中华医学教育杂志

中华医学教育杂志 ›› 2026, Vol. 46 ›› Issue (3): 224-229.DOI: 10.3760/cma.j.cn115259-20250409-00396

• 医学教育评估 • 上一篇    下一篇

里程碑改良三维评价体系在儿科住院医师核心胜任力培养中的应用

陈文娟1, 曹清1, 张静2, 王莹3, 董璐4, 李萍萍4, 王翠锦5, 步军6   

  1. 1上海交通大学医学院附属上海儿童医学中心感染科, 上海 200127;
    2上海交通大学医学院附属上海儿童医学中心呼吸科, 上海 200127;
    3上海交通大学医学院附属上海儿童医学中心儿童重症监护病房, 上海 200127;
    4上海交通大学医学院附属上海儿童医学中心儿科临床医学院, 上海 200127;
    5上海交通大学医学院附属上海儿童医学中心神经内科, 上海 200127;
    6上海交通大学医学院附属上海儿童医学中心新生儿科, 上海 200127
  • 收稿日期:2025-04-09 出版日期:2026-03-01 发布日期:2026-02-28
  • 通讯作者: 步军, Email: bujun@scmc.com.cn
  • 基金资助:
    上海交通大学医学院儿科学院教学类科研课题项目(EXJX2020001DGD)

Application of a modified three-dimensional milestones evaluation system in cultivating core competencies among pediatric residents

Chen Wenjuan1, Cao Qing1, Zhang Jing2, Wang Ying3, Dong Lu4, Li Pingping4, Wang Cuijin5, Bu Jun6   

  1. 1Department of Infectious Diseases, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China;
    2Department of Respiratory Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China;
    3Pediatric Intensive Care Unit, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China;
    4Pediatric College of Clinical Medicine, Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China;
    5Department of Neurology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China;
    6Department of Neonatology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Received:2025-04-09 Online:2026-03-01 Published:2026-02-28
  • Contact: Bu Jun, Email: bujun@scmc.com.cn
  • Supported by:
    Educational Research Project, School of Pediatrics, Shanghai Jiao Tong University School of Medicine(EXJX2020001DGD)

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摘要： 目的 分析以胜任力为导向的里程碑(Milestones)改良三维评价体系在儿科住院医师规范化培训(简称住培)学员核心胜任力培养中的应用效果。方法 2021年10月至2024年10月,采用前瞻性队列研究设计,基于ACGME milestones评价框架,修订符合儿科临床实践的改良版《儿科住院医师胜任力评估量表》。连续纳入上海交通大学医学院附属上海儿童医学中心儿科专业基地2020至2022年接受住培的78名学员;培训第二年和第三年住培学员完成年度考核(教师评价)的同时,运用里程碑评估表进行自我评价(住培学员自评),建立包含教师评价、住培学员自评和系统追踪的三维评价框架用于评估住培学员的核心胜任力。采用配对t检验和独立样本t检验进行组内前后比较及组间比较,采用Pearson线性相关分析评估变量的相关性。结果 第三年住培学员的教师评分与住培学员自评评分均高于第二年住培学员[(433.60±25.59)分比(393.08±48.37)分,(63.11±13.63)分比(54.39±12.16)分,均P<0.001];自主培训住培学员与专业学位硕士研究生的教师评分和住培学员自评评分在第二年和第三年的差异均无统计学意义[第二年:(393.36±49.68)分比(387.37±53.97)分,(58.85±12.17 比)分比(59.96±12.55)分;第三年:(431.77±28.39)分比(437.26±23.20)分,(62.79±14.64)分比(62.41±13.69)分,均P>0.05];教师评价总评分与住培学员自评总评分的相关性在第二年为负向相关(r=-0.26,P=0.003),第三年为正向相关(r=0.24,P=0.039)。结论 Milestones改良三维评价体系能够有效追踪儿科住培学员核心胜任力的发展轨迹。住培学员的核心胜任力随培训年限呈阶梯式上升,不同身份归属的住培学员在培训中后期的核心胜任力趋于一致。相对客观的教师评价和主观的住培学员自评相互校验与整合,有助于全面、系统评价住院医师的临床核心胜任力。

关键词: 儿科学, 胜任力, 里程碑评价, 住院医师规范化培训, 住培学员

Abstract: Objective To analyze the application effect of a competency-oriented modified three-dimensional Milestones evaluation system in tracking the development of clinical core competencies among pediatric residency trainees. Methods A prospective cohort study was conducted from October 2021 to October 2024. Based on the ACGME Milestones framework, a modified ″Pediatric Resident Competency Assessment Scale″ tailored to pediatric clinical practice was developed. Seventy-eight trainees who underwent standardized residency training at the Pediatric Specialty Base of Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine from 2020 to 2022 were consecutively enrolled. During the second and third years of training, while completing the annual assessment (teacher evaluation), trainees also performed self-evaluations using the milestones assessment form (trainee self-evaluation), establishing a three-dimensional evaluation framework integrating teacher evaluation, trainee self-evaluation, and system tracking to assess the clinical core competencies of the trainees. Paired t-tests and independent samples t-tests were used for within-group longitudinal comparisons and between-group comparisons, respectively. Pearson linear correlation analysis was employed to assess correlations between variables. Results Both teacher evaluation scores and trainee self-evaluation scores in the third year were significantly higher than those in the second year [(433.60 ± 25.59) vs. (393.08 ± 48.37), (63.11 ± 13.63) vs. (54.39 ± 12.16), all P < 0.001]. There were no statistically significant differences in teacher evaluation scores or trainee self-evaluation scores between independent residency trainees and clinical medicine master's degree residents in either the second or third year [Year 2: (393.36 ± 49.68) vs. (387.37 ± 53.97), (58.85 ± 12.17) vs. (59.96 ± 12.55); Year 3: (431.77 ± 28.39) vs. (437.26 ± 23.20), (62.79 ± 14.64) vs. (62.41 ± 13.69); all P > 0.05]. The correlation between total teacher evaluation scores and total trainee self-evaluation scores was negative in the second year (r=-0.26, P =0.003) but positive in the third year (r = 0.24, P = 0.039). Conclusions The modified three-dimensional milestones evaluation system can effectively track the developmental trajectory of clinical core competencies in pediatric residency trainees. The core competencies of trainees increase in a stepwise manner with additional years of training, and competencies among trainees with different backgrounds tend to converge in the mid-to-late stages of training. The mutual verification and integration of relatively objective teacher evaluations and subjective trainee self-evaluations contribute to a comprehensive and systematic assessment of residents' clinical core competencies.

Key words: Pediatrics, Competence, Milestones evaluation system, Standardized residency training, Residency trainees

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