上海市住院医师临床思维能力测试结果分析  

Preliminary analysis on the results of Shanghai residents' clinical thinking abilities test

作　　者：蒋莹[1] 向阳[2] 陈迟[3] 郑玉英[4] 许淼 周蓉 张勘 蔡端[2] JIANG Ying;XIANG Yang;CHEN Chi;ZHENG Yuying;XU Miao;ZHOU Rong;ZHANG Kan;CAI Rui(Ruijin Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200025, China)

机构地区：[1]上海交通大学医学院附属瑞金医院临床医学院,上海200025 [2]复旦大学附属华山医院外科,上海200040 [3]同济大学附属东方医院教学培训办公室,上海200120 [4]复旦大学附属中山医院医学教育处,上海200032 [5]上海市住院医师规范化培训事务中心,上海200040 [6]上海市卫生和计划生育委员会科技教育处,上海200125

出　　处：《中国毕业后医学教育》2017年第2期112-113,158,共3页Chinese Journal of Graduate Medical Education

摘　　要：培养住院医师的临床思维能力及建立临床思维方法是住院医师规范化培训的重要组成部分,建立客观的临床思维评价指标体系和评估平台是保证标准化、同质化培训的重要手段。专家团队在上海市卫生计生委领导下,经过2年的反复实践,自主研发出一套相对简便易行的基于计算机软件平台临床思维能力评估方法。以临床真实病例为基础,对其主诉、现病史、既往史、家族史,体征及辅助检查、诊断、鉴别、诊治原则等进行设计,制作成40例计算机软件病例。2016年3月对上海市44家培训基地的4 559位在培住院医师进行了临床思维能力测评。从考核结果来看,三甲医院的住院医师测评成绩(76.00±11.18)明显高于非三甲医院的住院医师(73.00±12.02),差异具有统计学意义(P<0.05),这提示非三甲医院住院医师临床思维培训和考核有待进一步提高;三甲医院的临床思维测评结果与培训时间有一定相关性。计算机软件病例的设计能够客观真实反映住院医师的临床思维能力。Developing residents’clinical thinking abilities and establishing clinical thinking methods are the important parts in standardized residency training.To Build a fairly objective clinical thinking evaluation index system and assessment platform is vital in ensuring standardized and homogeneous training.After two years of practice and revision,a specialist expert team,leading by Shanghai Municipal Commission of Health and Family Planning,independently developed a relevantly simple and feasible method for clinical thinking abilities evaluation based on computer software platform.This method is derived from real clinical cases and designed with data of chief complaint,present history,past history,family history,symptoms and signs,lab results,diagnosis,differential diagnosis and treatment principles etc,from these40cases.In March2016,clinical thinking abilities tests for total4559current residents in44Shanghai training bases were conducted by using this medical cases software.The test results of residents in Grade-A Tertiary hospitals is statistically higher than that of residents in Non-Grade-A Tertiary hospitals(P<0.05),and there is certain connection between Grade-A Tertiary hospitals’clinical thinking abilities test results and training durations.These results indicate that there is a big gap between clinical thinking training provided by Non-Grade-A Tertiary hospitals and Grade-A Tertiary hospitals,and the current residents’clinical thinking training and examinations need improvements.By using medical cases programmed by computer software,it could accurately reflect residents’clinical thinking abilities.

关 键 词：计算机软件 临床思维 住院医师规范化培训 

分 类 号：G434[文化科学—教育学]