目的 构建适用于我国住院医师的非专业临床能力框架。方法 采用文献研究、内容分析、访谈等方法,形成专家函询问卷初稿。采用德尔菲法,围绕住院医师非专业临床能力的概念和内涵、维度、定义及权重对19名专家进行了2轮函询,运用优序图法判定各维度的权重。结果 2轮专家函询问卷回收率分别为95.0%(19/20)和100.0%(19/19),专家权威系数为0.89,经Kendall's W检验专家意见具有一致性。整合专家意见,讨论后形成住院医师非专业临床能力内涵和6个能力维度,即人文关怀能力、沟通能力、团队合作能力、批判性思维能力、自主学习能力和信息素养。结论 本研究构建的住院医师非专业临床能力内涵明确,住院医师非专业临床能力框架包括6个维度,各个能力维度定义清晰、可操作性强,可用于住院医师非专业临床能力测评工具的开发。
姜宇
,
夏洁
,
陈心航
,
臧悦
,
李危石
,
谷士贤
,
汪恒
,
李楠
,
田华
. 住院医师非专业临床能力框架的构建[J]. 中华医学教育杂志, 2021
, 41(8)
: 749
-753
.
DOI: 10.3760/cma.j.cn115259-20210104-00006
Objective To construct a framework of non-professional competency residents in China. Methods The questionnaire of expert consultation was designed through literature retrieve, content analysis and interview. Then, Delphi method and precedence chart method were used to conduct 2 rounds of expert consultation to 19 experts to evaluate the concept and connotation of non-professional clinical competency of residents, as well as the composition, definition and weight of each dimension. Results The recovery of questionnaires of 2 rounds was 95.0%(19/20)and 100.0%(19/19)respectively,the expert authority coefficient was 0.89,and the expert opinion was unanimous after Kendall's W test. The competency framework was finally constructed based on experts' opinions and discussion concerned, which included six dimensions, namely humanistic care, communication, teamwork, critical thinking, self-directed learning and information collection. Conclusions The concept and connotation of the framework were well identified. The competency framework included six dimensions, each dimension was clearly described and easy to operate, so it can be used for development of assessment tool for non-professional clinical competency.
[1] 杜治政. 论现代临床医学发展的人文走向[J].医学与哲学(人文社会医学版),2008,29(6):2-6,11.
[2] Frenk J, Chen L, Bhutta ZA, et al.Health professionals for a new century: transforming education to strengthen health systems in an interdependent world[J]. Lancet, 2010, 376(9756):1923-1958.DOI:10.1016/S0140-6736(10)61854-5.
[3] Swainson J, Marsh M, Tibbo PG. Psychiatric residents as teachers: development and evaluation of a teaching manual[J]. Acad Psychiatry, 2010,34(4):305-309. DOI: 10.1176/appi.ap.34.4.305.
[4] Royal College of Physicians and Surgeons of Canada. CanMEDS 2015 physician competency framework[EB/OL]. [2020-08-28]. http://www.royalcollege.ca/rcsite/documents/cbd/canmeds-2015-physician-competency-framework-e.
[5] 孟现志. 就业困境下大学生非专业素质培养的路径选择[J].中国高教研究,2009(7):88-89.
[6] 林昭雄, 庞永师, 孟强. 大学生成才与“非专业能力”培养[J].广州大学学报(社会科学版),2008(5):45-48.
[7] 李安.论职业教育中的“非专业能力”[J].中国建设教育, 2012(Z2):31-35.
[8] 李原福,张鑫,曹阳.高职教育学生管理中非专业能力培养的有效方法和途径[J].教育与职业,2011(35):167-168.
[9] 李强, 徐元彬. 大学生非专业能力培养体系的构建及效果评估[J].中国成人教育,2014(17):58-60.
[10] 中华人民共和国教育部. 国家卫生计生委 中央编办 国家发展改革委 教育部 财政部 人力资源社会保障部 国家中医药管理局关于建立住院医师规范化培训制度的指导意见[EB/OL]. [2020-08-28].http://www.moe.gov.cn/jyb_xxgk/moe_1777/moe_1779/201404/t20140402_166632.html.
[11] Accreditation Council for Graduate Medical Education . Milestones guidebook for residents and fellows [EB/OL]. [2020-08-28].https://www.acgme.org/What-We-Do/Accreditation/Milestones/Resources.
[12] 陈海波.我国首个住院医师核心胜任力框架共识发布[N/OL].光明日报,2018-09-14[2020-08-28]. https://baijiahao.baidu.com/s?id=1611584227875675195&wfr=spider&for=pc.
[13] 黄省利, 李宗芳, 刘原, 等. 应重视住院医师规范化培训中非技术性技能的培养[J].中国卫生事业管理,2017,34(9):649-650.
[14] Gordon M, Farnan J, Grafton-Clarke C, et al. Non-technical skills assessments in undergraduate medical education: a focused BEME systematic review: BEME Guide No. 54[J]. Med Teach, 2019,41(7):732-745. DOI: 10.1080/0142159X.2018.1562166.
[15] 李勇, 马小波, 高新春, 等. 非技术技能培训在基层胸痛中心建设中的应用[J].中华灾害救援医学,2019,7(7):380-383. DOI: 10.13919/j.issn.2095-6274.2019.07.005.
[16] Hull L, Sevdalis N. Advances in teaching and assessing nontechnical skills[J]. Surg Clin North Am, 2015,95(4):869-884. DOI: 10.1016/j.suc.2015.04.003.
[17] Taylor DR, Park YS, Smith CA, et al. Creating entrustable professional activities to assess internal medicine residents in training: a mixed-methods approach[J]. Ann Intern Med, 2018,168(10):724-729. DOI: 10.7326/M17-1680.
[18] 刘翔宇, 谌永毅, 周钰娟, 等. 住院患者护理服务满意度评价指标体系的构建[J].中华护理杂志,2015,50(1):18-21. DOI: 10.3761/j.issn.0254-1769.2015.01.004.
[19] 曾光.现代流行病学方法与应用[M].北京:北京医科大学中国协和医科大学联合出版社, 1994:250-270.
[20] 刘小康.医学本科生一般能力评价指标体系的构建研究[D].北京:北京大学, 2017.
[21] 李娟生, 李江红, 刘小宁, 等. Kendall's W分析方法在医学数据处理中的应用及在SPSS中的实现方法[J].现代预防医学,2008(1):33,42.
[22] 季新强, 刘志民. Delphi法及其在医学研究和决策中的应用[J].中国药物依赖性杂志,2006,15(6):422-426. DOI: 10.3969/j.issn.1007-9718.2006.06.003.
[23] 曹望楠, 蔡景一, 常春. 优序图法在确定高等医学院校教师教学能力指标体系权重中的应用[J].中华医学教育杂志,2014,34(3):381-383. DOI: 10.3760/cma.j.issn.1673-677X.2014.03.017.
[24] 戴一鸣, 乔旺忠. 德尔菲法、优序图法建立课堂教学评价指标体系的研究[J].中医教育,2011,30(5):8-11. DOI: 10.3969/j.issn.1003-305X.2011.05.003.
[25] 贾文妍, 景惠荣, 赵桂秋, 等. 住院医师规范化培训中医学人文教育的思考[J].医学与哲学,2014,35(5A):80-83.
