基于SMART和EPAs的肾脏专科住院医师规培体系建立及效果评估

Establishment and Effectiveness Evaluation of a Standardized Training System for Renal Resident based on SMART and EPAs

目的探讨基于SMART和EPAs的肾脏专科住院医师规培体系建立及效果评估,为提高肾脏专科医师规培效果提供参考。方法从某院2015年3月1日-2020年3月31日进行肾病专科住院医师二阶段培训的10名住院医师为研究对象,按SMART和EPAs原则制定详细的2年期培训计划,培训结束后进行理论和临床实践及操作技能考核,通过座谈会及问卷调查等多角度评价教学满意度及教学效果。培训结束后,对规培对象的Mini-CEX评分及各项能力达标率、住院医师自主能力、岗位胜任力达标率等进行评估。结果培训考核能力:培训医师均通过理论和临床操作二阶段规培考核,通过率100%;临床综合能力:规培对象的Mini-CEX评分、沟通技能、临床诊断、360度评核能力显著提高率90%,患者接诊、体格检查、专业素养、人文关怀能力显著提高率100%;自主能力:临床综合能力、学习主动性、专科素养、主治医师评分、多学科会诊、人文沟通能力显著提高率90%,临床思维、护理评分、科研评分、教学管理者评分、学习兴趣提高率100%;岗位胜任力评估:病房主治医师、医护360度评核能力非常确定者90%,门诊慢病随访、肾病专科会诊、透析质控管理、住院医师带教、发表文章、科普文章、患者满意度能力非常确定者100%,肾科操作和手术、获得基金者能力非常确定者80%。结论基于SMART和EPAs的肾病专科住院医师规培目标明确,评估可量化,有助于提高专科住院医师培训水平和岗位胜任力。

Objectives This study aims to establish and evaluate the effect of the renal resident training system based on SMART and entrustable professional activities(EPAs),to provide a reference for improving the effectiveness of kidney specialist training.Methods A detailed two-year training plan was developed based on the principles of SMART and EPAs for 10 resident physicians who underwent a two-stage training program for nephrology specialists in a hospital from March 1,2015 to March 31,2020.After the training,theoretical and clinical practice as well as operational skills assessments were conducted.Teaching satisfaction and effectiveness were evaluated from multiple perspectives such as symposiums and questionnaires.After the training was completed,the Mini-CEX score and compliance rate of various abilities of the designated trainees,as well as the independent ability of resident physicians and the compliance rate of job competence were evaluated.Results Training and assessment ability:All training doctors passed the two-stage training assessment of theory and clinical operation,pass rate 100%.Comprehensive clinical ability:Mini-CEX scores,communication skills,clinical diagnosis,and 360-degree evaluation abilities of regulated training subjects were significantly improved by 90%;The patient reception,physical examination,professionalism,and humanistic care abilities were significantly improved by 100%.Autonomous ability:Comprehensive clinical ability,learning initiative,professional literacy,attending physician rating,multidisciplinary consultation,and humanistic communication skills had a significant improvement rate of 90%;Clinical thinking,nursing ratings,scientific research ratings,teaching manager ratings,and learning interest improvement had a significant improvement rate of 100%.Job competency assessment:90% of people were very certain about the 360-degree evaluation ability of ward attending and medical care;100% of people were very certain about outpatient chronic disease follow-up,nephrology specialist consultation,dialysis quality control management,resident physician guidance,published articles,popular science articles,patient satisfaction;80% of people were very certain about nephrology operations and surgeries,funder ability.Conclusions The training objectives for nephrology resident physicians based on SMART and EPAs are clear and the evaluation can be quantified,which helps to improve the training level and job competency of specialty residents.