胜任力导向的Mini-CEX和DOPS在骨科住院医师规范化培训中的应用研究

Application of Competency⁃Based Mini⁃CEX and DOPS in Orthopaedic Resident Standardization Training

目的评估应用胜任力导向的迷你临床演练评估(mini-clinical evaluation exercise,Mini-CEX)和操作技能直接观察评估(direct observation of procedural skills,DOPS)在骨科住院医师规范化培训中岗位胜任力提高的效果。方法将2020年8月至2023年7月在华中科技大学同济医学院附属协和医院骨科住培基地进行住院医师规范化培训的46名住院医师,随机分为试验组和对照组,每组23例。两组教学方法相同,试验组采用胜任力导向的Mini-CEX和DOPS形成性评价和终结性评价方法,对照组单纯采用终结性评价方法。通过年度理论考核,包括基础理论考试及临床技能操作,比较两组住院医师的临床综合能力;通过Mini-CEX和DOPS评估比较试验组培训前后的评分。结果试验组住院医师在年度考核中的技能考核成绩和总成绩均高于对照组(P<0.05),两组的理论考核成绩无显著性差异(P>0.05)。试验组培训后Mini-CEX考核在医疗面谈、体格检查、人文素养、临床判断、沟通技能、组织效能、整体表现7项核心能力评分上均有显著改善(P<0.05)。试验组培训后DOPS考核在人文素养、相关知识、准备工作、病人安全、技术能力、无菌观念、后期管理7项核心能力评分上均有显著改善(P<0.05)。结论胜任力导向的Mini-CEX和DOPS的形成性评价有助于提高骨科住院医师的临床综合能力及岗位胜任力。

Objective To explore the application and effect of mini-clinical evaluation exercise(Mini-CEX)and direct observation of procedural skills(DOPS)in orthopaedic resident standardized training.Methods Between August 2020 to July 2023,46 residents who underwent standardized resident training in the Department of Orthopaedics in Union Hospital,Tongji Medical College,Huazhong University of Science and Technology were divided into experimental group(23 cases)and control group(23 cases).Both groups underwent the same teaching method.The experimental group was assessed by Mini-CEX,DOPS and summative evaluation,while the control group was assessed by summative evaluation.Annual theoretical test,clinical examination skills assessment and sum score were compared between two groups.The Mini-CEX,DOPS scores of the experimental group before and after standardized training were compared.Results Annual clinical examination skills scores and sum scores of experimental group were higher than those of control group(P<0.05),while annual theoretical test scores of the two groups showed no significant difference(P>0.05).The Mini-CEX scores of the experimental group after standardized training were higher than those before standardized training,including interviewing skills,clinical examination skills,humanistic qualities,clinical judgment,counseling skills,organization and overall clinical competence(P<0.05).The DOPS scores after standardized training were higher than those before standardized training,including humanistic qualities,operation knowledge,preoperative preparation,patient safety,operation skills,aseptic technique,postoperative management(P<0.05).Conclusion The formative assessment including Mini⁃CEX and DOPS can improve the clinical comprehensive ability and job competence of orthopedic resident physicians.