试用诊断三联征试题测评全科医师疾病诊断水平

目的 了解北京市全科医师基于症状和体征的疾病诊断水平。方法选用代表多种临床问题的10个诊断三联征试题，对参加北京市全科医师骨干培训班的城八区152名全科医师进行测试。结果发出试卷152份，回收有效试卷129份，有效率为84．9％。试卷满分为20分，最高得分16分，最低1分，平均（8．5±2．9）分；10种疾病判别结果中，只有脑膜炎和异位妊娠答对率超过半数，分别为78．3％和72．1％；答对率最低的是儿童铅中毒和甲状腺功能减退症，均只有2．3％。结论全科医师的临床知识结构不完整，对疾病的诊断识别能力不强；需完善培训制度、提高培训水平；诊断三联征测试是一种快速有效鉴别临床诊断能力的考核方法，应在全科医学培训中加以利用。

Using triad test questions to examine diagnostic performance among general practitioners in Beijing

Objective To understand symptom- and sign-based diagnostic performance among general practitioners (GPs) in Beijing. Methods A diagnostic triad test paper with 10 questions involving variety of clinical issues was used to evaluate diagnostic performance among GPs attended the training class for backbone GPs from community health-care service institutions of eight districts in urban Beijing. Results Totally, 152 GPs took the test, with 129 (84. 9% ) finished. The highest score of them was 16 credits of a full 20, and lowest was only one credit, with an average of 8. 5 credits plus or minus of 2. 9 (standard deviation, SD) credits. And, 78. 3 % and 72. 1 % of the GPs answered correctly diagnostic questions about meningitis and ectopic pregnancy, respectively, from all 10 kinds of illness, but only 2. 3% of them could correctly answer those about lead poisoning in children and hypothyroidism, respectively. Conclusions Structure of clinical knowledge is not so complete in GPs attended the training class with limited ability in disease identification. It is necessary to perfect and improve training for GPs. Triad test questions for disease diagnosis were a simple, rapid and effective way to evaluate their clinical performance in GPs training.