Analysis of three-year completion assessment results of standardized training for resident doctors in Gansu Province from 2019 to 2021
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摘要:
目的 分析甘肃省住院医师规范化培训（简称住培）结业考核成绩，探讨培训中存在的问题并提出策略。 方法 收集2019—2021级甘肃省住培结业考核成绩，计数资料以例(%)表示，组间比较采用χ2检验或Fisher精确检验。 结果 本研究共纳入住培结业考生2 841人，其中2019级708人，2020级1 083人，2021级1 050人。各专业参加考核人数由多到少依次为外科（725/2 841，25.52%）、内科（718/2 841，25.27%）、全科（581/2 841，20.45%），最少的专业为皮肤（21/2 841，0.74%）。培训基地参加考试人数由多到少依次为兰州大学第二医院（780/2 841，27.45%）、兰州大学第一医院（668/2 841，23.51%）、甘肃省人民医院（681/2 841，23.97%）。3年来专业理论考核通过率（88.21%）低于实践技能通过率（97.79%，P＜0.05）。通过率逐年提升的专业是内科、全科、妇产等，培训基地是甘肃省人民医院、第九四〇医院等。通过率最高的专业是神经内科（98.03%），其次为全科（96.13%）、麻醉(95.48%)，耳鼻咽喉最低(73.42%)。 结论 近3年甘肃省住培结业考核通过率逐年上升，理论考核通过率要低于实践技能，因此需加强临床思维的培养。各培训基地、各住培专业的结业考核通过率差异大，需规范教学活动，实现同质化培训。 Abstract:Objective To analyze the graduation assessment results of the standardized residency training (hereinafter referred to as "Resident Training") in Gansu Province, investigate existing issues in the training program, and propose improvement strategies. Methods The graduation assessment results of the standardized residency training in Gansu Province over the past three years were collected. Categorical data presented as [cases (%)]. Intergroup comparisons were conducted using the χ2 test or Fisher's exact test. Results This study included a total of 2 841 candidates who completed the standardized residency training program. The distribution by enrollment year was as follows: 708 candidates from the 2019 cohort, 1 083 from the 2020 cohort, and 1 050 from the 2021 cohort. The specialties were ranked by descending order of participation: Surgery (725/2 841, 25.52%), Internal Medicine (718/2 841, 25.27%), General Practice (581/2 841, 20.45%), Dermatology (21/2 841, 0.74%, lowest participation). The training bases were ranked by descending order of examinee participation: the Second Hospital of Lanzhou University (780/2 841, 27.45%), the First Hospital of Lanzhou University (668/2 841, 23.51%), Gansu Provincial People's Hospital (681/2 841, 23.97%). Over the three-year period, the theoretical knowledge pass rate (88.21%) was significantly lower than the practical skills pass rate (97.79%, P < 0.05). Specialties demonstrating year-on-year improvement in pass rates included Internal medicine, General practice, Obstetrics & Gynecology, among others, while training bases with consistent progress included Gansu Provincial People's Hospital and 940th Hospital. The highest pass rates by specialty were: Neurology (98.03%), General practice (96.13%), Anesthesiology (95.48%), Otorhinolaryngology (73.42%, lowest). Conclusion Over the past three years, the graduation assessment pass rates for standardized residency training in Gansu Province have shown a year-on-year increase. However, the theoretical knowledge pass rate remains significantly lower than the practical skills pass rate, highlighting the need to strengthen the cultivation of clinical reasoning abilities among trainees. Furthermore, substantial disparities in pass rates are observed across different training bases and specialties, underscoring the urgency to standardize teaching practices and achieve homogeneous training quality throughout the program. -
表 1 2019—2021级(2022—2024年)甘肃省各专业住培结业考核考生人口学特征
Table 1. Demographic characteristics of candidates for residential training and completion examination of various majors in Gansu Province from 2019 to 2021(2022-2024)
项目 人口学特征 人数(%) 性别 男性 1 233(56.60) 女性 1 608(43.40) 年级 2019级 708(24.92) 2020级 1 083(38.12) 2021级 1 050(36.96) 专业 内科 718(25.27) 外科 725(25.52) 妇产科 176(6.20) 儿科 84(2.95) 急诊科 23(0.81) 神经内科 91(3.20) 全科 581(20.45) 皮肤科 21(0.74) 病理科 34(1.20) 精神科 27(0.95) 眼科 44(1.55) 影像科 168(5.91) 检验科 33(1.16) 麻醉科 84(2.96) 耳鼻咽喉科 32(1.13) 培训基地 甘肃省人民医院 681(23.97) 联勤保障部队第九四〇医院 310(10.91) 兰州大学第二医院 780(27.45) 兰州大学第一医院 668(23.51) 甘肃医学院附属医院 88(3.10) 河西学院附属张掖人民医院 86(3.03) 天水市第一人民医院 130(4.58) 甘肃省妇幼保健医院 98(3.45) 
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表 2 2019—2021级三年结业考核首考通过率情况
Table 2. The passing rate of the first test of the three-year completion assessment from 2019 to 2021
项目 2019级(%) 2020级(%) 2021级(%) 三年平均通过率(%) χ2值 P值 总通过率 86.30(611/708) 87.26(945/1 083) 93.24(979/1 050) 88.93 28.262 0.001 理论通过率 87.15(617/708) 86.52(937/1 083) 90.95(955/1 050) 88.21 11.398 0.001 技能通过率 99.29(703/708) 97.41(1055/1 083) 96.67(1015/1 050) 97.79 12.768 0.002 性别 男 86.82(270/311) 87.96(402/457) 97.85(455/465) 39.791 0.001 女 85.64(342/397) 86.74(543/626) 96.07(562/585) 37.832 0.001 规培基地 甘肃省人民医院 83.01(127/153) 85.77(223/260) 94.78(254/268) 87.85 17.039 0.001 联勤保障部队第九四〇医院 77.61(52/67) 89.47(102/114) 96.12(124/129) 87.73 16.333 0.001 兰州大学第二医院 88.12(178/202) 91.81(269/293) 89.82(256/285) 89.92 1.876 0.391 兰州大学第一医院 91.61(142/155) 84.70(227/268) 92.65(227/245) 89.65 9.615 0.008 甘肃医学院附属医院 87.10(27/31) 91.43(32/35) 100.00(22/22) 92.84 2.956 0.219 河西学院附属张掖人民医院 83.78(31/37) 81.48(22/27) 86.36(19/22) 83.87 0.212 0.899 天水市第一人民医院 88.57(31/35) 93.18(41/44) 98.04(50/51) 93.26 3.272 0.192 甘肃省妇幼保健医院 82.14(23/28) 69.05(29/42) 96.43(27/28) 82.54 8.118 0.015 专业 内科 76.05(127/167) 77.90(208/267) 94.01(267/284) 82.66 36.136 0.001 外科 89.76(149/166) 89.19(231/259) 89.00(267/300) 89.32 0.065 0.977 妇产科 76.74(33/43) 87.30(55/63) 92.86(65/70) 85.64 6.099 0.047 儿科 91.30(21/23) 88.89(24/27) 94.12(32/34) 91.44 0.544 0.885 急诊科 80.00(4/5) 85.71(6/7) 100.00(11/11) 88.57 0.258a 神经内科 100.00(23/23) 96.77(30/31) 97.30(36/37) 98.03 0.713 0.999 全科 92.62(138/149) 96.27(232/241) 99.48(190/191) 96.13 11.320 0.003 皮肤科 80.00(4/5) 85.71(6/7) 77.78(7/9) 81.17 0.999a 精神科 100.00(7/7) 90.00(9/10) 90.00(9/10) 94.00 0.999a 眼科 75.00(12/16) 100.00(13/13) 80.00(12/15) 85.00 0.160a 病理科 100.00(7/7) 80.00(8/10) 76.47(13/17) 85.49 0.432a 影像科 91.04(61/67) 84.78(78/92) 88.89(8/9) 87.91 1.407 0.495 检验科 100.00(4/4) 50.00(7/14) 100.00(15/15) 83.34 0.001a 麻醉科 90.00(18/20) 96.43(27/28) 100.00(36/36) 95.48 3.733 0.102 耳鼻咽喉科 50.00(3/6) 78.57(11/14) 91.67(11/12) 73.42 0.134a 注：2019—2021级按照男女性别进行通过率比较，P值分别为0.796、0.551、0.100，性别差异无统计学意义(P＞0.05)。a为采用Fisher精确检验。
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表 3 甘肃省各住院医师规范化培训基地三年结业考核不同专业通过率情况[人(%)]
Table 3. The passing rates of different specialties in the three-year completion assessment of each standardized training base for resident doctors in Gansu Province[people(%)]
项目 甘肃省人民医院 联勤保障部队第九四〇医院 兰州大学第二医院 兰州大学第一医院 甘肃医学院附属医院 河西学院附属张掖医院 天水市第一人民医院 甘肃省妇幼保健院 χ2值 P值 总通过 604/681(88.69) 278/310(89.68) 703/780(90.13) 597/668(89.37) 81/88(92.05) 72/86(83.72) 122/130(93.85) 79/98(80.61) 14.874 0.038 内科 151/180(83.89) 56/74(75.68) 126/151(83.44) 208/240(86.67) 13/15(86.67) 19/23(82.61) 28/33(84.85) 2/2(100.00) 5.628 0.287 外科 172/199(86.43) 75/78(96.15) 252/274(91.97) 95/113(84.07) 9/11(81.82) 17/23(73.91) 27/27(100.00) 20.305 0.002 妇产科 28/30(93.33) 7/10(70.00) 26/29(89.66) 53/59(89.83) 6/6(100.00) 5/6(83.33) 7/8(87.50) 21/28(75.00) 8.713 0.274 儿科 13/13(100.00) 1/1(100.00) 20/24(83.33) 9/9(100.00) 5/5(100.00) 2/2(100.00) 8/8(100.00) 19/22(86.36) 6.446 0.489 急诊科 3/3(100.00) 0/1(0) 6/7(85.71) 6/6(100.00) 2/2(100.00) 4/4(100.00) 0.032a 神经内科 12/12(100.00) 13/13(100.00) 48/50(96.00) 7/7(100.00) 2/2(100.00) 2/2(100.00) 5/5(100.00) 0.941a 全科 139/144(96.53) 84/89(94.38) 134/139(96.40) 114/117(97.44) 40/41(97.56) 14/14(100.00) 35/37(94.59) 2.433 0.942 皮肤科 2/2(100.00) 2/3(66.67) 10/12(83.33) 3/4(75.00) 0.999a 精神科 6/6(100.00) 7/8(87.50) 12/13(92.31) 0.999a 眼科 13/14(92.86) 3/3(100.00) 15/19(78.95) 5/6(83.33) 1/2(50.00) 0.406a 病理科 5/5(100.00) 11/12(91.67) 1/2(50.00) 8/11(72.73) 3/4(75.00) 0.300a 影像科 25/30(83.33) 6/6(100.00) 39/42(92.86) 42/48(87.50) 2/4(50.00) 6/6(100.00) 5/5(100.00) 22/27(81.48) 10.044 0.295 检验科 14/18(77.78) 5/5(100.00) 3/3(100.00) 4/7(57.14) 0.362a 麻醉科 15/16(93.75) 11/12(91.67) 31/31(100.00) 2/2(100.00) 3/4(75.00) 2/2(100.00) 8/8(100.00) 0.173a 耳鼻咽喉科 6/9(66.67) 6/6(100.00) 8/11(72.73) 4/5(80.00) 1/1(100.00) 0.380a 注：a为采用Fisher精确检验。空格表示医院因无本专业培训基地等原因而无具体的数据。
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