Department of Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina 28599-7213, USA.
Acad Med. 2013 May;88(5):682-7. doi: 10.1097/ACM.0b013e31828b0007.
Data indicate that students are unprepared to perform basic medical procedures on graduation. The authors' aim was to characterize graduating students' experience with and opinions about these skills.
In 2011, an online survey queried 156 fourth-year medical students about their experience with, and actual and desired levels of competence for, nine procedural skills (Foley catheter insertion, nasogastric tube insertion, venipuncture, intravenous catheter insertion, arterial puncture, basic suturing, endotracheal intubation, lumbar puncture, and thoracentesis). Students self-reported competence on a four-point Likert scale (4=independently performs skill; 1=unable to perform skill). Data were analyzed by analysis of variance and Student t test. A five-point Likert scale was used to assess student confidence.
One hundred thirty-four (86%) students responded. Two skills were performed more than two times by over 50% of students: Foley catheter insertion and suturing. Mean level of competence ranged from 3.13±0.75 (Foley catheter insertion) to 1.7±0.7 (thoracentesis). A gap in desired versus actual level of competence existed for all procedures (P<.0001). There was a correlation between the number of times a procedure had been performed and self-reported competence for all skills except arterial puncture and suturing.
Participants had performed most skills infrequently and rated themselves as being unable to perform them without assistance. Strategies to improve student experience and competence of procedural skills must evolve to improve the technical competency of graduating students because their current competency varies widely.
数据表明，学生在毕业时还没有准备好进行基本的医疗操作。作者的目的是描述即将毕业的学生在这些技能方面的经验和看法。
2011 年，一项在线调查询问了 156 名四年级医学生，了解他们在 9 项手术技能（ Foley 导管插入术、鼻胃管插入术、静脉穿刺术、静脉导管插入术、动脉穿刺术、基本缝合术、气管插管术、腰椎穿刺术和胸腔穿刺术）方面的经验、实际和期望的熟练程度。学生们在 4 分制的李克特量表上自我报告了他们的熟练程度（4=独立完成技能；1=无法完成技能）。数据通过方差分析和学生 t 检验进行分析。使用 5 分制李克特量表评估学生的信心。
有 134 名（86%）学生做出了回应。有两项技能的操作次数超过了 50%的学生：Foley 导管插入术和缝合术。平均熟练程度从 3.13±0.75（Foley 导管插入术）到 1.7±0.7（胸腔穿刺术）不等。所有操作的期望熟练程度与实际熟练程度之间存在差距（P<.0001）。除了动脉穿刺术和缝合术，所有操作的操作次数与自我报告的熟练程度之间都存在相关性。
参与者大多数技能的操作次数都很少，并且自我评估在没有帮助的情况下无法独立完成这些技能。为了提高即将毕业的学生的技术能力，必须制定策略来提高他们的实践经验和程序技能的熟练程度，因为他们目前的技能水平差异很大。
