Tang Biyun, Lin Danfeng, Zhang Fengjiang, Yan Mengling, Shao Anwen
Clinical Skills Training Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Surgical Oncology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Front Public Health. 2021 Feb 23;8:598774. doi: 10.3389/fpubh.2020.598774. eCollection 2020.
Medical education is a demanding lifelong learning process, which includes three tightly connected stages: college education, post-graduate education, and continuous education. Residency, the first several years after a college education, is a pivotal time in the development of a qualified doctor. Additionally, residents are the main force that undertakes much of the clinical work in hospitals. Therefore, guaranteeing and improving residents' clinical skills and abilities through the standardized training of resident physicians (STRP) is important. However, compared with other hospitals in the Zhejiang Province, the STRP assessment results of residents in our hospital were not satisfactory in recent years. Therefore, the objective of this study was to find the problems causing the unsatisfactory performance and identify the role of the "Plan-Do-Check-Action" (PDCA) plan in providing a valuable framework for future training. Relevant studies of STRP in China and abroad were investigated by the literature review. According to published data by the Health Commision of Zhejiang Province, we collected the STRP assessment rsults of a total number of 12,036 residents. The inclusion cretria of these residents include: (1) 3rd-year residents. (2) taking STRP in the Zhejiang Province during 2016-2018 or 2017-2019. (3) the first time taking the clinical practice ability examination (CPAE) in 2018 or 2019. The results of 634 3rd-year residents from The Second Affiliated Hospital of Zhejiang University (SAHZU) were provided by the Department of Medical Education and were analyzed in depth. Three hundred and eight residents from SAHZU received normal training and took the CPAE in 2018, whereas 326 residets received PDCA and took the CPAE in 2019. PDCA is a program designed to improve the performance of residency in SAHZU. It includes the formulation and implementation of specific training plans, the check of effects, and continuous improvements. There was no change in the STRP assessment in these 2 years and the indicator of performance in the STRP assessment was the first pass rate (FPR). Statistical analyses were performed using Pearson's test, Yates-corrected test, or Fisher's exact test (SPSS Statistics, version 25). A -value of < 0.05 was considered significant. A total number of 6,180 and 5,856 examinees in the Zhejiang Province took the clinical practice ability examination in 2018 and 2019, respectively. In 2018, a total of 308 residents from 20 departments of the SAHZU took the STRP assessment. In 2019, a total of 326 residents from 22 departments of the SAHZU underwent the PDCA plan and took the STRP assessment. Compared with the results in 2018, the average FPR in the Zhejiang Province increased by 2.92% from 87.87 to 90.79% ( < 0.001). The FPR of the SAHZU increased by 7.88% from 85.06 to 92.94% ( = 0.001). In the SAHZU, the FPRs of the Department of Emergency and Department of Anesthesiology improved 34.51% ( = 0.024) and 20.36% ( = 0.004), respectively. There were no significant differences between the performances in the 2 years of the other 20 departments. There were improved results in the "Clinical Thinking and Decision-Making" and "Operation of Basic Skills" assessment stations with increases of 3.01% ( = 0.002) and 3.94% ( = 0.002), respectively. No statistically significant differences in the FPRs of the other six stations were found. The performances in all the stations in the final tests were better than in the stimulation tests ( < 0.001). Although our sample size was relatively small, our results showed a small success of the PDCA plan in improving the quality of the STRP, especially for the residents in the Departments of Emergency and Anesthesiology. The PDCA plan also contributed to enhancing residents' abilities in the "Clinical Thinking and Decision-Making" and "Operation of Basic Skills" stations. Taken together, the PDCA plan may provide a practical framework for developing future training plans.
医学教育是一个要求严格的终身学习过程，它包括三个紧密相连的阶段：大学教育、研究生教育和继续教育。住院医师培训是大学教育后的头几年，是培养合格医生的关键时期。此外，住院医师是承担医院大部分临床工作的主力军。因此，通过住院医师规范化培训（STRP）来保障和提高住院医师的临床技能和能力很重要。然而，与浙江省其他医院相比，近年来我院住院医师的STRP评估结果并不理想。因此，本研究的目的是找出导致评估结果不理想的问题，并确定“计划-执行-检查-行动”（PDCA）计划在为未来培训提供有价值框架方面的作用。通过文献综述对国内外STRP的相关研究进行了调查。根据浙江省卫生健康委公布的数据，我们收集了总共12036名住院医师的STRP评估结果。这些住院医师的纳入标准包括：（1）三年级住院医师。（2）2016 - 2018年或2017 - 2019年在浙江省参加STRP。（3）2018年或2019年首次参加临床实践能力考试（CPAE）。浙江大学医学院附属第二医院（SAHZU）634名三年级住院医师的结果由医学教育部门提供并进行了深入分析。SAHZU的308名住院医师接受了常规培训并于2018年参加了CPAE，而326名住院医师接受了PDCA培训并于2019年参加了CPAE。PDCA是一项旨在提高SAHZU住院医师培训效果的计划。它包括制定和实施具体的培训计划、检查效果以及持续改进。这两年STRP评估没有变化，STRP评估中的绩效指标是首次通过率（FPR）。使用Pearson检验、Yates校正检验或Fisher精确检验（SPSS Statistics，版本25）进行统计分析。P值<0.05被认为具有统计学意义。浙江省分别有6180名和5856名考生在2018年和2019年参加了临床实践能力考试。2018年，SAHZU的20个科室共有308名住院医师参加了STRP评估。2019年，SAHZU的22个科室共有326名住院医师接受了PDCA计划并参加了STRP评估。与2018年的结果相比，浙江省的平均FPR从87.87%提高到90.79%，提高了2.92%（P<0.001）。SAHZU的FPR从85.06%提高到92.94%，提高了7.88%（P = 0.001）。在SAHZU，急诊科和麻醉科的FPR分别提高了34.51%（P = 0.024）和20.36%（P = 0.004）。其他20个科室在这两年的表现没有显著差异。“临床思维与决策”和“基本技能操作”评估站的结果有所改善，分别提高了3.01%（P = 0.002）和3.94%（P = 0.002）。其他六个站的FPR没有统计学上的显著差异。最终测试中所有站的表现均优于模拟测试（P<0.001）。虽然我们的样本量相对较小，但我们的结果表明PDCA计划在提高STRP质量方面取得了小的成功，特别是对于急诊科和麻醉科的住院医师。PDCA计划也有助于提高住院医师在“临床思维与决策”和“基本技能操作”站的能力。综上所述，PDCA计划可能为制定未来培训计划提供一个实用的框架。
