Jain S S, DeLisa J A, Campagnolo D I
Department of Physical Medicine and Rehabilitation, UMD-New Jersey Medical School, Newark.
Am J Phys Med Rehabil. 1994 Jul-Aug;73(4):234-9. doi: 10.1097/00002060-199407000-00002.
A 17-item questionnaire was designed to determine how physical medicine and rehabilitation (PM&R) training directors assess their residents' clinical competency. A response rate of 83% (62/75) was obtained. Seventy-nine percent (49/62) have a written resident supervision policy, and 73% (45/62) have a written resident probation policy. Ninety-four percent (58/62) believe that their system of evaluating residents' clinical competency is effective, although many commented that it could be improved. 76% (47/62) of the residency training directors made the final decision regarding residents' clinical competency. Fifty-two percent (32/62) have a departmental written examination, and 23% (14/62) have formal oral examinations. Eighteen percent (11/62) use an objective structured clinical examination (OSCE), 8% (5/62) use standardized patients and 3% (2/62) use videotaped patient encounters. Forty percent (25/62) use medical record audits. Fifty percent of the programs have rated at least one resident unsatisfactory during a clinical rotation in the past 3 yr, and 11% (7/62) have reported to the American Board of Physical Medicine and Rehabilitation that the overall clinical evaluation of one resident was unsatisfactory in the past 3 yr. Forty-seven percent (29/62) of the programs have asked at least one resident to leave their program in the past 3 yr. The OSCE is emerging as the state-of-the-art method for assessing clinical skills, although it is expensive. The measurement of clinical competency is important in the certification and recertification process, and our specialty needs better methods to assess these performance skills.
设计了一份包含17个条目的问卷，以确定物理医学与康复（PM&R）培训主任如何评估其住院医师的临床能力。获得了83%（62/75）的回复率。79%（49/62）的机构有书面的住院医师监督政策，73%（45/62）有书面的住院医师试用期政策。94%（58/62）的人认为他们评估住院医师临床能力的系统是有效的，尽管许多人评论说它可以改进。76%（47/62）的住院医师培训主任对住院医师的临床能力做出最终决定。52%（32/62）的机构有部门书面考试，23%（14/62）有正式的口试。18%（11/62）的机构使用客观结构化临床考试（OSCE），8%（5/62）使用标准化病人，3%（2/62）使用录像的患者会诊。40%（25/62）的机构使用病历审核。在过去3年中，50%的项目在临床轮转期间至少对一名住院医师给出了不满意的评价，11%（7/62）的机构向美国物理医学与康复委员会报告说，在过去3年中对一名住院医师的整体临床评价不满意。在过去3年中，47%（29/62）的项目至少要求一名住院医师离开他们的项目。尽管OSCE成本高昂，但它正成为评估临床技能的最先进方法。临床能力的评估在认证和重新认证过程中很重要，我们这个专业需要更好的方法来评估这些操作技能。
