国家命题对全科医师住培结业临床实践能力考核质量提升的分析

Analysis of the national proposition to promote the standardized training quality of general practice residents

目的2023年在全科住院医师规范化培训结业临床实践能力考核中首次采取全国统一命题的考试方式,该命题方式对住院医师临床实践能力水平的考核效果如何,对于住培考核质量提升的影响如何,尚无研究。本文旨在比较国家命题与省级命题方式对全科住院医师规范化培训结业临床实践能力的评估效果,分析国家命题对考核质量提升的促进作用,提出可靠建议。方法收集2022年、2023年湖北省全科住院医师规范化培训结业临床实践能力考核成绩,对考试难度进行分析,并通过问卷收集考生及考官对不同命题方式的建议与反馈。结果2023年(98.88%)与2022年(98.38%)考核通过率比较差异无统计学意义。2023年基本技能操作考站平均分(19.00±2.34)低于2022年(20.88±2.40),2023年医患沟通考站平均分(11.78±1.44)低于2022年(13.20±1.09),2023年总成绩平均分(79.24±6.75)低于2022年(81.86±7.29),差异均有统计学意义(P<0.001)。考生与考官对选择住培结业实践考核的组织形式均倾向于全国统一命题统一考核。2023年考题难度系数(0.79)较2022年(0.82)难。结论国家命题能促进全科住院医师规范化培训和考核质量的提升,更加符合目前的住培发展形势。

Objective In 2023,the national unified proposition was adopted in the assessment of clinical practice ability after standardized training for general practice residents.There is no research on the effect of this proposition on the assessment of the clinical practice ability level of residents and the impact on the improvement of the quality of resident training.This paper aims to compare the evaluation effect of the national proposition and provincial proposition method on the clinical practice ability of general practice residents in standardized training,analyze the promotion effect of the national proposition on the improvement of assessment quality,and put forward reliable suggestions.Methods The results of the clinical practice ability assessment of standardized training of general practice residents in Hubei Province in 2022 and 2023 were collected,the difficulty of the examination was analyzed,and the suggestions and feedback of candidates and examiners on different proposition methods were collected by questionnaires.Results There was no significant difference in the pass rate between 2023(98.88%)and 2022(98.38%).The average score of the basic skills operation test station in 2023(19.00±2.34)was lower than that in 2022(20.88±2.40),the average score of the doctor-patient communication test station in 2023(11.78±1.44)was lower than that in 2022(13.20±1.09),and the average score of the total score in 2023(79.24±6.75)was lower than that in 2022(81.86±7.29),all of which showed significant significance(P<0.001).Candidates and examiners tend to choose the organizational form of the practical assessment of the national unified proposition assessment.The difficulty coefficient of the 2023 exam(0.79)was more difficult than that of 2022(0.82).Conclusion The national proposition promotes the improvement of the standardized training and assessment quality of general practice residents,which is more in line with the current development situation of resident training.