目的 探讨客观结构式临床技能考核(OSCE)结合标准化患者(SP)在住院医师规范化培训(规培)临床实践考核中的应用效果.方法 选择新疆医科大学第一附属医院2016年8月至2017年8月参加住院医师规培的临床医学专业型内科研究生97人为研究对象,按随机数字表法分为A组(48例)和B组(49例).规培2年,规培第1年结束时对A组采用OSCE+SP模式考核;B组采用传统模式考核.规培第2年结束时再次进行考核,两组考核模式互换.比较两组考生考核成绩的差异.结果 第1次考核中,A组医学生考核成绩收集和分析病史能力、体格查体能力、临床技能操作能力、临床思维能力、总成绩等均明显高于B组〔收集和分析病史能力(分):24.9±2.9比22.9±2.4,体格查体能力(分):11.0±1.3比10.0±1.3,临床技能操作能力(分):21.3±2.0比19.9±2.2,临床思维能力(分):72.0±7.2比66.8±13.8,总成绩(分):72.9±4.7比68.0±3.1,均P＜0.05〕.第2次考核中,A组医学生考核成绩收集和分析病史能力、体格查体能力、临床技能操作能力、临床思维能力、总成绩等均明显低于B组〔收集和分析病史能力(分):23.1±2.4比25.0±2.7,体格查体能力(分):10.4±1.3比11.2±1.3,临床技能操作能力(分):20.1±2.4比21.4±2.2,临床思维能力(分):69.1±6.4比72.2±8.0,总成绩(分):68.9±3.8比73.4±4.6,均P＜0.05〕.两阶段交互设计方差分析结果显示,新型考核模式是两组医学考生考核成绩有统计学差异的主要因素(P＜0.05).结论 新型考核模式(OSCE+SP)较传统考核模式更能促进医学生各项成绩的提高,有利于医学生从课本理论过度到临床实际工作,更有助于住院医师提高自身综合素质,符合新形势下医学发展要求.%Objective To explore the application effect of objective structured clinical examination (OSCE) combined with standardized patients (SP) in the clinical practice assessment of standardized residenncy training. Methods A total of 97 clinical internal medical graduates from the First Affiliated Hospital of Xinjiang Medical University who participated in resident training from August 2016 to August 2017 were selected as the subjects, and they were divided into group A (48 cases) and group B (49 cases) according to the random number table. The standardized training course was 2 years, at the end of the first year of training, OSCE+SP model was used in group A for the examination, and group B was examined by traditional mode. After the 2nd year of training, the examination was again carried out, and the assessment models were exchanged between the A and B groups. The differences in various abilities and total scores of two groups were compared and analyzed statistically. Results In the first examination, the ability of collecting and analyzing medical history, physical examination ability, clinical skill operation ability, clinical thinking ability and total score of group A were significantly higher than those of group B (ability of collecting and analyzing medical history scores: 24.9±2.9 vs. 22.9±2.4, physical exam ability scores: 11.0±1.3 vs.10.0±1.3, clinical skill operation ability scores: 21.3±2.0 vs.19.9±2.2, clinical thinking ability scores: 72.0±7.2 vs. 66.8±13.8, total score:72.9±4.7 vs. 68.0±3.1, all P < 0.05). In the second exam, the ability of collecting and analyzing medical history, physical exam ability, clinical skill operation ability, clinical thinking ability and total score of group A were significantly lower than those of group B (ability of collecting and analyzing medical history score: 23.1±2.4 vs. 25.0±2.7, physical exam ability score: 10.4±1.3 vs. 11.2±1.3, clinical skill operation ability score: 20.1±2.4 vs. 21.4±2.2, clinical thinking ability score: 69.1±6.4 vs. 72.2±8.0, total score: 68.9±3.8 vs. 73.4±4.6, all P < 0.05). The results of variance analysis of two-stage interactive design showed that the new assessment model was the main factor that caused the statistical significant differences in medical students' examination results between the two groups (P < 0.05). Conclusion The new OSCE+SP model can more promote the improvement of medical students' achievements, benefit medical students from textbook theory entering into clinical practice, help resident doctors elevate their self comprehensive competency, and meet the requirements of medical development under the new national situation.
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