Department of Obstetrics and Gynecology, New York University School of Medicine, New York, New York 10016, USA.
J Surg Educ. 2013 Jan-Feb;70(1):10-4. doi: 10.1016/j.jsurg.2012.08.005. Epub 2012 Sep 18.
Educators of trainees in procedure-based specialties need focused assessment tools that are valid, objective, and assess technical skills in a realistic context. A framework for hybrid assessment using standardized patient scenarios and bench skills testing might facilitate evaluation of competency.
Seven PGY-1 obstetrics and gynecology residents participated in a hybrid assessment that used observed structured clinical examination (OSCE) by a standardized patient who had sustained a vaginal laceration during vaginal delivery. The residents elicited a history and counseled the patient, and then completed a laceration repair on a pelvic model. The residents were rated on their performance in the scenario, which included issues of cultural competency, rapport-building, patient counseling. The technical skills were videotaped and rated using a modified global assessment form by 2 faculty members on a 3-point scale from "not done" to "partly done" to "well-done." Residents also completed a subjective assessment of the station.
Mean technical performance of the residents on the technical skills was 55% "well-done," with a range of 20%-90%. The assessment identified 3 residents as below the mean, and 1 resident with areas of deficiency. Subjective assessment by the residents was that juggling the technical, cognitive, and affective components of the examination was challenging.
Technical skills can be included in a case-based assessment using scenarios that address a range of cognitive and affective skills required of physicians. Results may help training programs assess individuals' abilities as well as identify program needs for curricular improvement. This framework might be useful in setting standards for competency and identifying poor performers.
以程序为基础的专业培训师需要使用有针对性的评估工具，这些工具应具有有效性、客观性，并能在现实背景下评估技术技能。使用标准化患者情景和基础技能测试的混合评估框架可能有助于评估能力。
7 名妇产科住院医师参加了一项混合评估，由一位因阴道分娩而遭受阴道裂伤的标准化患者进行观察性结构化临床检查（OSCE）。住院医师获取病史并为患者提供咨询，然后在骨盆模型上完成裂伤修复。住院医师在情景中的表现，包括文化能力、建立融洽关系、患者咨询等方面进行评分。技术技能通过录像进行评估，并由 2 名教员使用经过修改的整体评估表，按照“未完成”、“部分完成”到“完成良好”的 3 分制进行评分。住院医师还对该站点进行了主观评估。
住院医师在技术技能方面的平均技术表现为 55%“完成良好”，范围为 20%-90%。评估确定了 3 名低于平均值的住院医师和 1 名有缺陷的住院医师。住院医师的主观评估是，在检查中兼顾技术、认知和情感等方面具有挑战性。
可以在基于案例的评估中使用情景来纳入技术技能，这些情景涵盖了医生所需的一系列认知和情感技能。结果可能有助于培训计划评估个人的能力，并确定课程改进的计划需求。该框架可能有助于确定能力标准和识别表现不佳的人员。
