目的 评价住院医师规范化培训(简称住培)对住院医师胜任力的影响,为完善住培政策提供参考。方法 选取全国310所住培基地的15 830位带教教师,使用住院医师置信职业行为量表对住院医师在住培初期和住培结束时的胜任力分别进行评价。采用Wilcoxon秩和检验比较各项指标的带教教师评分与预期评分,采用Marginal Homogeneity检验比较住培初期和住培结束时各项指标的带教教师评分。结果 住培初期,住院医师的治疗决策、危急重症识别与处置、患者转运与交接、本专科基本操作、告知坏消息、临床教学和公共卫生事件应对7个指标的带教教师评分为1(1,2)分,其他8个指标的带教教师评分为2(1,2)分;住培结束时,住院医师的危急重症识别与处置和公共卫生事件应对2个指标的带教教师评分为3(3,4)分,其他指标的带教教师评分分别为4(3,4)或4(4,4)或4(4,5)分,各项指标的带教教师评分均高于住培初期时的带教教师评分,如接诊患者的带教教师评分分别为4(4,4)分和2(1,2)分(χ²=107.81,P＜0.001)。结论 经过住培,住院医师的胜任力有了显著提升,但无论住培初期还是住培结束时,大部分指标的带教教师评分仍然低于预期评分。因此应当加强医教协同,进一步设计好院校教育和毕业后教育的制度衔接,确保住院医师在进入住培基地时和离开住培基地时均能够达到相应的培养目标。

Objective To evaluate the effect of residency training on trainees' competence and to provide a reference for improving the training policy. Methods Totally 15 830 teachers from 310 resident training institutions across the country were sampled and surveyed by the entrustable professional activity scale to evaluate the competence of the trainees before and after the training. The Wilcoxon rank sum test was used to compare the scores of each index with the expected score and the Marginal Homogeneity test was used to compare the scores of each index before and after the training. Results When entering training institutions, clinical decision making, critical illness identification and treatment, patient transfer and handover, essential skills of specialty, notification of bad news, clinical teaching, and public health incident response were all scored at 1 (1,2). The scores of the other 8 indicators were all 2 (1, 2). At the end of the training, the residen's scores of critical illness identification and treatment, and public health incident response were all 3 (3, 4) and the other indicators are 4 (3,4) or 4(4,4) or 4(4,5).The scores of all indicators were higher than those when entering the training (such as the scores of receiving patients were 4(4, 4) vs. 2(1, 2), χ²=107.81, P<0.001). Conclusions After training, residents' competence has been significantly improved. However, whether trained or not, the scores of the indicators still fail to reach the level of expectations. The collaboration in clinical performance and education should be strengthened and the integration of under-graduate education and post-graduate education should be further designed to ensure that the residents are able to achieve the training goals before and after residents' training.