Warf B C, Donnelly M B, Schwartz R W, Sloan D A
Department of Surgery, University of Kentucky, Lexington, Kentucky 40536, USA.
J Surg Res. 1999 Sep;86(1):17-23. doi: 10.1006/jsre.1999.5679.
The objective structured clinical examination (OSCE), an established instrument for evaluating resident competence, was used to test the hypothesis that faculty assessment of clinical competence in residents at various levels of training may be influenced more by general skills as a physician and less by competency in the actual skills being specifically tested. In this study, advantage was taken of the anticipated observation that general surgery residents did not demonstrate improvement in their ability to perform a focused neurological assessment over time.
An OSCE, which was administered to 56 general surgery residents at all levels of training, included the assessment of a specific clinical neurosurgical problem (sciatica). Univariate and multivariate analyses were used to evaluate the relationship between the global faculty judgment of competent or noncompetent and the other performance measures that were applied.
At different levels of training, there was no observed difference in the specific skills being tested; nevertheless, junior and senior residents were more likely than incoming interns to be judged "competent" and received better evaluations of how well they introduced themselves to the patient. The competence judgment correlated significantly with all of the other performance measures, including the skills being tested.
The perception of competence is not solely dependent upon the particular skills under scrutiny. General competence does not guarantee competence in each specific skill set of a medical specialty.
客观结构化临床考试（OSCE）是一种用于评估住院医师能力的既定工具，本研究旨在验证以下假设：教员对不同培训阶段住院医师临床能力的评估，可能更多地受到作为一名医生的一般技能的影响，而较少受到所具体测试的实际技能能力的影响。在本研究中，利用了这样一个预期观察结果：普通外科住院医师在进行重点神经系统评估方面的能力并不会随着时间的推移而有所提高。
对56名处于不同培训阶段的普通外科住院医师进行了OSCE，其中包括对一个特定临床神经外科问题（坐骨神经痛）的评估。采用单因素和多因素分析来评估教员对合格或不合格的总体判断与所应用的其他绩效指标之间的关系。
在不同培训阶段，所测试的具体技能没有观察到差异；然而，与初入的实习生相比，低年级和高年级住院医师更有可能被判定为“合格”，并且在向患者自我介绍方面得到了更好的评价。能力判断与所有其他绩效指标显著相关，包括所测试的技能。
对能力的认知不仅仅取决于所审查的特定技能。一般能力并不能保证在医学专业的每个特定技能集方面都具备能力。
