目的 分析基于里程碑式胜任力评价的评估反馈模式在神经内科专科医师规范化培训中的应用效果。方法 2023年,以2019至2022年在北京大学第三医院神经内科进行专科医师规范化培训(简称专培)的全部14名专科医师为研究对象(其中,博士研究生6名,本院医师8名,不同培养阶段专科医师人数不同),应用前期制定的里程碑式胜任力评价标准,以考核—评估—反馈—培训循环模式进行连续随访,评价专科医师培训效果。采用卡方检验或Kruskal-Wallis检验分析相关数据。结果 随着专科医师专培年资的升高,其胜任力评分在各胜任力维度均逐年增加,然而其在各胜任力维度的达标比值却呈现波动,与评分的一致性提高不匹配[如临床带教维度,专培第一年、第二年和第三年,专科医师的胜任力评分分别为2.0(2.5)分、4.0(1.2)分、6.0(1.2)分,相邻两年度间比较,差异均具有统计学意义(均P<0.05);而达标比值分别为4/10,2/10,4/6。针对个体的动态随访雷达图提示,不同专科医师的胜任力提升轨迹差异明显。结论 基于里程碑式胜任力评价的评估反馈模式可以用于神经内科专科医师胜任力的评估、监测,并根据评估结果对其进行有针对性的培训。在培训过程中,不仅需要关注专科医师的整体水平,更需要关注其个体差异,予以因材施教。根据专科医师不同年资所需要达到的水平对其进行考核,有助于增加评估敏感性,促进胜任力提升。

Objective To analyze the effectiveness of the assessment feedback model grounded in milestone-based competency assessment standards in the neurology fellowship training. Methods In 2023, all 14 neurology specialists (including 6 doctoral students and 8 physicians from the hospital, with varying numbers of specialists from different training years) who underwent standardized training at the Department of Neurology, Peking University Third Hospital, from 2019 to 2022 were enrolled. The milestone-based competency assessment standards established earlier were applied, and a continuous follow-up was conducted using the assessment-feedback-training cycle model to evaluate the effectiveness of the specialist training. Chi-square test and Kruskal-Wallis tests were used to analyze the relevant data. Results As the seniority of the specialists increased, their competency scores increased annually in all competency dimensions. However, the proportion of meeting standards fluctuated and did not match the increased consistency with the scores [for example, in the clinical teaching dimension, the scores of the specialists from the first year of specialized training to the third year were 2.0 (2.5), 4.0(1.2), and 6.0(1.2), respectively, and the differences in ratings between adjacent years were statistically significant (all P<0.05), while the proportion of meeting standards were 4/10, 3/10, and 3/6, respectively]. Dynamic follow-up radar charts for individuals indicated that the trajectories of competency improvement among different specialists were significantly different. Conclusions The assessment feedback model grounded in milestone-based competency assessment standards can be used for the assessment and monitoring of the competency development among neurology specialists, and targeted training can be conducted based on these results. During the training process, it is not only necessary to focus on the development of the overall level but also to pay attention to the individual differences among specialists, tailoring teaching according to their individual aptitude. Assessing specialists based on the level they need to achieve in different years of seniority can increase the sensitivity of the assessment and promote the enhancement of competency.