中华医学教育杂志

中华医学教育杂志 ›› 2023, Vol. 43 ›› Issue (2): 156-160.DOI: 10.3760/cma.j.cn115259-20220826-01082

• 医学教育评估 • 上一篇    

住院医师置信职业行为量表在住培评价中的应用探索

刘喆1, 刘林2, 周文静3, 江哲涵4, 齐建光5, 闫辉5, 李海潮6, 齐心7   

  1. 1北京大学第一医院妇产科,北京 100034;
    2北京大学第一医院内分泌科,北京 100034;
    3北京大学公共卫生学院卫生政策与管理学系,北京 100191;
    4北京大学医学教育研究所 全国医学教育发展中心,北京 100191;
    5北京大学第一医院儿科,北京 100034;
    6北京大学第一医院呼吸和危重症医学科,北京 100034;
    7北京大学第一医院整形烧伤科,北京 100034
  • 收稿日期:2022-08-26 出版日期:2023-02-01 发布日期:2023-01-31
  • 通讯作者: 齐心, Email: randyq@126.com
  • 基金资助:
    2021年北京市住院医师规范化培训质量提高项目(2021034);2021年“北大研究”课题(2021ZZ04)

Exploration of the evaluation with the entrustable professional activities scale in standardized residency training

Liu Zhe1, Liu Lin2, Zhou Wenjing3, Jiang Zhehan4, Qi Jianguang5, Yan Hui5, Li Haichao6, Qi Xin7   

  1. 1Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China;
    2Department of Endocrinology, Peking University First Hospital, Beijing 100034, China;
    3Department of Health Policy and Management,School of Public Health, Peking University, Beijing 100191, China;
    4Institute of Medical Education & National Center for Health Professions Education Development, Peking University, Beijing 100191, China;
    5Department of Pediatrics, Peking University First Hospital, Beijing 100034, China;
    6Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing 100034, China;
    7Department of Plastic Surgery & Burns, First Hospital Peking University, Beijing 100034, China
  • Received:2022-08-26 Online:2023-02-01 Published:2023-01-31
  • Contact: Qi Xin, Email: randyq@126.com
  • Supported by:
    2021 Resident Doctor Standardized Training Quality Improvement Project (2021034);2021 ″Peking University Research″ Project(2021ZZ04)

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摘要： 目的 分析住院医师置信职业行为量表在住院医师规范化培训中的应用效果。方法 2022年1月,采用目的抽样方法,选择2021年12月至2022年1月北京大学第一医院内科、外科、妇产科和儿科进行规范化培训的230名住院医师及其71名指导医师为研究对象,指导医师采用住院医师置信职业行为量表对住院医师的15项置信职业行为进行评价。采用Kruskal-Wallis H检验比较不同学科、不同年资住院医师之间置信级别的差异,以确定能否达到分层递进的培训原则。采用概化系数检验住院医师置信职业行为量表的评价信度。 结果 住院医师置信职业行为量表的概化系数为0.980。指导医师对内科、妇产科和儿科住院医师的评价中,第二年住院医师的置信级别评价高于第一年住院医师[如妇产科住院医师接诊患者,4.0(0.6)比3.0(0),均矫正P＜0.001];第三年住院医师的置信级别评价高于第二年住院医师 [如妇产科住院医师接诊患者,4.5(0.8)比4.0(0.6),均矫正P＜0.001],差异均具有统计学意义。指导医师对外科住院医师的评价中,第一年与第二年住院医师[如一般临床问题识别与处理,4.0(0.3)比4.0(0.5),矫正P=0.591]、第二年和第三年住院医师[如一般临床问题识别与处理,4.0(0.5)比4.0(0.5),矫正P=0.047]的置信级别评价差异均无统计学意义。结论 住院医师置信职业行为量表可靠、稳定,能够有效反映住院医师规范化培训效果。其中内科、妇产科、儿科住院医师规范化培训符合分层递进的培训原则,外科住院医师培训有必要重新规划年度培训计划。

关键词: 住院医师规范化培训, 置信职业行为, 胜任力导向医学教育

Abstract: Objective To explore the application of the entrustable professional activities scale in standardized residency training. Methods In January 2022, 230 residents who received standardized training in the Department of Internal Medicine, Surgery, Obstetrics & Gynecology and Pediatrics of Peking University First Hospital from December 2021 to January 2022 and 71 clinical instructors were selected as the research participants by purposive sampling. Clinical instructors were instructed to assess trainees using the entrustable professional activities scale for 15 entrustable professional activities. The Kruskal-Wallis H test was used to compare the differences in entrustable levels among residents of different disciplines and grades to determine whether the educational principle of hierarchical progression could be achieved, and the generalization coefficient was used to test the evaluation confidence of the entrustable professional activities scale. Results The generalizability coefficient of the entrustable professional activities scale was 0.980. Entrustable levels from internal medicine, obstetrics & gynecology and pediatrics second-year residents by clinical instructors were higher than those of the first-year residents[for example, in history-taking and physical examination during patient encounter by obstetrics & gynecology residents: 4.0 (0.6) vs. 3.0 (0), all adjust P<0.001], and the third-year residents' entrustable levels were higher than the second-year residents' [for example, in history-taking and physical examination during patient encounter by obstetrics & gynecology residents: 4.5 (0.8) vs. 4.0 (0.6), all adjust P<0.001]. Levels of entrustability by clinical instructors from surgical residents were no significant differences between the first-year residents and the second-year residents either [for example, in indentify and manage the general clinical conditions: 4.0 (0.3) vs. 4.0 (0.5), adjust P=0.591], and there were no significant differences between the second-year residents and the third-year residents [for example, in indentify and manage the general clinical conditions: 4.0(0.5)vs.4.0(0.5), adjust P=0.047]. Conclusions The entrustable professional activities scale is reliable and stable, and can effectively reflect the effect of standardized training of residents. Among them, the standardized training of obstetrics & gynecology residents conforms to the principle of hierarchical and progressive training, and it is necessary to re-plan the annual training programme for internal medicine, surgery, and pediatrics.

Key words: Standardized residency training, Entrustable professional activities, Competency-based medical education

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