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台湾地区住院医师规范化培训中,6 年制与 7 年制医学生客观结构化临床考试表现比较:2 组前后测试非同步研究。

Comparison between residents with a 6-year medical program and a 7-year medical program in terms of objective structured clinical examination performance in postgraduate year training in Taiwan: a 2-group pre- and post-test non-synchronized study.

机构信息

Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.

Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

出版信息

J Educ Eval Health Prof. 2022;19:13. doi: 10.3352/jeehp.2022.19.13. Epub 2022 Jun 24.

DOI:10.3352/jeehp.2022.19.13
PMID:35918140
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9345762/
Abstract

PURPOSE

In 2013, medical schools in Taiwan implemented a 6-year medical program that replaced the previous 7-year medical education program. The postgraduate year (PGY) program was also extended from 1 year to 2 years. The new program is characterized by diversified teaching, integration of medical skills, a system-oriented curriculum, and the implementation of primary care and clinical thinking training. The purpose of this study was to examine whether postgraduate residents who learned under the new program have better patient care skills than those who learned under the previous program.

METHODS

Of 101 residents in the PGY program at Taipei Veterans General Hospital, 78 were trained in the 6-year program, while 23 were trained in the 7-year program. During the PGY training, 2 objective structured clinical examinations (OSCEs) were used to evaluate clinical reasoning, communication skills, and procedural skills at the beginning of the training and after 11 months of training, respectively. The scores of each OSCE and the rate of improvement of the pre- and post-tests were analyzed.

RESULTS

Residents trained in the new program scored higher on clinical reasoning (P<0.001) and the total scores of the 3 tested skills (P=0.019) on the pre-test. In terms of improvement, residents educated in the previous system improved more in clinical reasoning than those educated in the new education system.

CONCLUSION

The new medical education program, which emphasizes clinical thinking, improved residents' clinical skills. The PGY program was effective in improving the clinical performance of residents who were educated in the previous system.

摘要

目的

2013 年,台湾的医学院校实施了一项为期 6 年的医学课程,取代了之前的 7 年制医学教育课程。住院医师规范化培训(PGY)计划也从 1 年延长至 2 年。新计划的特点是教学多样化、医学技能整合、以系统为导向的课程以及实施初级保健和临床思维培训。本研究旨在检验在新计划下学习的住院医师是否比在之前的计划下学习的住院医师具有更好的患者护理技能。

方法

在台北荣民总医院的 PGY 计划中,有 101 名住院医师,其中 78 名是在 6 年制课程中培训的,而 23 名是在 7 年制课程中培训的。在 PGY 培训期间,分别在培训开始和 11 个月后进行了 2 次客观结构化临床考试(OSCE),以评估临床推理、沟通技巧和操作技能。分析了每个 OSCE 的分数和前后测试的提高率。

结果

在新计划中接受培训的住院医师在临床推理方面的得分更高(P<0.001),并且在 3 项测试技能的总分上也更高(P=0.019)。就提高而言,接受旧系统教育的住院医师在临床推理方面的提高幅度大于接受新教育系统教育的住院医师。

结论

强调临床思维的新医学教育课程提高了住院医师的临床技能。PGY 计划在提高接受旧系统教育的住院医师的临床表现方面是有效的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd76/9345762/244edd4c17f5/jeehp-19-13f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd76/9345762/e4b6159ec7f5/jeehp-19-13f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd76/9345762/244edd4c17f5/jeehp-19-13f2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd76/9345762/e4b6159ec7f5/jeehp-19-13f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd76/9345762/244edd4c17f5/jeehp-19-13f2.jpg

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本文引用的文献

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Comparison of OSCE performance between 6- and 7-year medical school curricula in Taiwan.台湾地区 6 年制与 7 年制医学课程客观结构化临床考试表现之比较。
BMC Med Educ. 2022 Jan 4;22(1):15. doi: 10.1186/s12909-021-03088-7.
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Methods to Improve Diagnostic Reasoning in Undergraduate Medical Education in the Clinical Setting: a Systematic Review.
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J Gen Intern Med. 2021 Sep;36(9):2745-2754. doi: 10.1007/s11606-021-06916-0. Epub 2021 Jun 22.
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