第1年外科住院医师客观结构化临床考试的实施及评价

目的 探讨第1年外科住院医师采用客观结构化临床考试进行年终考核的效能、合理性，根据考试结果改进培训和考试的形式及内容。 方法 31名第1年外科住院医师参与考核。考核共设病例分析、污染伤口换药、石膏固定术、腹腔镜模拟器基础技能、不规则创面清创缝合术等5站，各站均采用百分制，每站考核15分钟。考后即刻问卷调查住院医师对此次考核的意见和看法，共发放调查问卷31份，回收31份。测算各考站的难度、区分度、信度，考站间进行相关性分析。 结果 OSCE平均成绩74.66±4.39，OSCE总体难度为0.747，区分度为0.578，信度为0.402。第1站难度最低，第5站难度最大。各站的区分度均＞0.400。第2、4站信度偏低。1、2站间和1、4站间存在中等程度相关，其余各站间无明显相关性。住院医师的问卷调查显示第4、5站被认为最难，第2站被认为最简单，第4站对临床最有帮助，考核中住院医师第2站表现最好，第5站表现最差。结论 客观结构化临床考试能够有效评价住院医师培训效果。模拟复杂临床情景的考题更能考核出住院医师的实际临床能力。考后还需要客观评价考核效能，并根据住院医师的主观评价动态调整培训内容和考核形式。     

Objective Structured Clinical Examination From Virtually Anywhere!

The Objective Structured Clinical Examination (OSCE) is used in nurse practitioner (NP) education programs to evaluate students’ clinical competency. The OSCE was developed to be done with students on campus in a simulation laboratory, but for online NP programs, an on-campus environment is a barrier to the use of OSCEs. The virtual OSCE eliminates this barrier and provides an effective method of implementing OSCEs and evaluating student competencies in online NP education.     

OSCE考核模式在护理硕士专业学位研究生临床实践能力考核中的应用

目的 评估客观结构化临床考试(OSCE)模式在护理硕士专业学位(Master of Nursing Specialist,MNS)研究生临床实践能力毕业考核中的应用效果。方法 便利抽样法选取牡丹江医学院2018、2019两届全体MNS毕业研究生12人为研究对象,结合OSCE考核模式制定临床实践能力毕业考核方案,设计病例,基于MNS研究生岗位核心胜任力指标体系制定考核评价标准,并实施毕业考核,考核结束后采用满意度问卷(自行设计)对所有考生及考官进行调查。结果 12名MNS研究生考核成绩合格率为100%,综合成绩平均为(78.91±6.73)分。考生及考官对OSCE考核模式及考核工作满意率均90.0%,对OSCE考核模式评价MNS研究生临床实践能力的总体满意率均80.0%。结论 该考核模式能够综合客观评价MNS研究生临床实践能力,值得推广。     

Does an Advanced Pelvic Simulation Curriculum Improve Resident Performance on a Pediatric and Adolescent Gynecology Focused Objective Structured Clinical Examination? A Cohort Study

Study ObjectiveTo determine the effect of an advanced pelvic simulation curriculum on resident performance on a pediatric and adolescent gynecology (PAG) focused objective structured clinical examination (OSCE).DesignObstetrics and gynecology residents in a single academic Canadian center participated in a PAG simulation curriculum. An OSCE on prepubertal vaginal bleeding was administered at the biannual OSCE examination 2 months before the simulation curriculum and again 3 months after the simulation curriculum.SettingAcademic half-day at the University of Ottawa Skills and Simulation Centre.ParticipantsObstetrics and gynecology residents from the University of Ottawa.InterventionsParticipants completed 4 stations teaching PAG-appropriate history-taking, genital examination, Tanner staging, vaginal sampling and flushing, hymenectomy, vaginoscopy, laparoscopic adnexal detorsion, and approach to the child and/or adolescent. Advanced pelvic models were used for procedure-specific stations.Main Outcome MeasuresThe primary outcome measure was change in mean score on a prepubertal vaginal bleeding OSCE station. Secondary outcome measures were changes in individual component scores.ResultsFourteen residents completed the simulation curriculum and the PAG OSCE at the 2 separate time points (before and after simulation curriculum). The mean OSCE score before the simulation curriculum was 54.6% (20.5 of 37) and mean score after the curriculum was 78.1% (28.9 of 37; P < .001). Significant score increases were found in history-taking, examination, differential diagnosis, identification of organism, surgical procedures, and identification of foreign body (P < .01 for all).ConclusionThis innovative PAG simulation curriculum significantly increased residents' knowledge in PAG history-taking, examination skills, operative procedures, and approach to the child and/or adolescent. Obstetrics and Gynecology Program Directors should consider incorporating PAG simulation training into their curriculum to ensure that residents meet their learning objectives and increase their knowledge and confidence, which will ultimately benefit patient care.     

网络化OSCE初探

OSCE考试是目前世界上用于评估临床能力的一种较为流行的标准化的考核方法。总结我校实行该考核方法三年来的经验，认为目前的考试形式组织较为烦琐，不利于大规模考试的开展。因此，我校进行了OSCE考试网络化的初步探索，拟将各考试站点利用计算机局域网联结起来，利用网络优化各站点，实现考试的统一、高效、有序管理。     

OSCE在妇产科临床教学的应用

OSCE是一种客观评估临床技能的方法,本文总结了几年来该科应用OSCE方法于妇产科临床教学的经验和体会,旨在提高妇产科临床教学效果     

标准化病人在循证医学教学中的作用

采用标准化病人（standardized patient,SP）模拟临床场景实践和考核医学生,强化和促进临床技能的掌握,而且促进循证医学教学的实践性、社会性,以此获得个体病人特征和重要信息,这是搜寻循证最佳证据以及积累丰富经验的基础和前提.循证医学强调“以病人为中心”的教学,不同的个体病人在循证决策中应采取不同的策略和形式.     

Item Analysis to Improve Reliability for an Internal Medicine Undergraduate OSCE

Utilization of objective structured clinical examinations (OSCEs) for final assessment of medical students in Internal Medicine requires a representative sample of OSCE stations. The reliability and generalizability of OSCE scores provides validity evidence for OSCE scores and supports its contribution to the final clinical grade of medical students. The objective of this study was to perform item analysis using OSCE stations as the unit of analysis and evaluate the extent to which OSCE score reliability can be improved using item analysis data. OSCE scores from eight cohorts of fourth-year medical students (n = 435) in a 6-year undergraduate program were analyzed. Generalizability (G) coefficients of OSCE scores were computed for each cohort. Item analysis was performed by considering each OSCE station as an item and computing the corrected item-total correlation. OSCE stations which negatively impacted the reliability were deleted and the G-coefficient was recalculated. The G-coefficients of OSCE scores from the eight cohorts ranged from 0.48 to 0.80 (median 0.62). The median number of OSCE stations that negatively impacted the G-coefficient was 3.5 (out of a median of 25 total stations). When the ‘‘problem stations’’ were deleted, the median G-coefficient across eight cohorts increased to 0.62--0.72. In conclusion, item analysis of OSCE stations is useful and should be performed to improve the reliability of total OSCE scores. Problem stations can then be identified and improved.     

Medical Student Competence in Eliciting a History for “Chronic Fatigue”

Purpose: We report an observational study of medical students abilities in taking a complex history for which sleep disorders is one of several possible conditions. Methods: Students are observed taking a focused history from a simulated patient whose chief complaint is I am tired. I cannot get anything done. Nine groups of students (n = 360) completing the internal medicine core-clerkship were evaluated by one of three examiners. Students received full, partial, or no credit for each item on a uniform behavioral checklist, which included prompts for common medical and psychiatric disorders associated with chronic fatigue. Results: Observed means were lowest for items pertaining to sleep behaviors and head trauma. Fewer than half of the students inquired about whether or not the person had difficulty falling asleep at night, family history of sleep apnea, and frequency and length of naps. In contrast, the majority of students inquired about heart disease, metabolic disorders, the use of illicit drugs, alcohol consumption, and the taking of medications. Examiners accounted for a significant source of variance in scores; yet the station discriminated among top and bottom students as measured by the Objective Structured Clinical Examination (OSCE) overall. No statistically significant differences were observed on the basis of clerkship site, primary care versus traditional-track students, time of year, or gender. Conclusion: A majority of students do not adequately cover issues relevant to sleep in contrast to other associated disorders when taking a focused history for chronic fatigue.