客观结构化临床考试在八年制临床医学专业学生见习阶段的实施与评价

Implementation and evaluation of objective structured clinical examination for eight-year program medical students of clinical medicine in clerkship

目的在八年制临床医学专业学生见习阶段实施客观结构化临床考试(objective structured clinical examination,OSCE)并评价其效果,旨在为其在临床见习阶段的应用提供参考。方法选取2020年6月至2021年1月在北京大学第一医院进行临床见习的2017级八年制临床医学专业49名学生为研究对象,在见习结束时实施OSCE,包含病史采集、体格检查、技能操作各2站。通过学生成绩,OSCE难度、区分度、信度和对学生进行问卷调查,评价OSCE实施效果。结果学生总成绩为[9.23(8.98,9.41)]分;OSCE总体难度系数为0.087,区分度为0.126,克朗巴赫系数为0.739。85.7%(42/49)的学生认为考核总体设计合理,91.8%(45/49)的学生表示需要考官反馈;分别有81.6%(40/49)、75.5%(37/49)、85.7%(42/49)的学生认为OSCE能够考核病史采集、体格检查、技能操作的掌握情况,多数学生认为OSCE能够促进胜任力的提升,尤其是能够促进胜任交流者[93.9%(46/49)]、职业人[71.4%(35/49)]等角色的胜任力;16.3%(8/49)的学生对其在OSCE中的自我表现表示满意。结论OSCE信度较好,区分度尚可,难度偏低;OSCE设计合理,可以考虑完善考官反馈;OSCE的效果良好,有助于胜任力的提升;学生对OSCE中自我表现评价较低,可以考虑增加学生培训。

Objective Objective structured clinical examination(OSCE)was implemented as an evaluation tool for clerkship trainees of eight-year program of clinical medicine.Its effect was evaluated in order to provide reference for its application in clerkship.Methods Forty-nine medical students of 2017 grade who were trained in clerkship in Peking University First Hospital from June 2020 to January 2021 were involved in the examination.The examination was composed of 6 stations including 2 stations for clinical history taking,2 stations for physical examination and 2 stations for essential skills.The effect of OSCE implementation was evaluated by the students'scores of OSCE,the degree of difficulty,the degree of discrimination,the reliability of OSCE and the students'questionnaire.Results The student's total score was[9.23(8.98,9.41)].The overall difficulty was 0.087,discrimination was 0.126 and the Cronbachαof reliability was 0.739.There were 85.7%(42/49)of the students who considered that the overall design of the assessment was reasonable,and 91.8%(45/49)of them asked for feedback from examiners.The results also showed that 81.6%(40/49),75.5%(37/49)and 85.7%(42/49)of the students believed that OSCE well evaluated the mastery of skills dealing with medical history taking,physical examination and essential clinical skills.Most students believed that it may promote competency building,especially communicator[93.9%(46/49)]and professional capacity[71.4%(35/49)].However,only 16.3%(8/49)of the students were satisfied with their self-performance in OSCE.Conclusions OSCE is characterized by reliability,fair discrimination and low difficulty.The evaluation of the OSCE assessment design is fine,and the feedback from examiners of the examination is needed.The assessment effect is good and can promote competency;since students have a low evaluation of self-performance,it is necessary to provide more facilities and resources to support practical training in the future.