VARIABILITY IN THE CLINICAL SKILLS OF RESIDENTS ENTERING TRAINING-PROGRAMS IN SURGERY
VARIABILITY IN THE CLINICAL SKILLS OF RESIDENTS ENTERING TRAINING-PROGRAMS IN SURGERY
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DOI：
10.1016/s0039-6060(05)80338-1
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发表时间：
1995-08-01
期刊：
影响因子：
3.8
通讯作者：
ROSLYN, JJ
中科院分区：
文献类型：
--
作者：
SACHDEVA, AK;LOIACONO, LA;ROSLYN, JJ
背景。外科培训开始时，住院医师在临床技能方面可能存在显著差异。本研究的目的是通过客观结构化临床考试来调查这些技能的变异性。
方法。进行了需求评估，并开发了由10个两部分站点组成的客观结构化临床考试。对标准化病人（SP）进行培训、验证，并将其用作模拟病人和评估者，以评估10名一年级外科住院医师的病史采集、体格检查和人际交往能力。住院医师在与标准化病人接触后所写的结构化病人记录（PN）用于评估病史和体格检查记录技能。由于一个站点超过25%的标准化病人评分缺失，该站点的数据未被使用。
结果。标准化病人评分的α信度为0.78，病人记录分数的α信度为0.91，综合分数的α信度为0.91。方差分析显示，通过标准化病人（F = 4.56，p < 0.01）、病人记录（F = 11.09，p < 0.001）或两者（F = 10.9，p < 0.001）评估，个体住院医师的临床技能存在显著差异。配对t检验显示，住院医师在病史采集方面的得分显著高于体格检查，并且与病史采集和体格检查的表现相比，在记录方面的得分显著较低（每次比较p < 0.001）。
结论。结果显示住院医师群体的临床技能存在显著变异性，并提供了每个住院医师表现的详细信息。这些数据与个体住院医师共享，并正被用于对该项目的教育活动进行调整。
Background. Residents may have significant differences in clinical skills at the start of their surgical training. The purpose of this study was to investigate the variability in these skills by using an objective structured clinical examination.Methods. A needs assessment was performed, and an objective structured clinical examination composed of 10, two-part stations was developed. Standardized patients (SPs) were trained, validated, and used as both simulated patients and evaluators to assess history taking, physical examination, and interpersonal skills of 10 firs-year surgical residents. Structured patient notes (PNs) written by residents after the SP encounters were used to assess history and physical examination documentation skills. Data from one station were not used because more than 25% of the SP ratings were missing.Results. The alpha-reliability was 0.78 for SP ratings, 0.91 for PN scores, and 0.91 for the combined scores. ANOVA revealed significant variation in individual residents' clinical skills as assessed by SPs (F = 4.56, p < 0.01), PNs (F = 11.09, p < 0.001), or both (F = 10.9, p < 0.001). Paired t tests showed that residents scored significantly higher on history taking than on physical examination and attained significantly lower scores on documentation as compared with performance of both history and physical examination (p < 0.001 for each comparison).Conclusions. The results showed significant variability in clinical skills of the group of residents and yield detailed information on the performance of each resident. The data were shared with individual residents and are being used to make changes in the educational activities of the program.