临床医学外科专业学位硕士研究生临床技能考核模式的探讨

目的：探讨临床医学外科专业学位硕士研究生结业临床技能考核模式。方法：收集2013年首都医科大学临床外科专业硕士研究生结业临床技能考核方案、成绩及总结报告和2013年北京市外科住院医师临床技能考核的方案、成绩及总结报告,进行两者的对比分析。结果：2013年首都医科大学外科学临床技能考核的硕士研究生118人,北京市住院医师临床技能考核人数274人。两者的考核方案存在明显差异,表现在组织的机构和考核所涵盖的内容不同。临床医学外科专业学位硕士研究生临床技能考核内容缺少沟通能力、辅助检查阅读与分析,并且在相同项目上有的也存在细化程度和要求的差异。研究生在病例分析项目的分数高于住院医师(84.60±11.47 vs 82.18±10.18,P=0.039),而外科基本操作项研究生成绩显著低于住院医师(78.2±14.02 vs 90.50±6.34,P=0.000)。此外,在病历书写、病例分析、外科操作等项目≥70分的通过率上也存在明显的差异,p＜0.05。结论：临床医学外科专业学位硕士研究生临床技能考核模式需与住院医师培训目标相适应，增加沟通能力、实验室检查及影像检查的判读内容，强化临床思维能力的培养，除采用过程评估外，多站式客观结构化临床技能考核（OSCE）可作为结业考核模式。

Analysis of clinical competence assessment in the graduation examination for surgical professional degree postgraduate in clinical medicine

Objective: To investigate clinical competence assessment model in the graduation examination for surgical professional postgraduate in clinical medicine. Methods: Data of clinical competence assessment of graduation examination for surgical postgraduates in clinical medicine from Capital Medical University(CMU) and residents from Beijing surgical residency training programs in 2013 were summarized and analyzed. Results: There were 118 surgical postgraduates in clinical medicine form CMU and 274 residents from Beijing surgical residency training programs, who attended final clinical competence assessment. There were significant differences between the postgraduate and resident clinical competence assessment system. The differences included their organization in charge of examination and the contents of assessment system. The assessment system of clinical competence for the surgical postgraduates did not involved communication skills, reading and analysis of laboratory tests and imaging investigation. The score of case analysis in the postgraduate group was higher than that in the resident group (84.6 1.1 vs 8.2 10.2, P=0.039), however the score of surgical skill assessment in postgraduate group was significantly lower than that of the resident group(78.2 14.0 vs 90.5 6.3, P=0.000). In addition, the rate in the score being higher or equal to 70 of medical record writing, case analysis, surgical skill assessment between postgraduates and residents was significant difference, p< 0.05. Conclusion: Clinical competence assessment system for the surgical postgraduates should be adapt to their training goal, to increase communication skills, laboratory tests and imaging interpretation, as well as strengthen the cultivation of clinical thinking ability. In addition to the process assessment, the objective structured clinical skills examination (OSCE) could be as a reasonable postgraduate graduation examination mode.