标准化病人在考核全科学员临床能力中的应用研究

目的采用标准化病人（SP）考核学员的临床能力，探讨改革全科规范化培训的毕业考核方法。方法上海2006级3个全科医学临床培训基地的52名学员参加考试，SP站点的考核分3个环节，包括重点问诊和体检、病历书写和口试，分别测试学员的沟通技能、信息收集、综合接诊能力以及临床思维、诊疗决断能力。结果SP对于学员问诊、体检及沟通技能的评分均高于考官评分，但两者间有相关性（P〈0．01），其中体检项目的相关系数最高（r=0．774）。各项技能平均分的差异有统计学意义（F=9．867，P〈0．01），其中综合接诊能力的平均分最低（64±22，P〈0．01）。沟通技能与信息收集的相关系数最大（r=0．582，P〈0．01）。考核成绩的影响因素分析发现，男女学员各项技能的平均分差异无统计学意义（P〉0．05）；有工作经历的学员综合接诊能力成绩明显低于没有工作经历的学员（P〈O．05），而其余各项技能中不同工作年限的学员成绩差异无统计学意义（P〉0．05）；学员沟通技能、病历书写和病例分析成绩随考核病例的不同，差异有统计学意义（P〈0．01）；此外，不同培训基地的学员信息收集和病历书写成绩差异也有统计学意义（P〈0．05）。结论应用SP能较为全面、客观地评估学员的临床能力，指导教学内容、教学模式的改进。

Standardized patients in assessment for clinical competencies of trainees in general practice training

Objective To assess clinical competencies of trainees with standardized patients(SPs)and explore reform in methods of assessment for trainees at their completion in standardized training for general practice.Methods Totally,52 trainees in clinical training bases for general practice in Shanghai attended the examinations.Their skills in commanication skills,information and data gathering,comprehensive consultation,clinical thinking and decision-making in diagnosis and treatment were examined by rotation of three serial assessment stations in a specified time to perform standardized tasks,including medical history-taking,physical examinations(PE),medial record writing and oral tests.Results Scoresof history-taking,PE and skills of communication with SPs were higher than those agsessed by examiners themselves.but they both correlated each other with a P-value less than 0.01,with the highest coefficient of correlation of 0.774 between score of PE and that assessed by examiners.There was significant difference in average score among all clinical skills(F=9.867,P＜0.01),with the lowest one of comprehensive consultation skills of 64±22(P＜0.01).Skills of communication with patients had the highest correlation with data gathering ability(r=0.582,P＜0.01).Results of analysis for influential factors showed no significant difference in average score for all skills between men and women trainees(P＜0.05).Average score of comprehensive consultation ability in those with work experience was lower than that in thoge without it(P＜0.05)and no significant difference in scores of all the other skills wag found between those with varied length of working(P＞0.05).There was significant difiefence in average scores of communication skills,medical record writing,and case analysis between various trainees(P＜0.01).In addition,average scores of information collecting and medical record writing also differed among trainees from varied bases for general practice training(P＜0.05).Conclusions Clinical skills,ability to direct teaching work,and improvement of teaching model can be assessed in a comprehensive and objectively way using standardized patients in general practice training.