操作技能直接观察评估在全科医学科毕业实习中的应用效果研究

背景　操作技能直接观察评估（DOPS）是评估者通过直接观察学生技能操作的过程即时给予评估和反馈，是一种具有教学功能的形成性评价工具，能够客观、全面地评估学生的学习过程。将DOPS引入全科医学专业教学评价具有重要意义。目的　探讨在全科医学科毕业实习中应用DOPS进行形成性评价的意义和效果。方法　于2018年9-10月，采用整群抽样方法选择中国医科大学2013级七年制临床医学专业学生72例为研究对象。采用随机数字表法将72例学生随机分为试验组和对照组，每组36例。试验组和对照组学生均安排在中国医科大学附属第一医院全科医学科病房参加为期1周的实习；实习结束后，进行为期1周的临床实践。对照组的临床实践操作技能培训采用传统带教方法，试验组在1周的临床实践过程中开展2次DOPS形成性评价，两组由相同教师授课。轮转结束时，应用小型临床评价演练（Mini-CEX）、临床技能操作评分、理论考试及问卷调查法进行教学评价。结果　试验组学生的理论考试成绩与对照组比较，差异无统计学意义（P>0.05）。试验组和对照组学生的临床技能操作得分分别为（76.67±6.20）、（72.50±7.66）分，组间差异有统计学意义（P<0.05）。两组Mini-CEX成绩比较：试验组学生体格检查、人文关怀、沟通技巧、整体表现得分高于对照组，差异有统计学意义（P<0.05）。DOPS临床操作时间为（11.32±1.76）min，反馈时间为（13.14±2.21）min，合计时间为（24.46±1.97）min。>80%的学生认为DOPS有利于发现自身操作中的小问题、有助于感受到教师的重视和关怀、可行性强、可以提高操作技能、培养人文素养和交流沟通能力。结论　在全科医学科毕业实习中开展DOPS作为形成性评价可以有效提高学生临床技能操作和Mini-CEX成绩，改善教学效果。

Application of Formative Evaluation with DOPS in Graduation Internship in General Practice Department

Background　Direct observation of procedural skills（DOPS） is a formative evaluation tool with teaching function for assessors to provide immediate assessment and feedback through direct observation of students' skills，which can evaluate students' learning process objectively and comprehensively. It is of great significance to introduce DOPS into teaching evaluation of general practice. Objective　To discuss the significance and effect of DOPS as formative evaluation tool in graduation internship in General Practice Department. Methods　A total of 72 seven-year clinical medical students of Grade 2013 in China Medical University were selected by cluster sampling from September to October in 2018. All students were randomly divided into experimental group and control group with 36 cases in each group by random number table method，and they were assigned to participate in a one-week internship in the General Practice Ward of the First Hospital of China Medical University. After the internship，a one-week clinical practice was conducted.In the control group，the traditional teaching method was used in the training of clinical practice skills.In the experimental group，formative evaluation with DOPS was conducted twice in the one-week course of clinical practice. The two groups were taught by the same teachers. At the end of rotation，mini-clinical evaluation exercise（Mini-CEX），clinical skill operation score，theoretical examination and questionnaire survey were used for teaching evaluation. Results　There was no significant difference between the experimental group and the control group in the theoretical test scores（P>0.05）. The clinical skill operation scores of the students in the experimental group and the control group were（76.67±6.20） and（72.50±7.66） respectively，and there was a significant difference between the two groups（P<0.05）. The Mini-CEX scores of the experimental group were higher than those of the control group in terms of physical examination，humanistic care，communication skills and overall performance（P<0.05）. The clinical operation time of DOPS was（11.32±1.76） min，the feedback time was（13.14±2.21） min，and the total time was（24.46±1.97） min. More than 80% of the students thought that DOPS was helpful to discover small problems in their operations and feel the attention and concern of teachers with strong feasibility. It could also improve operational skills and cultivate humanistic literacy and communication skills. Conclusion　Carrying out DOPS as formative evaluation tool in graduation practice of General Practice Department could improve students' clinical skills and Mini-CEX scores and improve the teaching effect effectively.