刘殿刚++++++曹战宇++++++楚长彪++++++李非

[摘要] 目的 探討在外科住院医师三年培训过程中应用与客观结构化临床考试（OSCE）培训模式相结合的教学方法的效果。 方法 选取首都医科大学宣武医院及北京天坛医院2012年9月入职的住院医师共80名，采用随机数字表法分为对照组及观察组，每组40人。对照组采用传统三年住院医师轮转培训加讲述式教学的方法；观察组采用传统培训方式加上OSCE模式相结合的培训教学方法。比较两组住院医师三年培训结束后临床理论、实践技能及沟通能力考核的结果，并对观察组进行问卷调查。 结果 住院医师培训三年后，两组理论考核成绩比较，差异无统计学意义（P > 0.05）；与对照组相比，观察组技能考核成绩明显提高（P < 0.01）。两组培训后沟通能力考核成绩较培训前均有不同程度提升（P < 0.01），培训后观察组得分明显高于对照组（P < 0.01）。 结论 在住院医师培训中加入OSCE模式相结合的培训教学模式可以提高临床技能和医患沟通技巧。

[关键词] 客观结构化临床考试；外科住院医师培训；临床技能；沟通能力

[中图分类号] R642 [文献标识码] A [文章编号] 1673-7210（2017）06（a）-0126-04

Applied research of OSCE-based teaching methods in surgical residents training

LIU Diangang1 CAO Zhanyu2 CHU Changbiao3 LI Fei1

1.Department of General Surgery， Xuanwu Hospital， Capital Medical University， Beijing 100053， China； 2.Department of General Surgery， Beijing Tiantan Hospital， Capital Medical University， Beijing 100050， China； 3.Department of Neurology， Xuanwu Hospital， Capital Medical University， Beijing 100053， China

[Abstract] Objective To study the application significance of objective structured clinical examination （OSCE） teaching method in surgical resident training program （the first phase）. Methods Eighty surgical training residents （accessed September， 2014） from Xuan Wu Hospital and Beijing Tian Tan Hospital of Capital Medical University were enrolled in this study. All residents were divided into observation group and control group according to random number table ， with 40 residents in each group. All the residents were trained by traditional teaching method， moreover the residents in observation group were trained by OSCE teaching method. Then at the end of three-year-training program， the skills in clinical theory， clinical practice and doctor-patient communication in two groups were compared. A questionnaire survey was conducted in observation group. Results Compared to control group， the skills of clinical practice in observation group were significantly improved （P < 0.01）， whereas their clinical theory skills were no significant difference （P > 0.05）. Specifically， the doctor-patient communication skill was improved after the training program within each group （P < 0.01）， and the improvement in the observation group was much more significantly （P < 0.01）. Conclusion Compared to the traditional training method， the OSCE teaching method is significantly better in improving the clinical practice and doctor-patient communication skills of the trained residents.

[Key words] Objective structured clinical examination； Surgical residents training clinical practice； Clinical practice skill； Doctor-patient communication skill

住院医师规范化培训是医学生毕业后继续教育的重要组成部分，是培养高层次临床人才，提高临床医疗水平的重要环节和措施，是医学生从事临床诊疗工作的必经之路[1-2]。如何能更好地提高外科住院医师的培训效果，目前仍在探索中。医学教育培养的目的更强调能力的培养而不单纯是知识获取[3]，客观结构化临床测试评价（objective structured clinical examination，OSCE）在现行的医学教育模式中承担中心作用，常用来评估各种技能，如病史、体检和技术能力，以及其他对医生要求的能力，如沟通和职业精神[4-5]。OSCE作为基于能力的评估模式已成为医疗卫生教育的中流砥柱，OSCE不单单是教育评价工具，还是很重要的具有可靠性、有效性或可行性的教学工具[6-7]。结……