基于置信职业行为的住院医师岗位胜任力评估探索

Exploration of post competency assessment of resident physicians based on entrustable professional activities in standardized residency training

目的 在已有住院医师规范化培训(简称住培)评价体系上,结合住院医师置信职业行为(entrustable professional activities,EPAs)指标综合评估东莞东华医院全科医学专业基地住院医师胜任力,探索构建新型全科住院医师的形成性评价体系,进而推动各专业基地EPAs评估体系建设。方法 分别采用原有形成性评价方法和EPAs评估方法对该院全科医学科专业基地3个年级的住院医师进行评估,选取原有评价方法中迷你临床演练评估(mini-clinical evaluation exercise,Mini-CEX)和操作技能直接观察(direct observation of procedural skills,DOPS)进行指标分析。EPAs评估包含5个评级15项指标,分别采取他评与自评办法。结果 3个年级Mini-CEX和DOPS评价中仅在Mini-CEX评估中的临床判断指标得分差异有统计学意义(H=6.95,P=0.03),其余指标差异均无统计学意义(均P> 0.05)。本研究中EPAs量表Cronbach's α系数为0.978。EPAs评估发现,3个年级住院医师15项评价指标的他评和自评得分差异均存在统计学意义(均P<0.05),随着培训年限的增加,得分提高,临床行为也逐渐提升。自评与他评之间存在差异的指标包括接诊患者、辅助检查选择和判读、医疗文书书写及病例汇报4项,差异均有统计学意义(均P <0.05)。结论 EPAs评估提供了简易可行且被住院医师接受的评估方法,与现有的形成性评价体系相结合,为胜任力导向的住院医师培养提供了更为真实可靠的依据。

Objective To explore the new formative evaluation system for general medical resident physicians to promote the development of the entrustable professional activities(EPAs) evaluation system,based on the existing standardized training evaluation system for resident physicians combined with the EPAs indicators.Methods The original formative evaluation method and EPAs evaluation method were used to evaluate the three-year general medical residents in Dongguan Tungwah Hospital's standardized training base for resident physicians.Mini-clinical evaluation exercise(Mini-CEX) and direct observation of procedural skills(DOPS) were selected from the original evaluation method for indicator analysis.EPAs evaluation referred to 15 indicators,was divided into 5 levels,and adopted peer-evaluation and self-evaluation methods.Results Among the Mini-CEX and DOPS evaluations,there was no statistical difference in indicator score between the three years of training,except for clinical judgment in the Mini-CEX evaluation(H=6.95,P=0.03).The Cronbach's α coefficient of the EPAs scale in this study was 0.978.The EPAs evaluation found that there were statistical differences in the peer-evaluation and self-evaluation scores of all 15 evaluation indicators between the three years of training(all P < 0.05).As the years of training increased,the scores increased,and clinical behavior was gradually improved.Among the indicators,there were four items with differences between self-evaluation and peer-evaluation:patient reception,selection and interpretation of auxiliary examinations,medical record writing,and case report(all P < 0.05).Conclusion Evaluation based on the EPAs provides a simple and feasible evaluation method that is accepted by resident physicians.Combined with the existing formative evaluation system,it provides a more reliable basis for competence-oriented resident training.