目的 对北京市麻醉科住院医师规范化培训(简称住培)临床实践能力考核成绩与住院医师自评成绩进行比较,探讨住培过程中的问题。方法 采用全样本调查方法,以2022年6月参加北京市住培临床实践能力结业考核的193名麻醉科住院医师为研究对象,以其操作考核视频和考核成绩为资料来源,并通过问卷调查获取考生对麻醉操作考核的自评成绩。采用t检验或配对t检验比较考生的自评成绩和考核成绩。结果 考生的腰麻操作自评成绩与考核成绩差异无统计学意义[(28.39±1.32)分比(28.26±1.32)分,P=0.317];考生在动脉穿刺置管、气管插管、中心静脉置管、心肺复苏和电除颤等方面的自评成绩均高于考核成绩[(28.99±1.32)分比(27.95±1.33)分,(29.06±1.30)分比(28.28±1.29)分,(29.07±1.30)分比 (28.37±1.35)分,(59.44±1.95)分比(57.78±1.42)分,均P<0.05]。其中,考生在操作规范、无菌操作、模拟器相关、非技能操作相关的自我评分均高于考核成绩[如:确定气管插管位置并固定:(1.93±0.19)分比(1.75±0.29)分;腰麻操作过程中的无菌原则:(1.98±0.13)分比(1.86±0.27)分;穿中血管后判断是否为中心静脉:(2.94±0.24)分比(2.66±0.70)分;在电除颤后清洁患者皮肤,清洁电极板并归位:(1.85±0.33)分比(0.98±0.94)分,均P<0.05]。结论 麻醉科住院医师在动脉穿刺置管、气管插管、中心静脉置管、心肺复苏和电除颤等方面的自我认知存在偏差,在技能培训中,住院医师需加强临床操作规范、无菌原则的学习,强化其非操作技能的培养。

Objective To compare the scores of a video-based surgical assessment by the examiners and the examinees to find out pitfalls in the process of standardized resident training in anesthesia. Methods Using a full sample survey method, a questionnaire survey was conducted on 193 resident anesthesiologists who participated in the Beijing residency training clinical practice ability graduation assessment in June 2022, along with its operation assessment video and assessment results as the data source to act as the candidates' clinical practice ability assessment results. The self-evaluation of the candidates was obtained. Student t-test or paired t-test was used for data analysis. Results There were no obvious differences between the scores by examinees or by examiners in the assessment of spinal anesthesia[(28.39±1.32)vs.(28.26±1.32),P=0.317].In arterial catheterization, endotracheal intubation, central venous catheterization and electric defibrillation, the scores by the examinees were significantly higher than those by the examiners [(28.99±1.32) vs. (27.95±1.33), (29.06±1.30) vs. (28.28±1.29), (29.07±1.30) vs. (28.37±1.35), (59.44±1.95) vs. (57.78±1.42), all P<0.05]. The scores by the examinees were significantly higher than those by the examiners in area related to the procedure protocols, aseptic principles, simulator-related items, and non-technical skills[for example, position and fixation of the endotracheal tube: (1.93±0.19) vs. (1.75±0.29), the sterility principle during spinal anesthesia: (1.98±0.13) vs. (1.86±0.27), the recognition of the central venous canal, the cleaning of the skin of patient: (2.94±0.24) vs. (2.66±0.70), the electrode plate during the electric defibrillation: (1.85±0.33)vs.(0.98±0.94), all P<0.05 ]. Conclusions There is a deviation in self-perception of arterial catheterization, endotracheal intubation, central venous catheterization, cardiopulmonary resuscitation and electrical defibrillation in resident anesthesiologists. In the skill training, residents should strengthen the study of clinical operation norms and aseptic principles, and strengthen the cultivation of their non-operational skills.