住培专项训练对某医院内科专业基地住培医师核心胜任力的影响

目的 探究住院医师规范化培训（简称住培）专项训练对内科专业基地住培医师核心胜任力的影响,明确其有无进一步推广价值。方法 选择某医院内科住培基地拟参加结业考核的69名住培医师为研究对象;根据内科专业基地培训细则,按照结业考核“临床思维”和“技能操作”考站的评分标准建立病例题库（考官版、考生版、评分标准）,确定训练样题,以考代训,每站考核15 min,使用“天堰”手持评分系统进行评分,集中时间开展“临床思维”和“技能操作”2种专项训练。专项训练前后均实施模拟OSCE考核,设5个独立考站：考站1（接诊患者）、考站2（临床思维-1）、考站3（临床思维-2）、考站4（临床操作）、考站5（交流沟通）。对比专项训练前后内科住培医师模拟OSCE成绩的变化。结果 专项训练后住培医师第1～4模拟OSCE考站总分均提高;考站1“问诊内容”“重点查体”,考站2-3“初步诊断”“体格检查”“辅助检查”,考站4“操作前准备”“操作过程”等项目的得分率均提高（P均<0.05）。结论专项训练增加了OSCE的总成绩,并对住培医师诊断疾病、重点查体和临床操作能力有重要影响,该训练有利于提升内科专业基地住培医师的核心...     

浅谈客观结构化临床考试(OSCE)的体会

客观结构化临床考试（OSCE）是一种客观的临床能力考试模式。我校今年首次在医学本科毕业生中进行。对标准化病人（SP）培训、考官、考场的准备工作、学生都有不同的要求。     

OSCE对临床医学生考试心理状况影响的情况分析

目的：观察客观结构化临床考试（OSCE）在评估临床医学本科毕业生临床能力中的应用及效果,并分析其对考生心理状况的影响,探讨其建立临床能力评价体系的可行性。方法：制定相关医学临床能力考核方案,选择2008级临床医学专业300名学生在预实习前,预实习结束OSCE与临床实习结束OSCE做心理健康症状自评量表SCL-90调查研究。结果：临床实习结束OSCE后,学生评分均明显低于预实习前与预实习结束OSCE,比较差异均有统计学意义（P〈0.05）。结论：OSCE可以客观、系统、准确评估临床医学生临床能力,但一定程度上造成考生抑郁、焦虑心理。     

从执业医师实践技能考试看临床技能教学存在的问题及对策

目的发现临床技能教学中存在的问题并提出对策。方法抽取即将毕业的学生356人,按照执业医师临床实践技能考试程序严格进行,对成绩进行分析总结。结果病史采集和病例分析合格率82.7%,平均分为（69.5±19）分,以疾病的鉴别诊断成绩最差;体格检查中,以神经系统检查、颈部检查、血管检查、淋巴结检查合格率低,腹部脏器体检中则以胆囊、脾脏检查合格率低;临床常用诊断技术操作考试以穿脱隔离衣合格率最低。结论需进一步加强临床技能教学,提高教学质量。     

头痛

头痛（headache）是最常见的症状之一，一般泛指头部上半部至枕下部（发际以上）范围内的疼痛。其病因及分类十分复杂，临床上往往缺乏客观体征，给临床医师的诊断和治疗造成困难，且有些严重的疾患常常是以头痛为先发症状。因此，详细的病史采集、体格检查及正确的临床思维十分重要。     

中医院校临床实训教学中运用SSP的效果与分析

通过培训学生标准化病人(即SSP)并将其运用于中医院校临床基本技能实训教学中,最终通过考核评分结果表明,此法可以激发学生学习兴趣,提高中医院校医学生的体格检查技能、医患沟通能力、病史采集能力,进一步巩固医学基础知识,提升医学生的职业素养,值得进一步推广应用。笔者还将教学实践中的体会、建议、教学中面临的问题等进行了总结、分析和探讨,为临床和其它学科的教学提供参考。     

健康评估课程客观结构化临床考试信度和效度评价

目的 探讨健康评估课程客观结构化临床考试（OSCE）的信度与效度。方法 在广州医科大学护理学院2012与2013届护理本科生健康评估教学评价中引入OSCE考核模式,采用Cronbach′s α、重测信度、内容效度、结构效度、校标效度评价其信度与效度,并对OSCE考核站点的难度与区分度进行评价。结果 OSCE考核站点总Cronbach′s α系数为0.793,重测信度系数为0.727。OSCE考核内容效度指数为0.872,两届学生考核站点总分与理论成绩相关系数分别为0.781、0.803。探索性因子分析提取了3个公因子,解释了总变异的63.420%,验证性分析证实该结构模型合理,符合理论假设。OSCE各站点的难度系数在0.221~0.702之间,区分度在0.171~0.390之间。结论 健康评估课程OSCE考试具有较好的信度与效度,适用于综合评价护理本科生的临床评估能力。     

浅谈诊断学临床技能教学改革

为提高诊断学教学质量，笔者所在校区对诊断学临床技能教学进行了改革，以掌握基本理论，加强l临床技能教学，强化问诊、体格检查及临床常用穿刺技术的训练为主要内容，以培养学生实际工作能力作为改革的重点。     

从执业医师实践技能考试看临床技能教学存在的问题及对策

目的发现临床技能教学中存在的问题并提出对策。方法抽取即将毕业的学生356人,按照执业医师临床实践技能考试程序严格进行,对成绩进行分析总结。结果病史采集和病例分析合格率82.7%,平均分为(69.5±19)分,以疾病的鉴别诊断成绩最差;体格检查中,以神经系统检查、颈部检查、血管检查、淋巴结检查合格率低,腹部脏器体检中则以胆囊、脾脏检查合格率低;临床常用诊断技术操作考试以穿脱隔离衣合格率最低。结论需进一步加强临床技能教学,提高教学质量。     

简化OSCE模式在外科护理学实践教学中的应用

目的探讨客观结构化临床考试(Objective Structured Clinical Examination,OSCE)模式以教师为标准化病人(Teachers Standardized patients,TSP)在外科护理教学实践中的应用效果。方法将2015级普护班80名护理学生,随机分为对照组和研究组各40名,对照组实施传统模式教学,研究组实施基于TSP简化OSCE模式实验教学,通过课堂考核、课后作业、自制调查问卷评价教学效果。计量资料比较采用t检验,计数资料比较采用χ2检验,P0.05为差异有统计学意义。结果课程结束时研究组理论及操作成绩[(80.12±7.45)、(87.65±8.00)分]均高于对照组[(70.22±6.30)、(78.20±4.32)分](均P0.05)。研究组对OSCE模式教学效果高度肯定,OSCE各考站的成绩、平均成绩均较教学前提高(均P0.05)。结论 TSP兼具评估者和教学指导者双重功能,充分发挥在护理学教学、考核"特殊工具"的优势,基于TSP的简化OSCE模式用于外护实验教学可行性高。     

Teaching in the new NHS: the specialised ward based teacher

OBJECTIVES: To evaluate the effects of introducing specialised ward based teachers (WBTs) who had a broad remit to improve third year medical undergraduates' clinical experience. DESIGN: Quantitative and qualitative methods including interviews with WBTs, participating consultants and SIFT co-ordinator; student questionnaire and evaluations; analysis of Objective Structured Clinical Examination (OSCE) scores to ascertain if exposure to WBTs affected OSCE scores. SETTING: Two university teaching hospitals. PARTICIPANTS: Third year undergraduate medical students from one school of medicine; four WBTs; 25 consultants; SIFT co-ordinator. MAIN OUTCOME MEASURES: Student evaluations. Student questionnaires. Student OSCE scores. Interview data. RESULTS: WBTs had a demonstrable effect on student performance in OSCE examinations. 94% of students either agreed or strongly agreed that WBTs had helped them develop their examination skills and 87% either agreed or strongly agreed that WBTs had helped them develop their history taking skills. Interview data indicated that the consultants and SIFT co-ordinator considered that WBTs made an important contribution to clinical teaching. CONCLUSIONS: This study suggests that specialised WBTs are one way to manage clinical experience and enhance learning of undergraduate medical students. As clinical teaching moves into earlier parts of the undergraduate curriculum and into the community there is potential for this role to be developed.     

Effects of basic clinical skills training on objective structured clinical examination performance

OBJECTIVES: The aim of curriculum reform in medical education is to improve students' clinical and communication skills. However, there are contradicting results regarding the effectiveness of such reforms. METHODS: A study of internal medicine students was carried out using a static group design. The experimental group consisted of 77 students participating in 7 sessions of communication training, 7 sessions of skills-laboratory training and 7 sessions of bedside-teaching, each lasting 1.5 hours. The control group of 66 students from the traditional curriculum participated in equally as many sessions but was offered only bedside teaching. Students' cognitive and practical skills performance was assessed using Multiple Choice Question (MCQ) testing and an objective structured clinical examination (OSCE), delivered by examiners blind to group membership. RESULTS: The experimental group performed significantly better on the OSCE than did the control group (P < 0.01), whereas the groups did not differ on the MCQ test (P < 0.15). This indicates that specific training in communication and basic clinical skills enabled students to perform better in an OSCE, whereas its effects on knowledge did not differ from those of the traditional curriculum. CONCLUSION: Curriculum reform promoting communication and basic clinical skills are effective and lead to an improved performance in history taking and physical examination skills.     

1999-2008年胜利油田高考学生体检资料分析

[目的]了解胜利油田高中毕业生的身体健康状况,为指导学生预防保健工作提供科学依据。[方法]按照《普通高等学校招生体检标准》的各项规定及其分类方法,对胜利油田1999～2008年参加高考体检学生的资料进行统计分析。[结果]1999～2008年累计体检33591人,完全合格的2394人,合格率为7．130%合格率呈逐年下降的趋势．不同年份间的差异有统计学意义（P〈0．01）。报考专业受限者31187人,专业受限率为92．84％．不同年份间的差异有统计学意义（P〈0．01）;男生合格率（8．12％）高于女生（6．63％）,差异有无统计学意义（P〈0．01）;报考专业受限率为92．84％,考生受限的主要原因是视力低下和身高不足,分别占受限人数的82．61％和11．30％。不合格考生10人,不合格率为0．03％;不合格的主要原因是心脏病或其它器质性疾病。[结论]胜利油田高考生体检合格率有逐年下降的趋势,且合格率较低,而报考专业受限率逐年升高。考生视力低下极为严重。加强中小学生视力保护、提高综合素质应做为当前学校卫生保健工作的重点而引起足够重视。     

Benefiting from clinical experience: the influence of learning style and clinical experience on performance in an undergraduate objective structured clinical examination

OBJECTIVE: To assess the relationship between clinical experience, learning style and performance in an objective structured clinical examination (OSCE) in medical students at the end of their first clinical year. DESIGN: Prospective study of undergraduate students taking an OSCE examination at the end of their first clinical year. SUBJECTS: 194 undergraduate medical students (95 male). MAIN OUTCOME MEASURES: Performance in the OSCE examination, the Entwhistle Learning Style Inventory1 and a composite self-reported score of clinical activity during the students first clinical year. RESULTS: Performance in the OSCE examination was related to well-organized study methods but not to clinical experience. A significant relationship between clinical experience and organized deep-learning styles suggests that knowledge gained from clinical experience is related to learning style. CONCLUSIONS: The relationship between clinical experience and student performance is complex. Well-organized and strategic learning styles appear to influence the benefits of increased clinical exposure. Further work is required to elucidate the most beneficial aspects of clinical teaching.     

Does studying for an objective structured clinical examination make a difference?

PURPOSE: This study examines the extent to which second-year medical students studied for an objective structured clinical examination (OSCE), how they studied, and the impact of self-reported studying on OSCE performance. METHOD: One class of 113 medical students completed an end-of-second-year OSCE, held on two consecutive evenings. The OSCE was comprised of eight stations, each of which was of 20 minutes' duration. The OSCE was formative: students received performance feedback but were not graded. Prior to the OSCE, students completed a brief survey regarding their preparation for the OSCE and their perceptions of confidence, anxiety and preparedness. Only 78 students returned surveys with names, comprising the data for these analyses. RESULTS: Mean studying time was 3.3 h, ranging from 0 to 19 h. Studying time was positively associated with age and negatively associated with basic science examination scores. The most study time was dedicated to reviewing the physical examination textbook, class notes and supplemental course readings. The breadth of study strategies increased as more time was spent in OSCE preparation. OSCE performance was related to study time and to achievement on pre-clinical basic science examinations. DISCUSSION: The students whose performance was above average seemed to be the talented students whose records indicated a history of academic success. The amount of time they reported for OSCE preparation was comparable to that reported by students with below average performance. It appears that prior academic performance rather than preparatory studying time is a better predictor of OSCE outcomes.     

A Discrete System Simulation Study in Scheduling and Resource Allocation for the John A. Burns School of Medicine Clinical Skills Center

The Center for Clinical Skills (CCS) at the University of Hawai‘i''s John A. Burns School of Medicine (JABSOM) trains medical students in a variety of medical practice education experiences aimed at improving patient care skills of history taking, physical examination, communication, and counseling. Increasing class sizes accentuate the need for efficient scheduling of faculty and students for clinical skills examinations. This research reports an application of a discrete simulation methodology, using a computerized commercial business simulation optimization software package Arena® by Rockwell Automation Inc, to model the flow of students through an objective structure clinical exam (OSCE) using the basic physical examination sequence (BPSE). The goal was to identify the most efficient scheduling of limited volunteer faculty resources to enable all student teams to complete the OSCE within the allocated 4 hours. The simulation models 11 two-person student teams, using resources of 10 examination rooms where physical examination skills are demonstrated on fellow student subjects and assessed by volunteer faculty. Multiple faculty availability models with constrained time parameters and other resources were evaluated. The results of the discrete event simulation suggest that there is no statistical difference in the baseline model and the alternative models with respect to faculty utilization, but statistically significant changes in student wait times. Two models significantly reduced student wait times without compromising faculty utilization.     

西部地区某医学院营养学课程双语教学实践与探讨

[目的]探索西部地区实行双语教学的效果。[方法]以医学院预防专业大四学生为研究对象,分为实施双语教学(A班)和没有实施双语教学(B班)的两班,通过考试和教学质量测评指标评价实施双语教学的效果。[结果]虽然A班学习前营养专业英语测试成绩高于B班,但B班经过双语教学学习后掌握的营养专业英语知识明显好于A班(P﹤0.01)。学生和教师对双语教学给予了较好的评价,同时提出了中肯的建议。[结论]西部边远地区双语教学需要根据学生情况制定合理的教学目标和教学方法。     

Smoking history-taking skills: a simple guide to teach medical students

Many doctors rate themselves as ineffective smoking cessation counsellors. It is logical to initiate training efforts with medical students. We incorporated smoking history-taking in the physical diagnosis course at the University of North Carolina at Chapel Hill using a simple method to teach smoking history-taking skills and to assess its effectiveness as an educational intervention. The principal intervention was the distribution of a one-sheet Smoking-History Taking and Counseling Guide, adapted from the American Lung Association's Freedom From Smoking for You and Your Family self-help manual. The second intervention was a single prompt for 50% of the course preceptors. Students' smoking history-taking skills were evaluated in the Objective Structured Clinical Examination (OSCE) at the end of the course. Students who received the guide did significantly better on the OSCE, even after controlling for having discussed taking a smoking history with their preceptors. A simple guide combined with a one-time prompting of preceptors has a positive effect on the acquisition of smoking history-taking skills by the medical students. This strategy may also be useful for teaching and evaluating smoking-cessation counselling skills, for which good smoking history-taking is a necessary basis.