临床操作技能直接观察法评估在普通外科本科实习医师技能培训中的应用研究

Application Research of Direct Observation of Clinical Procedural Skills Assessment in Skill Training for Undergraduate Interns in General Surgery

摘要: 目的：探讨直接观察操作技能评估法(direct observation of procedural skills, DOPS)在普通外科本科实习医师临床技能培训中的应用效果及可行性。方法：选取2024年9月至2025年9月在某院普通外科轮转实习的临床医学专业本科实习医师60名，采用随机数字表法分为实验组和对照组，各30名。两组均接受以清创缝合术、换药术、腹部查体、无菌穿脱手术衣和腹腔穿刺为核心内容的常规操作培训法，常规操作培训法包括集中理论授课、标准化操作示教、模拟及床旁操作练习和一般性口头反馈等。实验组在常规操作培训法基础上，于轮转第2周和第4周分别接受1次DOPS形成性评估，由经过统一培训并完成评分校准的评估者在真实或模拟临床情境中对上述五项临床技能进行直接观察、评分并当场反馈；对照组不实施系统化DOPS评估，仅接受常规带教与终末考核。轮转结束前对两组学员进行终末临床技能考核，比较两组一般资料、第2周与第4周DOPS评估结果、终末操作技能总分及等级分布，以及五项具体临床技能得分。终末考核采用单盲方式进行。结果：两组学员在性别、年龄及入学平均成绩等一般资料方面差异均无统计学意义(P > 0.05)。实验组第4周DOPS评估的平均分及良好以上评价率均显著高于第2周(P < 0.05)。终末考核中，实验组总分和良好以上评价率均明显优于对照组(P < 0.05)；在清创缝合术、换药术、腹部查体、无菌穿脱手术衣和腹腔穿刺五项临床技能中，实验组得分均显著高于对照组(P < 0.05)。结论：将DOPS作为形成性评价工具融入普通外科本科实习医师技能培训，在本研究条件下可改善终末临床技能考核表现，并有望促进学员操作相关临床技能的持续改进。考虑到本研究样本量有限、为单中心研究且对照组常规操作培训法的界定仍较粗略，相关结论仍需在更大样本、多中心及长期随访的研究中进一步验证，DOPS在本科实习医师培训中的应用尚显示出一定推广潜力。

Abstract: Objective: To explore the application effect and feasibility of the Direct Observation of Procedural Skills (DOPS) in the clinical skills training of undergraduate interns in general surgery. Methods: Sixty clinical medical undergraduate interns rotating in the general surgery department of a certain hospital from September 2024 to September 2025 were selected and randomly divided into an experimental group and a control group, with 30 in each group. Both groups received conventional operation training methods focusing on debridement and suture, dressing change, abdominal examination, aseptic donning and doffing of surgical gowns, and abdominal paracentesis. The conventional operation training methods included centralized theoretical lectures, standardized operation demonstrations, simulation and bedside operation practices, and general verbal feedback. The experimental group, in addition to the conventional operation training methods, received two DOPS formative assessments in the second and fourth weeks of rotation, respectively. Trained and calibrated assessors directly observed, scored, and provided immediate feedback on the five clinical skills in real or simulated clinical scenarios. The control group did not undergo systematic DOPS assessment but only received conventional teaching and final assessment. Before the end of the rotation, a final clinical skills assessment was conducted for both groups. General information, DOPS assessment results in the second and fourth weeks, total scores and grade distributions of final operation skills, and scores of the five specific clinical skills were compared between the two groups. The final assessment was conducted in a single-blind manner. Result: The results showed that there were no statistically significant differences in general data such as gender, age, and average entrance scores between the two groups of trainees (P > 0.05). The average score and the rate of good or above evaluations in the DOPS assessment at the 4th week of the experimental group were significantly higher than those at the 2nd week (P < 0.05). In the final assessment, the total score and the rate of good or above evaluations of the experimental group were significantly better than those of the control group (P < 0.05); in the five clinical skills of debridement and suture, dressing change, abdominal examination, wearing and taking off surgical gowns in sterile conditions, and abdominal puncture, the scores of the experimental group were significantly higher than those of the control group (P < 0.05). Conclusion: Integrating DOPS as a formative evaluation tool into the training of general surgery undergraduate interns can improve the final clinical skill assessment performance under the conditions of this study, and is expected to promote the continuous improvement of trainees’ operational clinical skills. Considering the limited sample size of this study, it is a single-center study, and the definition of the control group’s conventional operation training method is still relatively rough, the relevant conclusions still need to be further verified in larger sample, multi-center, and long-term follow-up studies. The application of DOPS in the training of undergraduate interns shows certain promotion potential.