Régent A, Arlet J-B, Cheminet G, Pouchot J, Mouthon L, Le Jeunne C
Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence maladies auto-immunes et systémiques rares d'ile de France, hôpital Cochin, AP-HP-CUP, 75014 Paris, France.
Université de Paris, 15, rue de l'école de médecine, 75006 Paris, France; Service de médecine interne, centre de référence des syndromes drépanocytaires majeurs, hôpital européen Georges-Pompidou, AP-HP-CUP, 75015 Paris, France.
Rev Med Interne. 2022 Oct;43(10):581-588. doi: 10.1016/j.revmed.2022.07.014. Epub 2022 Sep 8.
During placements, there is an opportunity to learn clinical skills and to assess their application. However, it represents two different goals. The validity of an end-of-placement assessment is questionable, as the medical competency is contextual. We decided to evaluate the contribution and limits of different assessment modalities as an end-of-placement assessment.
Internal medicine clerks were assessed using the Mini-Cex grid by a structured objective clinical examination (OSCE), a long-case clinical examination (LCE) and a global end-of-placement marking (GEPM). Following these evaluations, students and teachers fulfilled an open questionnaire.
In 2021, 41 students and 16 teachers participated in the study. Physical examination was evaluated in 0%, 97% et 76% of cases during OSCE, LCE and GEPM, respectively; teaching skills were assessed for 100, 42 et 49% of students in OSCE, LCE and GEPM, respectively. As compared to OSCE, there was a perceived superiority of LCE regarding its formative value (P=0.07 and P=0.03) and its summative value (P=0.0007 and P=0.02), for students and teachers, respectively. Qualitative analysis highlights the breadth of clinical skills that could be assessed during OSCE stations. Integration into a team was an additional skill that could specifically be assessed during GEPM. GEPM could also take into account the progress made during placement.
Despite its subjectivity, LCE seemed to be the preferred modality for an end-of-rotation assessment.
在实习期间，有机会学习临床技能并评估其应用情况。然而，这代表着两个不同的目标。由于医学能力具有情境性，实习结束时评估的有效性值得怀疑。我们决定评估不同评估方式作为实习结束时评估的贡献和局限性。
通过结构化客观临床考试（OSCE）、长病例临床考试（LCE）和实习结束时整体评分（GEPM），使用Mini-Cex网格对内科实习生进行评估。在这些评估之后，学生和教师填写了一份开放式问卷。
2021年，41名学生和16名教师参与了该研究。在OSCE、LCE和GEPM期间，分别有0%、97%和76%的病例对体格检查进行了评估；在OSCE、LCE和GEPM中，分别有100%、42%和49%的学生的教学技能得到了评估。与OSCE相比，LCE在形成性价值（学生为P = 0.07，教师为P = 0.03）和总结性价值（学生为P = 0.0007，教师为P = 0.02）方面被认为具有优势。定性分析突出了在OSCE站点期间可以评估的临床技能的广度。融入团队是在GEPM期间可以专门评估的一项额外技能。GEPM还可以考虑实习期间取得的进展。
尽管LCE具有主观性，但它似乎是轮转结束评估的首选方式。
