为了提升住院医师规范化培训(以下简称住培)出科考核质量,武汉大学中南医院基于PDCA循环改革出科考核,并通过比较改革前后出科考核考务组织优秀率、命题质量,以及年度业务水平测试成绩来分析改革效果,采用t检验或秩和检验、χ²检验进行数据分析。改革后和改革前,考务组织平均优秀率分别为90.1%和64.2%,理论考核试题难度分别为[0.69(0.61,0.74)]和[0.81(0.70,0.89)]、区分度分别为[0.35±0.10]和[0.32±0.09],技能考核试题区分度分别为[0.28±0.07]和[0.26±0.06],综合考核试题区分度分别为[0.32±0.09]和[0.28±0.08],年度业务水平测试评分分别为[(95.3±12.5)]分和[(89.3±13.3)]分,其差异均具有统计学意义(均P<0.05)。改革前后技能考核试题难度分别为[0.85(0.81,0.95)]和[0.80(0.66,0.84)],综合考核试题难度分别为[0.86(0.79,0.96)]和[0.81(0.72,0.88)],其差异均无统计学意义(均P>0.05)。基于PDCA循环的住培出科考核改革能够有效提升出科考核质量,进而提升住培质量。

To improve the quality of rotation examinations of standardized training for residents, Zhongnan Hospital of Wuhan University adopted PDCA cycle based reform. This paper analyzed its effect. The compliance rate of rotation examinations, the quality of the proposition, the scores of Annual Business Level Test before and after adopting PDCA cycle based reform were statistically analyzed by t-test, rank sum test or χ² test. Post and pre- PDCA cycle based reform, the compliance rates of rotation examinations were 90.1% and 64.2%, the difficulty of theoretical exam were [0.69 (0.61, 0.74)] and [0.81 (0.70, 0.89)], the differentiation of theoretical exam were (0.35±0.10) and (0.32±0.09), the differentiation of skill exam were(0.28±0.07) and (0.26±0.06), the differentiation of comprehensive exam were (0.32±0.09)and (0.28±0.08), the scores of Annual Business Level Test were(95.3±12.5) and (89.3±13.3), respectively, and there were statistical differences (all P<0.05). Pre- and post PDCA cycle based reform, the difficulty of skill exam were [0.85 (0.81, 0.95)] and [0.80 (0.66, 0.84)], the difficulty of comprehensive exam were [0.86 (0.79, 0.96)] and [0.81 (0.72, 0.88)], respectively, and there were no statistical differences (all P>0.05). PDCA cycle based reform can effectively improve the quality of rotation examinations, which improves the quality of standardized training for residents.