住院医师置信职业行为量表在住培评价中的应用探索

Exploration of the evaluation with the entrustable professional activities scale in standardized residency training

目的:分析住院医师置信职业行为量表在住院医师规范化培训中的应用效果。方法:2022年1月,采用目的抽样方法,选择2021年12月至2022年1月北京大学第一医院内科、外科、妇产科和儿科进行规范化培训的230名住院医师及其71名指导医师为研究对象,指导医师采用住院医师置信职业行为量表对住院医师的15项置信职业行为进行评价。采用Kruskal-Wallis H检验比较不同学科、不同年资住院医师之间置信级别的差异,以确定能否达到分层递进的培训原则。采用概化系数检验住院医师置信职业行为量表的评价信度。结果:住院医师置信职业行为量表的概化系数为0.980。指导医师对内科、妇产科和儿科住院医师的评价中,第二年住院医师的置信级别评价高于第一年住院医师[如妇产科住院医师接诊患者,4.0(0.6)比3.0(0),均矫正P<0.001];第三年住院医师的置信级别评价高于第二年住院医师[如妇产科住院医师接诊患者,4.5(0.8)比4.0(0.6),均矫正P<0.001],差异均具有统计学意义。指导医师对外科住院医师的评价中,第一年与第二年住院医师[如一般临床问题识别与处理,4.0(0.3)比4.0(0.5),矫正P=0.591]、第二年和第三年住院医师[如一般临床问题识别与处理,4.0(0.5)比4.0(0.5),矫正P=0.047]的置信级别评价差异均无统计学意义。结论:住院医师置信职业行为量表可靠、稳定,能够有效反映住院医师规范化培训效果。其中内科、妇产科、儿科住院医师规范化培训符合分层递进的培训原则,外科住院医师培训有必要重新规划年度培训计划。

Objective To explore the application of the entrustable professional activities scale in standardized residency training.Methods In January 2022,230 residents who received standardized training in the Department of Internal Medicine,Surgery,Obstetrics&Gynecology and Pediatrics of Peking University First Hospital from December 2021 to January 2022 and 71 clinical instructors were selected as the research participants by purposive sampling.Clinical instructors were instructed to assess trainees using the entrustable professional activities scale for 15 entrustable professional activities.The Kruskal-Wallis H test was used to compare the differences in entrustable levels among residents of different disciplines and grades to determine whether the educational principle of hierarchical progression could be achieved,and the generalization coefficient was used to test the evaluation confidence of the entrustable professional activities scale.Results The generalizability coefficient of the entrustable professional activities scale was 0.980.Entrustable levels from internal medicine,obstetrics&gynecology and pediatrics second-year residents by clinical instructors were higher than those of the first-year residents[for example,in history-taking and physical examination during patient encounter by obstetrics&gynecology residents:4.0(0.6)vs.3.0(0),all adjust P<0.001],and the third-year residents'entrustable levels were higher than the second-year residents'[for example,in history-taking and physical examination during patient encounter by obstetrics&gynecology residents:4.5(0.8)vs.4.0(0.6),all adjust P<0.001].Levels of entrustability by clinical instructors from surgical residents were no significant differences between the first-year residents and the second-year residents either[for example,in indentify and manage the general clinical conditions:4.0(0.3)vs.4.0(0.5),adjust P=0.591],and there were no significant differences between the second-year residents and the third-year residents[for example,in indentify and manage the general clinical conditions:4.0(0.5)vs.4.0(0.5),adjust P=0.047].Conclusions The entrustable professional activities scale is reliable and stable,and can effectively reflect the effect of standardized training of residents.Among them,the standardized training of obstetrics&gynecology residents conforms to the principle of hierarchical and progressive training,and it is necessary to re-plan the annual training programme for internal medicine,surgery,and pediatrics.