OSCE情景化现场急救技能站的探索与实践研究

Exploration and practice of scenario-based onsite first-aid skills station in objective structured clinical examination

目的探讨客观结构化临床考试(objective structured clinical examination,OSCE)中情景化现场急救技能站的实施效果和应用价值。方法在OSCE考核中设置现场急救技能站,以学员现场急救能力评价为核心,任职岗位中常见的情景和案例为依托,从考核指标、考场布置、考前人员培训、考核流程等方面设计OSCE现场急救技能站考核方案,连续3年对临床医学(五年制)毕业学员现场急救能力进行考核评价。通过SPSS 24.0进行Kruskal-Wallis检验,通过Pearson相关分析计算课程考试成绩与OSCE现场急救技能站考核成绩相关性。利用Excel软件计算试题的难度和区分度。结果学员OSCE现场急救技能站考核成绩逐年提升,平均成绩在80分左右。考站试题难度适中(0.7~0.8)、区分度良好(大于0.4),内部一致性良好(Cronbach’sα>0.7),试题质量高。考官和学员对OSCE现场急救技能站设计和考核效果认可度较高。学员OSCE成绩与相应课程考试成绩呈正相关(2016级:r=0.245,P=0.001;2017级:r=0.108,P=0.026;2018级:r=0.198,P=0.006)。结论通过科学的评分标准和严密的考试组织,OSCE情景化现场急救技能站能够有效地评价不同环境下学员伤情救治能力,为课程教学提供参考依据。

Objective To explore the application of a scenario-based onsite first-aid skills station in objective structured clinical examination(OSCE).Methods Based on common scenarios and cases in medical practice,an evaluation framework of the OSCE onsite first-aid skills station—containing assessment indicators,exam room setting,examiner training,and assessment process—was designed to evaluate the onsite first-aid competencies of medical graduates of the five-year program for three consecutive years.SPSS 24.0 was used to perform the Kruskal-Wallis test and Pearson correlation analysis to calculate the correlation between course examination scores and OSCE onsite first-aid skills station assessment scores.Excel was used to calculate the difficulty index and discrimination index of test items.Results The graduates'OSCE onsite first-aid skills station assessment scores were improved year by year,with a mean score of about 80 points.The station assessment items showed a moderate difficulty level(0.7-0.8),a good discrimination level(>0.4),and good internal consistency(Cronbach'sα>0.7).The examiners and examinees had a high recognition of the design and effectiveness of this station assessment method.There was a positive correlation between theOSCE scores and corresponding course scores(2016,r=0.245,P=0.001;2017,r=0.108,P=0.026;2018,r=0.198,P=0.006).Conclusions Through scientific scoring and strict examination management,the OSCEscenario-based onsite first-aid skills station can effectively evaluate examinees'injury treatmentcompetencies in different situations,which can provide a reference for course teaching.