中华医学教育杂志

中华医学教育杂志 ›› 2017, Vol. 37 ›› Issue (1): 129-133.DOI: 10.3760/cma.j.issn.1673-677X.2017.01.028

• 医学教育评估 • 上一篇    下一篇

基于结果的住院医师石膏固定术考核方法的探讨

齐心, 翟伟, 张道俭, 李岩, 路潜, 金哲, 李海潮   

  1. 100034 北京大学第一医院整形烧伤科(齐心、翟伟),骨科(张道俭),心外科(李岩),呼吸内科(金哲、李海潮);
    100191 北京大学护理学院内外科护理学教研室(路潜)
  • 出版日期:2017-01-01 发布日期:2020-12-09
  • 通讯作者: 李海潮, Email:lhch91767@sina.com

A study on the outcome-based assessment of plaster fixation of residents

Qi Xin, Zhai Wei, Zhang Daojian, Li Yan, Lu qian, Jin Zhe, Li Haichao   

  1. Department of Plastic &
    Burn Surgery, Peking University First Hospital, Beijing 100034, China (Qi X, Zhai W);
    Department of Orthopaedics, Peking University First Hospital, Beijing 100034, China (Zhang DJ);
    Department of Cardiac Surgery, Peking University First Hospital, Beijing 100034, China (Li Y);
    Department of Respiratory Medicine, Peking University First Hospital, Beijing 100034, China (Jin Z, Li HC);
    Teaching and Research Section of Medical &
    Surgical Nursing, Peking University School of Nursing, Beijing 100191, China (Lu Q)
  • Online:2017-01-01 Published:2020-12-09
  • Contact: Li Haichao, Email:lhch91767@sina.com

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摘要： 目的 比较过程性评价和基于结果的评价在石膏固定术考核中的效果,为评价外科住院医师的临床胜任力提供依据。方法 选择2014年在北京大学第一医院进行第一年规范化培训的31名外科住院医师为研究对象,设立模拟外踝无移位骨折石膏固定术考试站点,采用基于过程的评价标准对石膏固定结果进行主观评分、经验判断和绷带下压力测量,比较不同评价方法的异同点和相关性。结果 31名外科住院医师平均成绩(80.32±7.19)分,平均包扎时间(8.90±2.12)分钟,结束时足跟部平均压力(20.94±18.25) mm Hg,足踝部平均压力(5.74±5.01) mm Hg。足跟压力达标组与不达标组之间主观评分差异无统计学意义(P＞0.05)。经验判断松紧度适中组和偏松组之间,足跟部压力差异无统计学意义(P＞0.05),足踝部压力差异有统计学意义(P＜0.05)。3种方法之间一致率均为67.7%,3者之间无相关性。是否轮转过骨科对主观评分结果具有显著影响。结论 现有基于过程的评价标准无法有效评价石膏固定术的实际效果,基于结果的评价能够弥补这一缺陷,在规范住院医师操作的基础上,切实有效提高他们的临床胜任力。

关键词: 住院医师, 基于过程的评价, 基于结果的评价, 临床胜任力

Abstract: Objective To compare the difference between procedure-based assessment and outcome-based assessment in plaster fixation examination and provide basis for assessing the clinical competency of surgical residents.Methods A total of 31 postgraduate year 1 (PGY1) surgery residents who had been trained in the Surgical School of Peking University First Hospital for 1 year were enrolled in the study. A station of plaster fixation was set to simulate lateral malleolus fracture and subjectively evaluated by procedure-based assessment. Besides, the plaster fixation final results were assessed by subjective assessment, empirical judgment andObjective measurement in order to compare the difference, similarity and correlation among them.Results The average score of the plaster test was (80.32±7.19), and the average dressing time was (8.90±2.12) min. The average heel pressure at the end of dressing was (20.94±18.25) mmHg, while the ankle pressure was (5.74±5.01) mmHg. There was no significant difference in subjective score of the group whose ankle pressure up to standard and the group whose were not. There was no significant difference in the heel pressure between moderate group and looser group considered by clinical tightness (P＞0.05), while there was significant difference in the ankle pressure (P＜0.05). The consistency between the three methods was 67.7%, but there was no correlation between the three methods. In addition, there was significant difference in score between the residents who have had or not the orthopedic rotation.Conclusions The study suggests that existing procedure-based assessment could not evaluate the actual result of plaster fixation effectively, while outcome-based assessment could compensate this kind of deficiency. It could help improve residents' competency efficiently and effectively based on standardizing their operation.

Key words: Resident, Procedure-based assessment, Outcome-based assessment, Clinical competency