客观结构化放射学考试在医学影像技术专业实习临床技能考核中的应用

Application of objective structured radiology examination in clinical skills assessment of medical imaging technology

目的探讨客观结构化放射学考试(objective structured radiology examination,OSRE)在医学影像技术专业临床技能考核中应用价值,并对该评估工具进行可重复性评价。方法选择南京医科大学附属逸夫医院医学影像科医学影像技术学专业实习生55人,随机分为11组(每组5人);并设计9个不同的OSRE病例,每位学生均需完成3个OSRE病例;再由5位高年资主治医师或副主任医师对每个OSRE病例进行独立评分;实习结束后2个月,随机选择3个OSRE病例进行评分,以评估评分者之间的内部一致性和评估方式的可重复性。采用SPSS 16.0进行统计分析,使用多元线性回归分析学历与OSRE成绩的相关性。结果所有学生的OSRE平均成绩为(12.0±4.9)分。评估者间的ICC平均范围为0.36到0.80(P<0.001);6个病例一致性良好,病例3的一致性较差,病例6和7的一致性中等;2个月后,4个评分者ICC等于或大于0.8(一致性极佳),评分者3的ICC为0.68,平均原始分数差的范围是-1~0.8。在多元线性回归中,学历的OR值为0.90(95%置信区间0.30~1.50,P=0.01),学历与OSRE评分呈正相关。结论客观结构化放射学考试旨在通过使用预先设定的标准评分表,在标准化的临床环境中评估临床技能和知识,从而使临床知识能够以高水平和可重复的方式进行评估。

Objective To explore the application value of objective structured radiology examination(OSRE)in clinical skills assessment of medical imaging technology,and evaluate the repeatability of the assessment tool.Methods A total of 55 interns majoring in medical imaging technology were randomly divided into 11 groups(5 in each group),and 9 different cases of OSRE were designed.Each student had to complete 3 cases of OSRE.Five senior attending doctors or deputy chief physicians independently evaluated each case of OSRE.Two months after the internship,three cases of OSRE were randomly selected for scoring to evaluate the internal consistency between raters and the repeatability of the evaluation method.SPSS 16.0 was used for statistical analysis,and multiple linear regression was used to analyze the correlation between academic qualifications and OSRE scores.Results The OSRE average score of all the students was(12.0±4.9),and the average ICC range between evaluators was 0.36 to 0.80(P<0.001).The consistency of 6 cases was good,that of case 3 was poor,and that of cases 6 and 7 was moderate.After 2 months,the ICC of 4 raters was equal to or greater than 0.8(excellent consistency),and the ICC of rater 3 was 0.68,and the average original score difference ranged from-1 to 0.8.In multiple linear regression,the OR value of education was 0.90(95%confidence interval 0.30-1.50,P=0.01),and education was positively correlated with OSRE score.Conclusion The OSRE aims to assess clinical skills and knowledge in a standardized clinical environment through the use of pre-set standard scoring scales,so that clinical knowledge can be evaluated in a high-level and repeatable manner.