CAJ | 학술논문

目的目前国内外将迷你临床演练评估(mini-CEX)广泛使用于医学生临床技能学习的过程评估之中.这一评价方法基于学生的实际表现,其评估和反馈为一对一形式,观察者多由高年资医师承担.由于不同的观察者之间认知和水平的差异,观察者之间的评分一致性是目前mini-cex考核亟需解决的问题.方法本文通过使用目前mini-cex常用的视频工作室培训方式,观察了标准考核录像培训对于初次接触mini-cex考核方式的临床医师评分一致性的影响.使用目前通行的视频工作室方式培训初次接触mini-cex考核医师共22人,均为任主治医师3年以上临床医师.评分结果使用秩和检验.结果经过2次标准考核录像培训,观察者对于mini-cex量表相对客观项目“医学面谈技巧”项目评分一致性有显著改善,P=0.003,“体格检查技巧”评分一致性有所改善,但无显著性(P=0.069).而相对主观项目(人道关怀/临床判断/组织能力/总体临床能力)评分一致性则无显著影响.结论初次接触mini-CEX考核方式的观察者通过2轮次视频工作室培训后,对于客观评价项目一致性有显著影响,但对于主观评价项目评分一致性没有影响.需要进一步研究以提高评价一致性.
목적 목전국내외장미니림상연련평고(mini-CEX)엄범사용우의학생림상기능학습적과정평고지중.저일평개방법기우학생적실제표현,기평고화반궤위일대일형식,관찰자다유고년자의사승담.유우불동적관찰자지간인지화수평적차이,관찰자지간적평분일치성시목전mini-cex고핵극수해결적문제.방법 본문통과사용목전mini-cex상용적시빈공작실배훈방식,관찰료표준고핵록상배훈대우초차접촉mini-cex고핵방식적림상의사평분일치성적영향.사용목전통행적시빈공작실방식배훈초차접촉mini-cex고핵의사공22인,균위임주치의사3년이상림상의사.평분결과사용질화검험.결과 경과2차표준고핵록상배훈,관찰자대우mini-cex량표상대객관항목“의학면담기교”항목평분일치성유현저개선,P=0.003,“체격검사기교”평분일치성유소개선,단무현저성(P=0.069).이상대주관항목(인도관부/림상판단/조직능력/총체림상능력)평분일치성칙무현저영향.결론 초차접촉mini-CEX고핵방식적관찰자통과2륜차시빈공작실배훈후,대우객관평개항목일치성유현저영향,단대우주관평개항목평분일치성몰유영향.수요진일보연구이제고평개일치성.
Aim Mini-CEX is used in the evaluation process of medical students' clinical training.This evaluation method is workplace-based direct assessments of students' performance.The observers of mini-cex are usually senior physicians.How to minimize inter-accessor scoring variation is crucial in the practice of mini-CEX.Method by using video-workshop training model,the inter-accessor scoring variations between first-contact trainees were accessed.Data were analyzed with rank-sum test.Results 22 first-contact physicians (with ＞ 3 years' experience of attendant doctor) underwent standard videoworkshop mini-CEX training program.After 2 rounds of video demonstration,significant difference in scoring variation was found in objective item as "Medical interviewing skills",P=0.003.An insignificant increase in physical examination skills was also noticed (P=0.069).No significant differences were found in other subjective scoring items (professional/clinical judgment/organization/overall clinical skills).Conclusion video-work shop training with 2 round of standard video demo could reduce the inter-accessor variation in objective scoring item,but had no significant effects on the subjective scoring items.