Women's College Hospital, Toronto, Canada Mt. Sinai Hospital, Toronto, Canada
Toronto East General Hospital, Toronto, Canada.
J Bone Joint Surg Am. 2015 Dec 2;97(23):1985-91. doi: 10.2106/JBJS.O.00252.
Competency-based medical education as a resident-training format will move postgraduate training away from time-based training, to a model based on observable outcomes. The purpose of this study was to determine whether junior residents and senior residents could demonstrate clinical skills to a similar level, after a sports medicine rotation.
All residents undertaking a three-month sports medicine rotation had to pass an Objective Structured Clinical Examination. The stations tested the fundamentals of history-taking, examination, image interpretation, differential diagnosis, informed consent, and clinical decision-making. Performance at each station was assessed with a binary station-specific checklist and an overall global rating scale, in which 1 indicated novice, 2 indicated advanced beginner, 3 indicated competent, 4 indicated proficient, and 5 indicated expert. A global rating scale was also given for each domain of knowledge.
Over eighteen months, thirty-nine residents (twenty-one junior residents and eighteen senior residents) and six fellows (for a total of forty-five participants) completed the examination. With regard to junior residents and senior residents, analysis using a two-tailed t test demonstrated a significant difference (p < 0.01) in both total checklist score and overall global rating scale; the mean total checklist score (and standard deviation) was 56.15% ± 10.99% for junior residents and 71.87% ± 8.94% for senior residents, and the mean global rating scale was 2.44 ± 0.55 for junior residents and 3.79 ± 0.49 for senior residents. There was a significant difference between junior residents and senior residents for each knowledge domain, with a significance of p < 0.05 for history-taking and p < 0.01 for the remainder of the domains.
Despite intensive teaching within a competency-based medical education model, junior residents were not able to demonstrate knowledge as well as senior residents, suggesting that overall clinical experience is critically important for achieving competency as measured by the Objective Structured Clinical Examination.
以能力为基础的医学教育作为住院医师培训模式，将使毕业后培训从基于时间的培训转变为基于可观察结果的模式。本研究的目的是确定在接受运动医学轮转培训后，初级住院医师和高级住院医师是否能够达到相似的临床技能水平。
所有接受为期三个月的运动医学轮转的住院医师都必须通过客观结构化临床考试。这些站点测试了病史采集、检查、图像解读、鉴别诊断、知情同意和临床决策等方面的基础知识。每个站点的表现都通过二进制的站点特定检查表和整体全球评分量表进行评估，其中 1 表示新手，2 表示初级入门者，3 表示熟练，4 表示精通，5 表示专家。还为每个知识领域提供了整体评分量表。
在十八个月的时间里，共有 39 名住院医师（21 名初级住院医师和 18 名高级住院医师）和 6 名研究员（共 45 名参与者）完成了考试。通过双尾 t 检验分析，初级住院医师和高级住院医师在总检查表得分和整体全球评分量表上均存在显著差异（p<0.01）；初级住院医师的总检查表平均得分（标准差）为 56.15%±10.99%，高级住院医师为 71.87%±8.94%，整体全球评分量表分别为 2.44±0.55 和 3.79±0.49。在每个知识领域，初级住院医师和高级住院医师之间都存在显著差异，在病史采集方面具有统计学意义（p<0.05），在其余领域具有统计学意义（p<0.01）。
尽管在以能力为基础的医学教育模式下进行了强化教学，但初级住院医师的知识水平仍不如高级住院医师，这表明整体临床经验对于通过客观结构化临床考试衡量的能力至关重要。
