探索改良版迷你临床演练评估在住院医师出科考核中的作用

To explore the effect of the improved Mini Clinical Exercise Evaluation in the examination of residents

目的探讨改良版迷你临床演练评估(mini-clinical evaluation exercise,Mini-CEX)在住院医师出科考核中的作用。方法选择北京大学第三医院2014年至2019年共2080份住院医师出科考试成绩和改良版Mini-CEX测评结果作为研究资料,探究改良版Mini-CEX八项测评指标对出科考核成绩的影响。结果改良版Mini-CEX各测评指标均与出科考试成绩呈现正相关(均P<0.001),其中问诊技巧、组织效能和体格检查对出科考试成绩影响较大(均P<0.05)。反馈内容中“知识”关键词出现频率随着评价次数增加呈现上升趋势(P=0.013)。随着住院医师参加出科考核次数的增加,改良版Mini-CEX评分和出科考核成绩均有所上升,其中组织效能、整体表现和出科考试成绩有明显上升(P=0.012;0.030;0.016);对住院医师规范化培训结业考试通过率分析,发现自2017年开始保持较高水平。结论基于改良版Mini-CEX的出科考核体系能够有效提高住院医师培训质量,但是仍需加强临床教师培训与信息化建设,完善质量评价体系。

Objective To explore the effect of the improved Mini-Clinical Evaluation Exercise(Mini-CEX)in the examination process of residents.Methods A total of 2080 test scores and Mini-CEX scores of resident doctors,eight-year students and graduate students from the Third Hospital of Peking University from 2014 to 2019 were selected as the research materials.The impact of eight indicators of Mini-CEX on the examination results was explored.Results It was found that all the evaluation indexes of Mini-CEX were positively correlated with the exam scores(P<0.001).Furthermore,interrogation skills,organizational efficiency and physical examination indexes had a greater impact on the scores of the exam(P<0.05).The frequency of"knowledge"in the feedback content increased(P=0.013).With the increase of the number of students participating in the exam,the scores of both Mini-CEX and exam increased,and the organizational efficiency,overall performance and exam scores significantly increased(P=0.012,0.030,0.016,respectively).The passing rates of the first-stage examination for resident doctors in Beijing were analyzed and found to be at a high level since 2017.Conclusion The department of examination system based on Mini-CEX can improve the teaching quality, but it still needs to strengthen teacher training andinformation construction, so as to improve the evaluation effect of students' examination.