目的 在外科住院医师规范化培训的石膏固定术考核中采用标准化病人(standardized patient,SP),以期将单纯的技能操作考核转化为有效反映住院医师的临床思维、操作技能、沟通交流以及操作效果等基于临床胜任力的考试。方法 选择2016年度在北京大学第一医院参加外科住院医师规范化培训中石膏固定术考核的39名住院医师、3名考官和3名SP为研究对象。在考核中设立模拟外踝无移位骨折的石膏固定术考站,设计SP模拟临床情境,应用考核评价量表对考核进行评价。比较考官与SP对住院医师的评分结果,并做相关性分析。同时采用客观测量方法检验石膏固定效果。结果 体格检查时,94.9% (37/39)的住院医师询问了致病原因。61.5% (24/39)的住院医师检查了踝部是否肿胀,84.6% (33/39)的住院医师检查了压痛,69.2% (27/39)的住院医师检查了踝关节活动度。100.0% (39/39) 的住院医师要求拍踝关节的正位X光线片。97.4% (38/39)的住院医师做出骨折诊断。制订治疗方案时,51.3% (20/39)的住院医师选择后托固定方案。考官与SP对住院医师的多项评分上差异均具有统计学意义(均P<0.05)。SP的评分在操作结果和术后随访成绩间存在较高相关性,而考官的评分无相关性;在术后随访的各项成绩间,考官和SP的评分存在中等程度相关。采用SP后,石膏下压力的最大值较去年降低。结论 在石膏固定术考核中采用SP可以增加考核的真实性和可靠性,能够更有效地反映住院医师的临床胜任力和实际操作结果。

Objective Using standardized patients (SP) to participate in plaster fixation examination,in order to simulate the more realistic clinical situation,make the simple skill test turn to a comprehensive examination which can simultaneously evaluate clinical knowledge,operative skills,and communication skills. Methods A total of 39 postgraduate year 1 (PGY1) surgery residents who had been trained in the Surgical School of Peking University First Hospital for 1 year were enrolled in the study. A test station of plaster fixation was set to simulate lateral malleolus fracture without displacement. The research object was three couple of examiner and SP. Through SP participate to simulate the real clinical situation,using assessment scales to evaluation the examination,compare the scores with examiner and SP,and check the consistency. At the same time,the objective measurement method was used to test the effect of plaster fixation. Results During the consultation process,94.9% (37/39) of the residents asked about the cause of the fracture. For physical examination,61.5% (24/39) of them examined whether the ankle was swollen,84.6% (33/39) examined tenderness,and 69.2% (27/39) examined the ankle activity. All residents recommended an ankle anteroposterior X-ray. Finally,97.4% (38/39) of them underwent a fracture diagnosis and 51.3% (20/39) of them chosen the posterior plaster fixation. There were significant differences between examiners and SP on scores. There was a high correlation between the scores of the operation results and the follow-up results in SP evaluation,but the scores of the examiners were not relevant. The scores of the examiners and SP had moderately relationship in the postoperative follow-up results. With SP participating,the maximum pressure under gypsum was lower than that of last year. Conclusions Using SP to simulate in the examination of plaster fixation can increase the authenticity and reliability of the test. It was more effectively to reflect the clinical competency of residents and the comprehensive ability of actual operation results.