醉访视,考试时间共70 min。共44名住院医师参加考试,平均成绩均合格。比较模拟口试、操作技能、麻醉访视3项成绩发现,住院医师的操作技能成绩显著高于模拟口试和麻醉访视成绩(P<0.01),模拟口试显著低于麻醉访视成绩(P<0.01)。3项成绩两两之间均存在中等程度的正相关关系。结论OSCE能够多方面评价麻醉科住院医师的临床能力,是麻醉科住院医师临床能力考核的有效方式。

Objective To set up methods of objective structured clinical examination(OSCE)for application in the assessment of clinical competencies of residents trainees in standardized training of anesthesiology.Methods Designed OSCE assessment stations,including writing medical records,training standardized patients,as well as creating forms for assessment scoring.All third-year residents attended the OSCE in 2018 and 2019.At the end of the exams,the residents performance was evaluated according to the preset score forms.Results Six stations were set up for OSCE,including oral examination,endo-tracheal intubation,spinal anesthesia,deep vein catheterization,cardiopulmonary resuscitation and preoperative interview,the OSCE lasted for 70 minutes.Totally 44 residents took part in OSCE and all passed examination.Compared with the results of oral exam,clinical skills and preoperative interview,the results showed that the score of clinical skills was significantly higher than that of oral exam and preoperative interview(P<0.01),the score of oral exam was significantly lower than that of preoperative interview station(P<0.01).There were moderate positive correlations between oral exam and clinical skill,clinical skill and preoperative interview,and between oral exam and preoperative interview.Conclusions Clinical competence of anesthetic residents can be assessed by OSCE in multiple aspects,which provides an effective examination method for residents training in anesthesiology.