中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2015年
13期
1552-1554,1559
,共4页
丁志良%方建新%赵齐%黄敏
丁誌良%方建新%趙齊%黃敏
정지량%방건신%조제%황민
全科医生%规范化培训%客观结构化临床考试
全科醫生%規範化培訓%客觀結構化臨床攷試
전과의생%규범화배훈%객관결구화림상고시
General practitioners%Standardized training%Objective structured clinical examination
目的：了解2006—2011届苏州市全科医师规范化培训学员临床技能结业考核情况，并对考核结果进行分析。方法于2009年7月—2014年7月，采用客观结构化临床考试（ objective structured clinical examination，OSCE）对苏州市全科医师规范化培训学员进行临床技能结业考核，比较并分析6年来各站点的合格情况。结果（1）2006—2011届共有192名全科医师规范化培训学员参加了临床技能结业考核，病史采集、体格检查、病例分析、病历书写、基本技能操作、X线片解读及心电图解读的总合格率分别为89.1%（171/192）、72.9%（140/192）、87.0%（167/192）、87.5%（168/192）、98.4%（189/192）、67.7%（130/192）及66.7%（128/192）。（2）各站点总合格率比较，差异有统计学意义（χ2=112.99，P﹤0.0024）。体格检查的总合格率与病史采集、病例分析、病历书写及基本技能操作的总合格率比较，差异有统计学意义（ P﹤0.0024）；X线片解读的总合格率与病史采集、病例分析、病历书写及基本技能操作的总合格率比较，差异有统计学意义（ P﹤0.0024）；心电图解读的总合格率与病史采集、病例分析、病历书写及基本技能操作的总合格率比较，差异有统计学意义（ P﹤0.0024）；基本技能操作的总合格率与病史采集、体格检查、病例分析、病历书写、X线片解读及心电图解读的总合格率比较，差异有统计学意义（ P﹤0.0024）。（3）6年来体格检查（χ2=7.56，P =0.007）、X 线片解读（χ2=14.98，P ﹤0.001）及心电图解读（χ2=19.63，P ﹤0.001）的合格率逐年提高。结论苏州市全科医师规范化培训学员结业考核的总合格率较高，但各站点间差异较大，体格检查和辅助检查结果解读是薄弱环节。OSCE能够充分考察学员的临床技能、“三基”水平、对医学知识的理解和应用能力、临床思维能力，可以提高全科医师对临床技能的重视程度，增强临床带教效果。
目的：瞭解2006—2011屆囌州市全科醫師規範化培訓學員臨床技能結業攷覈情況，併對攷覈結果進行分析。方法于2009年7月—2014年7月，採用客觀結構化臨床攷試（ objective structured clinical examination，OSCE）對囌州市全科醫師規範化培訓學員進行臨床技能結業攷覈，比較併分析6年來各站點的閤格情況。結果（1）2006—2011屆共有192名全科醫師規範化培訓學員參加瞭臨床技能結業攷覈，病史採集、體格檢查、病例分析、病歷書寫、基本技能操作、X線片解讀及心電圖解讀的總閤格率分彆為89.1%（171/192）、72.9%（140/192）、87.0%（167/192）、87.5%（168/192）、98.4%（189/192）、67.7%（130/192）及66.7%（128/192）。（2）各站點總閤格率比較，差異有統計學意義（χ2=112.99，P﹤0.0024）。體格檢查的總閤格率與病史採集、病例分析、病歷書寫及基本技能操作的總閤格率比較，差異有統計學意義（ P﹤0.0024）；X線片解讀的總閤格率與病史採集、病例分析、病歷書寫及基本技能操作的總閤格率比較，差異有統計學意義（ P﹤0.0024）；心電圖解讀的總閤格率與病史採集、病例分析、病歷書寫及基本技能操作的總閤格率比較，差異有統計學意義（ P﹤0.0024）；基本技能操作的總閤格率與病史採集、體格檢查、病例分析、病歷書寫、X線片解讀及心電圖解讀的總閤格率比較，差異有統計學意義（ P﹤0.0024）。（3）6年來體格檢查（χ2=7.56，P =0.007）、X 線片解讀（χ2=14.98，P ﹤0.001）及心電圖解讀（χ2=19.63，P ﹤0.001）的閤格率逐年提高。結論囌州市全科醫師規範化培訓學員結業攷覈的總閤格率較高，但各站點間差異較大，體格檢查和輔助檢查結果解讀是薄弱環節。OSCE能夠充分攷察學員的臨床技能、“三基”水平、對醫學知識的理解和應用能力、臨床思維能力，可以提高全科醫師對臨床技能的重視程度，增彊臨床帶教效果。
목적：료해2006—2011계소주시전과의사규범화배훈학원림상기능결업고핵정황，병대고핵결과진행분석。방법우2009년7월—2014년7월，채용객관결구화림상고시（ objective structured clinical examination，OSCE）대소주시전과의사규범화배훈학원진행림상기능결업고핵，비교병분석6년래각참점적합격정황。결과（1）2006—2011계공유192명전과의사규범화배훈학원삼가료림상기능결업고핵，병사채집、체격검사、병례분석、병역서사、기본기능조작、X선편해독급심전도해독적총합격솔분별위89.1%（171/192）、72.9%（140/192）、87.0%（167/192）、87.5%（168/192）、98.4%（189/192）、67.7%（130/192）급66.7%（128/192）。（2）각참점총합격솔비교，차이유통계학의의（χ2=112.99，P﹤0.0024）。체격검사적총합격솔여병사채집、병례분석、병역서사급기본기능조작적총합격솔비교，차이유통계학의의（ P﹤0.0024）；X선편해독적총합격솔여병사채집、병례분석、병역서사급기본기능조작적총합격솔비교，차이유통계학의의（ P﹤0.0024）；심전도해독적총합격솔여병사채집、병례분석、병역서사급기본기능조작적총합격솔비교，차이유통계학의의（ P﹤0.0024）；기본기능조작적총합격솔여병사채집、체격검사、병례분석、병역서사、X선편해독급심전도해독적총합격솔비교，차이유통계학의의（ P﹤0.0024）。（3）6년래체격검사（χ2=7.56，P =0.007）、X 선편해독（χ2=14.98，P ﹤0.001）급심전도해독（χ2=19.63，P ﹤0.001）적합격솔축년제고。결론소주시전과의사규범화배훈학원결업고핵적총합격솔교고，단각참점간차이교대，체격검사화보조검사결과해독시박약배절。OSCE능구충분고찰학원적림상기능、“삼기”수평、대의학지식적리해화응용능력、림상사유능력，가이제고전과의사대림상기능적중시정도，증강림상대교효과。
Objective To conduct the final assessments on clinical skills in the 2006—2011 standard training for general practitioners in Suzhou and make analyses on the assessment results. Methods The final assessments on clinical skills of trainees who received 2006—2011 standardized training for general practitioners in Suzhou were carried out using objective structured clinical examination( OSCE)from July 2009 to July 2014. The pass rate of each training site in the six years was analyzed and compared. Results ( 1 ) A total of 192 trainees of 2006—2011 standardized training took part in the final assessments. The pass rates of medical history collection,physical examination,case analysis,medical record writing,clinical basic skills and operations,diagnostic decision -making based on x -ray films and electrocardiograms( ECGs)were 89. 1%(171/192),72. 9%( 140/192 ),87. 0%( 167/192 ),87. 5%( 168/192 ),98. 4%( 189/192 ),67. 7%( 130/192 )and 66. 7%(128/192). (2) The overall pass rates of various training sites were significantly different from each other(χ2=112. 99,P﹤0. 002 4). The overall pass rate of physical examination was significantly different(P﹤0. 002 4)from that of medical history collection,case analysis,medical record writing,and clinical basic skills and operations;the overall pass rate of diagnostic decision-making based on x -ray films was significantly different(P ﹤0. 002 4)from that of medical history collection,case analysis,medical record writing,and clinical basic skills and operations;the overall pass rate of diagnostic decision-making based on ECGs was significantly different ( P ﹤ 0. 002 4 ) from that of medical history collection, case analysis,medical record writing, and clinical basic skills and operations;the overall pass rate of clinical basic skills and operation was significantly different(P﹤0. 002 4)from that of medical history collection,physical examination,case analysis, medical record writing,and diagnostic decision -making based on ECGs and x -ray films. ( 3 ) The pass rates of physical examination(χ2 =7. 56,P=0. 007),diagnostic decision -making based on x -ray films(χ2 =14. 98,P ﹤0. 001)and ECGs(χ2 =19. 63,P﹤0. 001)remained an increasing trend in the six years. Conclusion The overall pass rate of the trainees in Suzhou is relatively higher, while large gaps exist among different training sites. The physical examination and diagnostic decision-making based on ECGs and x-ray films are the weak links for general practitioners. By using 0SCE,trainees could be comprehensively assessed on clinical skills, basic theories, basic medical knowledge, basic skills, understanding and application ability of medical knowledge and clinical thinking ability,in order to help general practitioners attach more importance on clinical skills and improve the clinical teaching effects.
