Margaret and Ian Smith Clinical Skills Center, Weill Cornell Medical College, New York, New York 10021, USA.
Med Educ Online. 2009 Aug 5;14:9. doi: 10.3885/meo.2009.T0000137.
To assess the feasibility of Direct Observation of Clinical Skills (DOCS), a program for formative assessment of students' clinical skills during a medicine clerkship and to determine relationships between DOCS measures and other clinical performance measures.
From August, 2004 through June, 2005, Medicine Clerks assigned to the primary on-campus clinical site were asked to participate in the pilot phase of the DOCS program. Students were asked to complete at least one DOCS exercise focused on interviewing, physical examination, or oral case presentation.
Of the 79 students who rotated on the Medicine Clerkship during the pilot period, 79% (n = 62) participated in DOCS, and 163 forms were submitted for evaluation. Seventy-seven percent (77%) of the clinical observations occurred while on-call or during daily rounds. Seventy-three (73%) of observations were completed in 30 minutes or less. In 89% of encounters students received at least 5 minutes of verbal feedback. Satisfaction ratings from both students and observers were "moderately satisfied" or better. Global ratings from DOCS physical exam and case presentation sections were strongly correlated with both faculty ratings of clinical performance and final clerkship grade. DOCS measures were not statistically related to clerkship written examination scores.
These data support the feasibility of the DOCS session for formative assessment of student interviewing, physical examination, and oral case presentation skills during a medicine clerkship. Observer ratings from DOCS physical examination and case presentation sections were found to be predictors of final clerkship grade.
评估直接观察临床技能（DOCS）的可行性，这是一项针对医学生临床技能形成性评估的计划，并确定 DOCS 测量指标与其他临床绩效测量指标之间的关系。
从 2004 年 8 月到 2005 年 6 月，被分配到校内主要临床基地的医学实习生被要求参与 DOCS 计划的试点阶段。学生被要求至少完成一项针对访谈、体检或口头病例陈述的 DOCS 练习。
在试点期间，有 79 名医学生参加了医学实习，其中 79%（n=62）参加了 DOCS，共有 163 份表格提交评估。77%的临床观察发生在值班或日常查房期间。73%的观察在 30 分钟或更短的时间内完成。在 89%的就诊中，学生至少收到了 5 分钟的口头反馈。学生和观察员的满意度评分均为“中度满意”或更高。DOCS 体检和病例陈述部分的总体评分与教师对临床表现和最终实习成绩的评分高度相关。DOCS 测量指标与实习书面考试成绩无统计学相关性。
这些数据支持在医学实习期间使用 DOCS 会议对学生的访谈、体检和口头病例陈述技能进行形成性评估的可行性。DOCS 体检和病例陈述部分的观察员评分被发现是最终实习成绩的预测因素。
