目的 比较基础医学融合型试题与非融合型试题(后文简称融合题和非融合题)在医学考试中的试题参数表现,为提高基础医学试题质量、适应以能力为导向的医学教育评价提供数据支持。方法 本研究通过在某次大规模临床医学考试中应用非融合题和融合题2种不同单项选择题题型,对相同的基础医学知识点进行考核,选取15个基础医学知识点,比较分析不同题型认知层次、考核要点,采用配对样本秩和检验比较不同题型难度,采用配对样本t检验比较不同题型区分度。结果 融合题认知层次为对基础医学知识点的应用,非融合题认知层次均为记忆或理解。融合题比非融合题平均每道试题的考核要点增加2.8个。融合题难度为[0.75(0.69,0.86)],非融合题难度为[0.77(0.59,0.92)],其差异无统计学意义(P=0.100)。融合题区分度为(0.31±0.10),非融合题区分度为(0.26±0.11),其差异具有统计学意义(P=0.015)。结论 融合题题型符合岗位胜任力为导向的医学教育改革要求,顺应医学考试评价发展趋势,提高了基础医学试题质量。

Objective To provide data support to test question used in medical examination of basic medicine in order to meet the requirement of competency-oriented medical education assessment through comparing the item parameters between integrated items and non-integrated items in basic medicine. Methods Two item formats, integrated item and non-integrated item, on the same basic medicine knowledge point were used to in a large-scale clinical medicine examination. Fifteen knowledge points were chosen and the cognitive level, assessment point, difficulty and discrimination of different item formats were compared and analyzed, with significance test using pared-samples Wilcoxon rank sum test for difficulty and pared-samples T test for discrimination. Results The cognitive level of non-integrated items were memory and comprehensive, while the cognitive levels of integrated items were application of basic medicine knowledge points. The average assessment point number of integrated items increased 2.8 than that of non-integrated items. The difficulty of non-integrated items was 0.77(0.59,0.92), and that of integrated items was 0.75 (0.69,0.86). There was no significant difference between the two item formats (P=0.100). The average discrimination of non-integrated items was (0.26±0.11), and that of integrated items was (0.31±0.10). The discrimination of integrated items was significantly higher than that of non-integrated items (P=0.015). Conclusions The integrated item format meets the requirement of competency-oriented medical education and reform, complies with the tendency of medical examination assessment, and improves the quality of test questions of basic medicine.