目的 了解全科住院医师规范化培训(以下简称“住培”)中存在的问题,并提出改进计划。方法 2019年4月选择浙江大学医学院附属第一医院52名全科住培医师进行临床技能竞赛,竞赛采用客观结构化临床考试(objective structured clinical examination, OSCE)形式,包括基本技能操作站(100分)、体格检查站(100分)、专科技能操作站(110分)、临床思维与决策站(100分)4站,考核时间、评委设置和考核评分表与往年浙江省全科住院医师结业考核保持一致。结果 基本技能操作站成绩、专科技能操作站成绩高于合格成绩(84.1分比80.0分,91.1分比80.0分),其差异具有统计学意义(P<0.01)。临床思维与决策站成绩低于合格成绩(62.4分比80.0分),其差异具有统计学意义(P<0.01)。多因素方差分析结果显示,全科住培医师中男性临床思维与决策能力较女性好[(67.23±9.01)分比(60.65±10.88)分],差异有统计学意义(P<0.05);全科医师在体格检查能力与临床思维与决策能力优于助理全科医师[(81.11±10.06)分比(72.58±12.45)分,(63.69±10.61)分比(56.06±9.52)分],差异有统计学意义(均P<0.05);省级单位的住培医师体格检查能力优于国家级单位住培医师[(83.52±4.04)分比(78.65±11.85)分],差异有统计学意义(P<0.05)。结论 全科住培医师临床思维与决策能力仍有待提高,后续应加强其临床思维与决策能力的训练,应着重培养女性、助理全科医师的临床思维能力及助理全科医师的体格检查能力。

Objective To find out the problems in the standardized residency training of general practitioners (GPs), and put forward further promoting plans. Methods All 52 general practitioners were selected from the affiliated first hospital of medical college in Zhejiang university in April 2019 to clinical skills competition. The objective structured clinical examination(OSCE) was used in the competition, including basic skills operation station, physical examination station, specialized skills operation station, clinical thinking and decision-making station, each station had a qualified score of 80 points, and the scoring table adopts the unified examination form used in the previous general education completion assessment of Zhejiang province, and the assessment time and judge setting were also consistent. Results The subjects passed the physical examination. The scores of basic skills operation station and specialized skills operation station were higher than qualified ones (84.1 vs 80.0 , 91.1 vs 80.0), the difference was statistically significant (P<0.01). The score of clinical thinking and decision-making station was lower than qualified one (62.4 vs 80.0), the difference was statistically significant (P<0.01). The results of multivariate analysis of variance showed that the clinical thinking and decision-making ability of male residents were better than that of female residents [(67.23±9.01)vs(60.65±10.88)],the difference was statistically significant (P<0.05).The general practitioner's physical examination ability and clinical thinking and decision-making ability were significantly better than assistant general practitioner's [(81.11±10.06)vs(72.58±12.45),(63.69±10.61)vs(56.06±9.52)], the difference was statistically significant (P<0.05); the provincial resident training physician's physical examination ability was better than the national resident training physician's [(83.52±4.04)vs(78.65±11.85)], the difference was statistically significant (P<0.05). Conclusions It is necessary to strengthen residency GPs' clinical thinking and decision-making ability through more practice training, to cultivate the clinical thinking and decision-making ability and physical examination ability of female and assistant general practitioners.