摘要
目的针对当前住院医师结业考核中临床思维能力评价存在随意性大、标准不一的突出问题,本研究旨在构建一套结构化的临床思维能力考核与评价模型,并验证其有效性与可行性,为住院医师临床思维能力评价提供科学工具。方法综合运用文献分析、德尔菲专家咨询法,搭建包含考核场景、评价维度及评分标准的结构化模型;将该模型嵌入广西2024年度住院医师规范化培训结业临床实践能力考核的“临床思维站”,对1250名跨15个专业的考生开展测试,采用SPSS 26.0对考核数据进行信度、效度及区分度分析。结果最终构建的模型涵盖信息收集、诊断鉴别、治疗方案制定、职业素养4个一级维度及12个二级指标。实证数据显示,该模型评分者间信度(ICC)为0.89,克伦巴赫α系数为0.91,各维度与总分的Pearson相关系数介于0.72~0.85(P<0.01),且可有效区分不同能力层级的考生。结论本研究构建的结构化考核与评价模型具备良好的信度、效度与区分度,既能为住院医师临床思维能力的科学、客观评价提供可靠工具,又能对住院医师日常临床思维训练形成正向导向,为提升住培结业考核科学化水平提供可复制方案。
Objective In response to the current problems in the assessment of clinical reasoning ability in the residency graduation examination,such as high arbitiness and inconsistent standards,this study aims to construct a structured assessment model for clinical reasoning ability and verify its effectiveness and feasibility,providing a scientific tool for the evaluation of clinical reasoning ability residents.Methods By comprehensively using literature analysis and Delphi expert consultation,a structured model was established,including assessment scenarios,evaluation dimensions,and scoring criteria.This model was in the“clinical reasoning station”of the clinical practice ability assessment of the standardized training graduation examination for residents in a province in 2024,and a test was on 1250 candidates across 15 specialties.Using SPSS 26.0,the reliability,validity,and discrimination of the assessment data were.Results The final model constructed covered four primary dimensions,including information collection,diagnosis and differential diagnosis,treatment plan formulation,and professional ethics,and 12 secondary indicators Empirical data showed that the inter-rater reliability(ICC)of the model was 0.89,the Cronbach’s α coefficient was 0.9,and the Pearson correlation coefficients between each dimension and the total score were between 0.72-0.85(P<0.01),and it effectively distinguish candidates at different levels of ability.Conclusion The structured assessment and evaluation model established in this study has good reliability,validity,and discrimination.It can not only a reliable tool for the scientific and objective evaluation of residents’clinical reasoning ability but also form a positive guide for the daily clinical reasoning training of residents,and provide a replicable solution improve the scientific level of the residency graduation examination.
作者
雷志胜
苏芳
LEI Zhisheng;SU Fang(Guangxi Zhuang Autonomous Region Health and Health Talent and Technical Service Center,Nanning 530021,China;The Affiliated Cancer Hospital of Guangxi Medical University,Nanning 530021,China)
出处
《现代医院》
2026年第3期501-504,共4页
Modern Hospitals
关键词
住院医师
规范化培训
结业考核
临床思维能力
结构化考核
评价模型
实证研究
Residents
Standardized training
Graduation assessment
Clinical reasoning ability
Structured assessment
Evaluation model
Empirical research
