基于非参数群决策方法的住院医师规范化培训绩效评价研究

    Research on the performance evaluation of standardized training of residents based on non-parametric group decision-making method

    • 摘要:
      目的: 针对住院医师规范化培训绩效评价中传统确定性指标难以适用、考官打分主观性强且权重难以客观确定的现实问题,探索基于非参数群决策的新型评价模型,以提升评价的科学性、区分度和诊断性。
      方法: 以蚌埠医科大学第一附属医院考点200名儿内科住院医师规范化培训技能考核数据为样本,设计非参数群决策方法,构建无投入的非径向绩效评价模型,对学员在心肺复苏、人文沟通、病史采集、体格检查、病历书写与病例分析5个维度的考核表现进行综合测算,并通过松弛变量量化各指标的改进空间。
      结果: 非径向模型测得200名学员中仅5人达到DEA有效;各考核指标中,病历书写与病例分析的平均得分最低,而其他四项指标均值均在90以上;松弛变量分析显示,病历书写与病例分析的最大改进量占比最高,人文沟通和体格检查次之,心肺复苏和病史采集较低;新方法与传统平均分排名的斯皮尔曼等级相关系数为0.845,且新方法消除了并列排名,区分度明显优于传统方法;2位考官评分的克朗巴哈系数为0.827,表明评分内部一致性良好,模型内生权重合理。
      结论: 新方法不依赖主观赋权,能稳健识别学员薄弱环节并给出量化改进方向,具有科学性和推广价值。基于实证结果,建议住培基地重点加强病历书写与病例分析的专项训练,增设真实案例模拟与阶段性反馈机制,并将该两项能力纳入核心考核指标并适当提高权重;同时可针对人文沟通和体格检查开展强化培训,以全面提升住院医师临床综合能力。本研究为住培绩效评价的精准化教学管理提供了可量化的决策工具。

       

      Abstract:
      Objective In view of the practical problems, such as the difficulty applying of the traditional deterministic indicators for performance evaluation of standardized training for resident physicians and the strong subjectivity of examiners' scoring and difficulty objectively determining of the weights, to explore anew evaluation model based on non-parametric group decision-making to enhance the scientificity, discrimination and diagnostic nature of the evaluation.
      Methods Taking the skills assessment data of 200 pediatric internal medicine resident physicians in the standardized training at the First Affiliated Hospital of Bengbu Medical University examination site as samples, a non-parametric group decision-making method was designed, and a non-radial performance evaluation model without input was constructed to comprehensively calculate the assessment performance of the trainees in five dimensions: cardiopulmonary resuscitation, humanistic communication, medical history collection, physical examination, medical record writing and case analysis, and the improvement space of each indicator was quantified through relaxation variables.
      Results The non-radial model measured that only 5 out of 200 trainees achieved DEA effectiveness. Among all the assessment indicators, the average score of medical record writing and case analysis was the lowest, while the average scores of the other four indicators were all above 90. The results of relaxation variable analysis showed that the proportion of the maximum improvement in medical record writing and case analysis was the highest, followed by humanistic communication and physical examination, while the cardiopulmonary resuscitation and medical history collection were relatively low. The correlation coefficient between the new method and Spearman rank of the traditional average score ranking is 0.845. Moreover, the new method eliminates the tied ranking, and its discrimination was significantly better than that of the traditional method. The Cronbach coefficient of the scores given by the two examiners was 0.827, indicating good internal consistency in the scores and reasonable endogenous weights in the model.
      Conclusions The new method does not rely on subjective empowerment, can stably identify the weak links of trainees and provide quantitative improvement directions, and has scientific and promotional value. Based on the empirical results, it is suggested that the resident training bases should focus on strengthening the specialized training of medical record writing and case analysis, add real case simulation and phased feedback mechanisms, and incorporate these two abilities into the core assessment indicators and appropriately increasing their weights. At the same time, the intensive training can be carried out for humanistic communication and physical examination to comprehensively enhance the clinical comprehensive ability of resident physicians. This research provides a quantifiable decision-making tool for the precise teaching management of performance evaluation in resident training.

       

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