中国全科医学 ›› 2025, Vol. 28 ›› Issue (04): 420-426.DOI: 10.12114/j.issn.1007-9572.2023.0743

• 论著·全科医学教育研究 • 上一篇    

程序性评价在全科临床诊疗思维课程评价中的应用

翟佳燚1,2,3, 陆媛1,3,4,*(), 石建军1,3,4, 于德华1,3,4   

  1. 1.200090 上海市,同济大学附属杨浦医院全科医学科
    2.201899 上海市嘉定区嘉定镇街道社区卫生服务中心
    3.200090 上海市,同济大学医学院全科医学系
    4.200090 上海市全科医学与社区卫生发展研究中心
  • 收稿日期:2023-11-14 修回日期:2024-05-14 出版日期:2025-02-05 发布日期:2024-12-03
  • 通讯作者: 陆媛

  • 作者贡献:

    翟佳燚负责文章构思与设计、研究的实施与可行性分析、撰写论文;陆媛负责文章的英文的修订、文章的质量控制及审校;石建军负责研究的实施;于德华负责论文的修订、监督管理,对文章整体负责。

  • 基金资助:
    中华医学会医学教育分会和中国高等教育学会医学教育专业委员会2020年医学教育研究立项课题(2020B-N08139); 上海市医药卫生发展基金会课题(SE1201933)

Effects of Programmatic Assessment in Clinical Reasoning Courses in General Practice

ZHAI Jiayi1,2,3, LU Yuan1,3,4,*(), SHI Jianjun1,3,4, YU Dehua1,3,4   

  1. 1. Department of General Practice, Yangpu Hospital of Tongji University, Shanghai 200090, China
    2. Community Health Service Center of Jiading Town in Jiading District, Shanghai 201899, China
    3. Academic Department of General Practice, Tongji University School of Medicine, Shanghai 200090, China
    4. Shanghai General Practice and Community Health Development Research Center, Shanghai 200090, China
  • Received:2023-11-14 Revised:2024-05-14 Published:2025-02-05 Online:2024-12-03
  • Contact: LU Yuan

摘要: 背景 全科临床诊疗思维是全科医生为患者提供高质量诊疗服务的关键,但因其属于无法被直接观察的抽象能力,所以并不适合用传统的方法进行评价。 目的 本文旨在通过优化课程教学评价方法提高全科医生临床诊疗思维培训效率,丰富医学教育评价。 方法 于2022年9—12月,以同济大学医学院38名全科方向硕士研究生为对象,根据学习与工作经历分为在职组16名与住培组22名。培训课程包含核心、案例、结果3个模块,采取混合式教学方法开展实践。定量评价的内容为技能评分表、PBL评分表与案例评分表,主观评价的内容来自多源反馈。 结果 两组学员核心和案例模块首次课程评分比较,差异无统计学意义(P>0.05);两个模块末次课程得分比较,差异有统计学意义(P<0.05)。将总体学员以及两组学员核心和案例模块首、末次课程的定量评价得分比较,差异均有统计学意义(P<0.001)。主观评价性质分为肯定性评价与改进性评价,问诊能力、体格检查、辅助检查、健康管理、慢病管理课程的肯定性评价占比较低,而改进性评价占比较高;医患沟通、病历书写、多病共存、心身疾病、未分化疾病课程的肯定性评价占比较高,而改进性评价占比较低。 结论 程序性评价能够丰富全科思维评价体系、促进学员循序建构全科思维,同时也发现了"翻转课堂"是程序性评价的呈现形式。

关键词: 全科医学, 教学, 教育,研究生, 程序性评价, 临床诊疗思维, 翻转课堂

Abstract:

Background

The clinical reasoning of general practitioners is the key to providing quality medical services to patients, but it is not suitable for traditional methods to evaluate this ability because it is an abstract ability that cannot be directly observed.

Objective

This paper aims to improve the efficiency of general practitioners' clinical reasoning training and enrich the evaluation of medical education by optimizing the evaluation method of curriculum teaching.

Methods

From September to December 2022, 38 master's degree students of the Medical School of Tongji University were divided into the in-service group (16) and residential training group (22). The course consists of three modules, namely core, case and result, and adopts blended teaching method to carry out teaching. The content of quantitative evaluation is different kinds of rating scale, while the content of subjective evaluation comes from multi-source feedback.

Results

The final course scores for the core and case modules were statistically significant for both groups (P<0.05), but the first course scores were not (P>0.05). The quantitative evaluation scores of the whole class and the two groups of students in the first and last courses of the above two modules were compared, and there was statistical significance (P<0.001). Subjective evaluation can be divided into positive evaluation and improvement evaluation. The positive evaluation of the courses on consultation skills, physical examination, auxiliary examination, health management, and chronic disease management is relatively low, while the improvement evaluation is relatively high; the positive evaluation of the courses on doctor-patient communication, SOAP, multiple diseases coexirelatively high, while the improvement evaluation is relatively low.

Conclusion

Programmatic assessment can enrich the evaluation system of general clinical reasoning, promote students' construction of general clinical reasoning in order, and also found that "flipped classroom" is a form of procedural evaluation.

Key words: General practice, Teaching, Education, graduate, Programmatic assessment, Clinical reasoning, Flipped classroom

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