研究生培训对 USMLE® Step 3®及其基于计算机的病例模拟部分的影响。

The impact of postgraduate training on USMLE® step 3® and its computer-based case simulation component.

机构信息

National Board of Medical Examiners, Philadelphia, PA 19104, USA.

出版信息

J Gen Intern Med. 2012 Jan;27(1):65-70. doi: 10.1007/s11606-011-1835-1. Epub 2011 Aug 31.

DOI:10.1007/s11606-011-1835-1

PMID:21879372

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3250543/

Abstract

BACKGROUND

The United States Medical Licensing Examination® (USMLE®) Step 3® examination is a computer-based examination composed of multiple choice questions (MCQ) and computer-based case simulations (CCS). The CCS portion of Step 3 is unique in that examinees are exposed to interactive patient-care simulations.

OBJECTIVE

The purpose of the following study is to investigate whether the type and length of examinees' postgraduate training impacts performance on the CCS component of Step 3, consistent with previous research on overall Step 3 performance.

DESIGN

Retrospective cohort study

PARTICIPANTS

Medical school graduates from U.S. and Canadian institutions completing Step 3 for the first time between March 2007 and December 2009 (n = 40,588).

METHODS

Post-graduate training was classified as either broadly focused for general areas of medicine (e.g. pediatrics) or narrowly focused for specific areas of medicine (e.g. radiology). A three-way between-subjects MANOVA was utilized to test for main and interaction effects on Step 3 and CCS scores between the demographic characteristics of the sample and type of residency. Additionally, to examine the impact of postgraduate training, CCS scores were regressed on Step 1 and Step 2 Clinical Knowledge (CK) scores. Residuals from the resulting regressions were plotted.

RESULTS

There was a significant difference in CCS scores between broadly focused (μ = 216, σ = 17) and narrowly focused (μ=211, σ = 16) residencies (p < 0.001). Examinees in broadly focused residencies performed better overall and as length of training increased, compared to examinees in narrowly focused residencies. Predictors of Step 1 and Step 2 CK explained 55% of overall Step 3 variability and 9% of CCS score variability.

CONCLUSIONS

Factors influencing performance on the CCS component may be similar to those affecting Step 3 overall. Findings are supportive of the validity of the Step 3 program and may be useful to program directors and residents in considering readiness to take this examination.

摘要

背景

美国医师执照考试®（USMLE®）第 3 步®考试是一项基于计算机的考试，由多项选择题（MCQ）和基于计算机的病例模拟（CCS）组成。第 3 步的 CCS 部分是独特的，因为考生会接触到互动的患者护理模拟。

目的

本研究的目的是调查考生的研究生培训类型和长度是否会影响第 3 步 CCS 部分的表现，这与之前关于整体第 3 步表现的研究一致。

设计

回顾性队列研究

参与者

2007 年 3 月至 2009 年 12 月期间首次参加第 3 步考试的来自美国和加拿大机构的医学院毕业生（n=40588）。

方法

研究生培训分为广泛关注医学的一般领域（例如儿科）或专注于医学的特定领域（例如放射科）。使用三因素组间 MANOVA 检验样本的人口统计学特征与住院医师类型之间第 3 步和 CCS 分数的主效应和交互效应。此外，为了检查研究生培训的影响，将 CCS 分数回归到第 1 步和第 2 步临床知识（CK）分数。从回归中得出的残差图。

结果

广泛关注（μ=216，σ=17）和狭义关注（μ=211，σ=16）住院医师之间的 CCS 分数存在显著差异（p<0.001）。与狭义关注的住院医师相比，广泛关注的住院医师的整体表现更好，并且随着培训时间的增加，他们的表现也更好。第 1 步和第 2 步 CK 的预测因素解释了整体第 3 步变异性的 55%和 CCS 分数变异性的 9%。