目的 分析湖南省2024年内科住院医师规范化培训(简称住培)结业临床实践能力考核成绩,为制定针对性的内科住培方案提供参考。 方法 本研究为基于考核数据的横断面研究,2024年12月,以参加2024年湖南省内科住培结业临床实践能力考核的708名内科住院医师考核成绩建立数据库,采用单因素方差分析比较住院医师不同站点考核成绩差异;采用单因素方差分析或两独立样本t检验分析不同特征住院医师的内科住培结业临床实践能力考核5个站点成绩和总成绩的差异;采用多元线性回归分析中的强迫进入法识别住院医师的内科住培结业临床实践能力考核5个站点成绩和总成绩的影响因素。 结果 湖南省2024年内科住培结业临床实践能力考核5个站点成绩从高到低分别为:交流沟通[(89.08±5.05)分]、临床操作[(83.04±7.78)分]、接诊病人[(79.74±8.87)分)]、临床思维1[(76.75±9.40)分]和临床思维2[(76.51±8.11)分],各站点成绩差异具有统计学意义(F=303.095,P＜0.001)。多元线性回归分析结果显示:①女性内科住院医师在接诊病人(β=0.101,P=0.008)、临床思维1(β=0.102,P=0.008)、临床操作(β=0.171,P＜0.001)、交流沟通(β=0.112,P=0.003)站点和临床实践能力考核总成绩方面(β=0.174,P＜0.001)均高于男性内科住院医师;②专业学位硕士研究生在临床操作(β=0.145,P=0.017)站点的成绩高于委托培训住院医师;③具有研究生学历的住院医师在临床操作(β=0.145,P=0.001)、交流沟通(β=0.120,P=0.005)站点和临床实践能力考核总成绩(β=0.105,P=0.013)均高于本科及以下学历的住院医师;④培训基地是省部级卫生健康行政主管部门隶属医院的内科住院医师在临床思维1(β=-0.096,P=0.033)、临床操作(β=-0.148,P=0.001)站点和临床实践能力考核总成绩(β=-0.102,P=0.021)均低于培训基地是地市级卫生健康行政主管部门隶属医院的内科住院医师。 结论 内科住院医师的交流沟通与临床操作能力表现良好,女性、专业学位硕士研究生和拥有研究生学历的内科住院医师及地市级卫生健康行政主管部门隶属医院的内科住院医师临床实践能力考核整体表现更佳。建议针对内科住院医师的不同性别、身份类型、学历和基地类型制定差异化培训方案,进一步提升内科住培质量。

Objective To analyze the results of end-of-training practical skills assessment among internal medicine resident trainees in Hunan province in 2024, and to inform future development of targeted internal medicine training plans. Methods This study was a cross-sectional investigation conducted in December 2024. A database was established using the assessment results of 708 internal medicine residents who participated in the 2024 end-of-training practical skills assessment for the internal medicine standardized residency training in Hunan Province. One-way analysis of variance (ANOVA) was used to compare differences in scores across various examination stations. Either one-way ANOVA or independent samples t-tests was used to analyze the differences in the five station scores and the total score among residents with different characteristics. The forced-entry method of multiple linear regression analysis was applied to identify influencing factors of the scores for the five stations and the total. Results The scores for the five stations, ranked from highest to lowest, were as follows: communication [(89.08±5.05)], clinical procedures [(83.04±7.78)], patient consultation [(79.74±8.87)], clinical reasoning 1 [(76.75±9.40)], and clinical reasoning 2 [(76.51±8.11)]. The differences in scores across the stations were statistically significant (F=303.095, P<0.001). Multiple linear regression analysis revealed that: (1) female internal medicine residents scored higher than males internal medicine residents in the patient consultation (β=0.101, P=0.008), clinical reasoning 1 (β=0.102, P=0.008), clinical procedures (β =0.171, P<0.001), and Communication stations (β=0.112, P=0.003), as well as in the total assessment score (β=0.174, P<0.001); (2) residents with professional master′s degree students scored higher than those in the commissioned training program in the clinical procedures station (β=0.145, P=0.017); (3) residents with postgraduate education scored higher than those internal medicine residents with a bachelor′s degree or lower in the clinical procedures (β=0.145, P=0.001) and communication stations (β=0.120, P=0.005), as well as in the total assessment score (β=0.105, P=0.013); (4) internal medicine residents trained at hospitals affiliated with provincial/ministerial-level health commissions scored lower than those internal medicine residents trained athospitals affiliated with municipal-level health commissions in the clinical reasoning 1 (β=-0.096, P=0.033) and clinical procedures stations (β=-0.148, P=0.001), as well as in the total assessment score (β =-0.102, P=0.021). Conclusions Internal medicine residents performed well in communication and clinical procedural skills. Female residents, professional master′s degree students, residents with postgraduate degrees, and hospitals affiliated with municipal-level health commissions perform better overall in the practical skills assessment. It is recommended to develop targeted training plans based on residents′ gender, trainee category, educational background, and training institution type to further enhance the quality of standardized residency training in internal medicine.