目的 分析北京市住院医师规范化培训(简称住培)年度业务水平测试成绩与住培结业考核成绩的关联性,评价年度业务水平测试的有效性,为提前识别能力较差的住院医师并对其开展针对性的培训提供参考。方法 参照Kane效度框架,对北京市2 745名同时参加2020年住培年度业务水平测试(仅包括理论考试,结果使用在全国相同专业住院医师中的成绩百分位表示)和2021年住培结业考核(包括理论考核和临床实践能力考核,使用通过与否表示)的住院医师成绩,采用趋势χ²检验和logistic回归模型分析两者之间的关联性。结果 住院医师年度业务水平测试成绩的中位数和四分位数是72.4%(43.4%,90.8%),结业理论考核、临床实践能力考核和整体通过率分别为95.9%(2 632/2 745)、96.2%(2 641/2 745)和93.3%(2 560/2 745)。按照年度业务水平测试成绩分组后,不同组间结业理论考核通过率、临床实践能力考核通过率和整体通过率的差异均具有统计学意义[如年度业务水平测试成绩在>90%~100%组和0~10%组的住院医师,其结业理论考核、临床实践能力考核和整体通过率分别是99.9%(722/723)比73.6%(89/121)、99.2%(717/723)比85.1%(103/121)、99.0%(716/723)比68.6%(83/121),均P＜0.001]。Logistic回归分析结果显示,相较年度业务水平测试成绩百分位在0~10%组,其他各组的结业理论考核、临床实践能力考核和整体通过的概率均有大幅提升,差异均具有统计学意义(如年度业务水平测试成绩百分位在>90%~100%组的住院医师,其结业理论考核、临床实践能力考核和整体通过的概率分别是0~10%组住院医师的204.63倍、18.02倍、37.08倍,均P＜0.001)。结论 北京市住培年度业务水平测试成绩与住培结业考核成绩存在正向关联,是评价培训质量的有效工具,应当重视对其结果的应用,通过针对性的指导和反馈,提升住培质量。

Objective By analyzing whether there is a correlation between the results of the annual clinic competency test and the final examination for residents in Beijing, to assess the validity of the annual clinic competency test, and to provide reference for early identification of residents with poor competency and targeted training. Methods Based on Kane's validity framework, 2 745 residents' results of the 2020 annual clinic competency test, which were expressed by the percentile of the national residents in the same specialty, and the 2021 final examination, which expressed by a pass or fail and including a theoretical assessment and an Objective structured clinical skills exam, were analyzed for the correlation by Cochran-armitage trend test and logistic regression model. Results The residents' national percentile of the annual clinic competency test score was 72.4% (43.4%, 90.8%), and pass rate of the final theory examination, skills examination and entirety were 95.9% (2 632/2 745), 96.2% (2 641/2 745) and 93.3% (2 560/2 745). After grouping according to the percentile of annual clinic competency test scores, pass rate of the theoretical examination, skill examination and entirety were statistically different between different groups [such as those pass rate of residents in the >90%-100% group vs. those in the 0-10% group: 99.9%(722/723) vs. 73.6%(89/121), 99.2%(717/723) vs. 85.1%(103/121), 99.0%(716/723)vs. 68.6%(83/121),all P＜0.001]. The results of logistic regression showed that, compared with the 0-10% group, the other groups had a significant increase in passing rate of the theoretical examination, skill examination and entirety, with statistical differences [such as the residents in the >90%-100% group, the probability of pass rate of theoretical examination, skill examination and entirety were 204.63 times and 18.02 times and 37.08 times of those in the 0-10% group, all P<0.001]. Conclusions There is a positive association between the results of the annual clinic competency test and the final examination for residents in Beijing,which means the annual business level test is a valid evaluation tool. More attentions should be paid to the application of the results of the annual clinic competency test, and the quality of training should be improved through targeted guidance and feedback.