操作技能直接观察评估作为形成性评价在基本医疗卫生服务毕业实习中的应用

  目的  探讨在医学本科生基本医疗卫生服务毕业实习中应用操作技能直接观察评估(direct observation of procedural skills, DOPS)作为形成性评价的意义和效果。  方法  选取2018年6月中国医科大学临床医学专业大学5年级的本科生62人为研究对象。应用随机数字表法将62名医学本科生分为观察组和对照组，每组31人。在观察组的临床操作技能培训中增加应用DOPS作为形成性评价，对照组仍沿用传统带教方法实施临床操作技能培训。培训结束进行效果评价。  结果  观察组的身体检查考试成绩(80.66±6.53)分]高于对照组(76.13±7.99)分，P < 0.05]。观察组的心电图机操作考试成绩(78.50±9.06)分]高于对照组(73.30±8.80)分，P < 0.05]。观察组学生的笔试成绩(74.43±7.96)分]高于对照组(73.28±9.32)分]，但差异无统计学意义(P>0.05)。Mini-CEX考试成绩中，观察组的病史采集(6.53±1.24)分]、身体检查(6.28±1.57)分]、人文关怀(6.21±1.31)分]、沟通技巧(6.44±1.48)分]和整体表现(6.31±1.15)分]成绩显著高于对照组(5.87±1.17)分、(5.40±1.30)分、(5.37±1.45)分、(5.57±1.36)分、(5.60±0.89)分，均P < 0.05]。Mini-CEX考试成绩中的临床诊断与处理、组织效能条目，观察组和对照组比较差异无统计学意义(均P>0.05)。  结论  在医学本科生基本医疗卫生服务毕业实习中开展DOPS作为形成性评价可以有效地提高临床操作技能操作考试成绩和Mini-CEX考试成绩，改善教学效果。 

Application of DOPS as formative evaluation in basic health services in graduation practice

  Objective  To discuss the effect of direct observation of procedural skills (DOPS) as formative evaluation in basic health services in graduation practice.  Methods  Total 62 fifth-year undergraduates from The Clinical Medicine Major University of China Medical University were selected as study subjects In June 2018. Using random number table method, 62 medical undergraduates were divided into experimental group and control group, 31 persons in each group. DOPS was added as formative evaluation in the clinical operation skill training of the experimental group, while the control group still carried out clinical operation skill training with traditional teaching methods. The effect was evaluated at the end of the training.  Results  The physical examination scores of the experimental group (80.66±6.53) points] were higher than those of the control group (76.13±7.99) points], and the results were statistically significant (P < 0.05). The test scores of ECG operation in the experimental group (78.50±9.06) points] were higher than those of the control group (73.30±8.80) points], and the results were statistically significant (P < 0.05). The written test scores of students in the experimental group (74.43±7.96) points] were higher than those of the control group (73.28±9.32) points], but the results were not statistically significant (P>0.05). In the Mini-CEX test scores, the experimental group's medical history collection (6.53±1.24) points], physical examination (6.28±1.57) points], humanistic care (6.21±1.31) points], communication skills (6.44±1.48) points] and overall performance (6.31±1.15) points] scores, were significantly higher than the control group (5.87±1.17) points, (5.40±1.30) points, (5.37±1.45) points, (5.57±1.36) points and (5.60±0.89) points, respectively], and the results were statistically significant (all P < 0.05). There was no statistically significant difference between the experimental group and the control group in the clinical diagnosis and treatment and organizational effectiveness items in the Mini-CEX test scores (all P>0.05).  Conclusion  Carrying out DOPS as formative evaluation in the basic health services in graduation practice could improve the teaching effect effectively.