Pugh Debra, Touchie Claire, Humphrey-Murto Susan, Wood Timothy J
a University of Ottawa , Canada.
Med Teach. 2016;38(2):168-73. doi: 10.3109/0142159X.2015.1029895. Epub 2015 Apr 24.
The purpose of this study was to explore the use of an objective structured clinical examination for Internal Medicine residents (IM-OSCE) as a progress test for clinical skills.
Data from eight administrations of an IM-OSCE were analyzed retrospectively. Data were scaled to a mean of 500 and standard deviation (SD) of 100. A time-based comparison, treating post-graduate year (PGY) as a repeated-measures factor, was used to determine how residents' performance progressed over time.
Residents' total IM-OSCE scores (n = 244) increased over training from a mean of 445 (SD = 84) in PGY-1 to 534 (SD = 71) in PGY-3 (p < 0.001). In an analysis of sub-scores, including only those who participated in the IM OSCE for all three years of training (n = 46), mean structured oral scores increased from 464 (SD = 92) to 533 (SD = 83) (p < 0.001), physical examination scores increased from 464 (SD = 82) to 520 (SD = 75) (p < 0.001), and procedural skills increased from 495 (SD = 99) to 555 (SD = 67) (p = 0.033). There was no significant change in communication scores (p = 0.97).
The IM-OSCE can be used to demonstrate progression of clinical skills throughout residency training. Although most of the clinical skills assessed improved as residents progressed through their training, communication skills did not appear to change.
本研究旨在探索将内科住院医师客观结构化临床考试（IM-OSCE）作为临床技能进展测试的应用情况。
对八次IM-OSCE考试的数据进行回顾性分析。数据经标准化处理，均值为500，标准差（SD）为100。采用以时间为基础的比较方法，将研究生年级（PGY）作为重复测量因素，以确定住院医师的表现如何随时间推移而进步。
住院医师的IM-OSCE总分（n = 244）在培训期间有所提高，从PGY-1的平均445分（SD = 84）提高到PGY-3的534分（SD = 71）（p < 0.001）。在对分项分数的分析中，仅纳入参加了全部三年培训的IM-OSCE的人员（n = 46），结构化口试平均分从464分（SD = 92）提高到533分（SD = 83）（p < 0.001），体格检查分数从464分（SD = 82）提高到520分（SD = 75）（p < 0.001），操作技能从495分（SD = 99）提高到555分（SD = 67）（p = 0.033）。沟通分数无显著变化（p = 0.97）。
IM-OSCE可用于证明住院医师培训期间临床技能的进展。尽管随着住院医师培训的推进，所评估的大多数临床技能有所提高，但沟通技能似乎没有变化。
