临床技能多站式考核在技能考核中的应用及内部影响因素评价

目的 探索临床技能多站式考核（objective structured clinical examination，OSCE）评价体系在地方医学院校临床毕业技能考核中的应用，及对医学生临床综合技能培养的意义。方法 20名考官采用四大考站的OSCE评价体系，对临床医学专业150名学生进行考核。通过方差分析比较各考站分数差异；采用李克特（Likert）5级计分法对满意度进行记分、Likert3级计分法对考核体系作用指标及内部影响因素进行记分，综合分析评价此考核体系。结果第一和第四考站学生得分较其他考站低（P〈0．05）。满意度调查中，学生不满意有8人（5．48％），考官不满意仅有1人（5％）（包括较不满意和不满意）。考生及考官普遍认为，通过此考评体系可以有效地检验学生心理素质、沟通交流、小组合作、临床思维和实践技能等方面的综合能力，其作用均为中度以上（得分均〉2．0）。考评体系内部影响因素评价，难度由高到低顺序为第四、第一、第三和第二考站。考官认为第二考站内容简单占4人（20％），时间过长占8人（40％），其余各项指标适中或合理均占70％以上。结论 OSCE评价体系能有效指导教与学，对培养学生临床思维等综合能力发挥重要作用；需要充分考虑体系内部影响因素，不断完善体系设计。

The application of the OSCE evaluation system on the medical skills examination and the evaluation on its intrinsic influencing factors

Objective To investigate the application of OSCE evaluation system on the medical skills examination of clinical medical students and the significance of this system on the training of their medical skills. Methods 20 teachers examed 150 students by the OSCE evaluation system with 4 test stations, by comparing the score of the students of different test stations by one-way ANOVA and evaluating the system by questionnaire survey with Likert 5 on the degree of satisfaction and Likert 3 on effects and intrinsic influencing factors of the system. Results The score of the first and forth test stations was lower than that in the other stations（P〈0.05）. 8/5.48% students and 1/5% teachers were not satisfied with the system. The OSCE evaluation system could exam the psychological diathesis, ability of communication, cooperation, and clinical thinking, practical skill of the students and its effects are moderate （the score was more than 2.0）. Evaluation on the intrinsic influencing factors： Students considered the questions were more difficulty in the 2nd, 3rd, 1st, 4th test stations order. 4/ 20% teachers considered the questions of the second test station was easy. 8/40% teachers considered the duration of the second test station was too long. More than 70% students and teachers considered the other indexes were rational. Conclusion The OSCE evaluation system can play an effective role in directing the teaching and learning. It can also help to culture the comprehensive capacity of the students. We should gradually improve the design of the system by considering the intrinsic influencing factors.