Schwartz R W, Donnelly M B, Sloan D A, Johnson S B, Strodel W E
Department of Surgery, University of Kentucky Chandler Medical Center, Lexington 40536-0084.
Surgery. 1994 Oct;116(4):634-7; discussion 637-40.
Surgical residents have traditionally been evaluated by ward evaluations and multiple-choice testing; overall resident performance has seldom been objectively evaluated. We developed a comprehensive evaluation program for senior residents. The purpose of this study was to determine whether the several different assessment methods included in this program provide similar information about senior residents' clinical knowledge and performance.
Sixteen senior general surgery residents were evaluated by subjective faculty ward evaluations, a structured oral examination, the American Board of Surgery In-Training Examination, and an objective structured clinical examination (OSCE). The OSCE was divided into two parts: part A required the resident to obtain a directed history or to perform a physical examination; part B required the resident to answer questions about the patient seen in part A.
The various evaluation methods differed in their estimates of clinical competence (ward evaluations rated residents highest; the OSCE, lowest). The American Board of Surgery In-Training Examination correlated with both the structured oral examination and OSCE part B, indicating that all are adequate measures of knowledge. Neither the total OSCE score nor OSCE part A correlated with other measures, but the fact that both are highly reliable suggests that they evaluate different clinical skills. Faculty ward evaluations are inflated and do not correlate with other measures.
We conclude that developing a comprehensive program for evaluating resident competence is desirable and feasible.
外科住院医师传统上通过病房评估和多项选择题测试进行评估；住院医师的整体表现很少得到客观评估。我们为高级住院医师制定了一个综合评估方案。本研究的目的是确定该方案中包含的几种不同评估方法是否能提供有关高级住院医师临床知识和表现的相似信息。
16名普通外科高级住院医师接受了主观的教员病房评估、结构化口试、美国外科委员会住院医师培训考试以及客观结构化临床考试（OSCE）。OSCE分为两部分：A部分要求住院医师获取定向病史或进行体格检查；B部分要求住院医师回答有关A部分中所见患者的问题。
各种评估方法对临床能力的评估结果不同（病房评估对住院医师的评分最高；OSCE评分最低）。美国外科委员会住院医师培训考试与结构化口试和OSCE B部分均相关，表明这三者都是知识的充分衡量指标。OSCE总分和OSCE A部分均与其他指标不相关，但两者都具有高度可靠性这一事实表明它们评估的是不同的临床技能。教员病房评估存在夸大现象，且与其他指标不相关。
我们得出结论，制定一个评估住院医师能力的综合方案是可取且可行的。
