Research On Clinical Competence And Its Influencing Factors Of Medical Students Based On Objective Structured Clinical Examination

Objective:With the development of society and the increasing demand for health,the medical model has been transformed from the previous biomedical model into a bio-physio-social medical model,and people's requirements on the clinical comprehensive competence of medical carers are getting higher and higher.Clinical competence has become one of the most important competences that medical students should get.Objective Structured Clinical Examination(OSCE)has become one of the most effective examination methods that can be used to evaluate clinical competence comprehensively and objectively.Among them,the standardized patient(SP)as the main evaluation method to improve the objectivity,comprehensiveness and accuracy of the examination.With the more and more widely application of OSCE,the reliability,validity and difficulty of the test,as well as the analysis and comparison of SP scores and its influencing factors,have become the hot issues in recent years.The subject of our research is to analysis,explore and evaluate the reliability,validity and difficulty of OSCE of standardized patient test station application in our university,and for the first time through the S-P analysis of typical cases in OSCE to explore the case,For evaluation criteria and the overall performance of students,the final step is to discuss and analyze the influencing factors of OSCE.The purpose is to evaluate the reliability and validity of OSCE in our school,to reveal the weakness of medical students' clinical competence,to find out the specific influencing factors and to provide a scientific basis for improving OSCE evaluation methods in the future,and providing scientific references and advice.Methods:The data were collected from clinical fifth-year medical students of China Medical University by cluster sampling method in 2016,of which the SP test stations were included in the study.At the same time the candidates conduct a questionnaire in the examination process and the exam was conducted on May 9,2016-May 24,2016 in China Medical University clinical skills training center.The data analysis of this study is divided into three parts.First,the reliability and validity of the test scores and thedifficulty are calculated and discussed by using the Cronbach's ? coefficient,exploratory factor analysis,correlation analysis and difficulty coefficient calculation method.Descriptive analysis of each test station and abilities,analysis of variance of clinical competence,using LSD test for comparison between groups.At the same time,one of the typical cases of Students Problem table analysis,evaluation of the case criteria and the performance of students to carry out a specific analysis;Finally,The main influencing factors of the test results are analyzed by t-test,analysis of variance and a variety of linear regression statistical methods from fifth-year clinical graduates in our school.All data in this study were entered and analyzed using SPSS 20.0,and S-P analysis of cases was conducted using Microsoft Excel.Results:The total number of medical students participating in the survey was 448,and the total Cronbach's ? coefficient of OSCE standardized patient test station was 0.736.The internal consistency of all the cases contained in each test station was 0.759,0.928,0.627,0.661,0.736,0.868,0.676,0.607,0.763,0.609,0.490 and 0.201.The results showed that all the cases except the last two cases had acceptable reliability.Exploratory factor analysis showed KMO = 0.745,Bartlett's sphericity test was 2969.931,P = 0.000,and its total variance explained 68.98%.Based on the clinical basic skills scores in the first phase of the "National Practitioner Phased Examination",and the correlation between the clinical competence of the students evaluated by the OSCE test of the SP evaluation,the results show that the SP test results had a good criterion-related validity.Difficulty coefficient results show that the difficulty index of “interview skills” is larger in all cases(that is,the test is a bit simpler),while the difficulty coefficient of case 5and case 8 is relatively large.The skills and contents examined in other cases In the0.45-0.75 range,the difficulty is moderate.Analysis of the OSCE results The survey showed that in the OSCE test of SP test station,the highest score of students was 89.59 points,the lowest score was 53.97 points,with an average of(73.16 ± 5.59)points,the test scores were normal distribution.The average score of each test station was 70.19,75.89,69.51,80.29,72.85 and 72.11 respectively.From the clinical competences of the four test sites examined,the average scores were from high to low,respectively,for the interview skills,interview content,physical examination skills and physical examination content,the average score of85.48,75.75,58.94 and 57.58,and the four abilities were statistically significant differences.Of the 230 students who studied this case,99 were Category A(good learning,high stability),one was Category A *(carelessness),and 128 were students Category B(further work is required)and 2 classmates as Category B *(occasional carelessness).Of the 57 criteria examined,14 were Category A(easy answers)and 14 were Category A *(Modified),9 evaluation criteria for Category B(Intermediate),12 for Category B *(easy questions),4 for Category C(difficult questions)and 4 for C *).Finally,the questionnaire research on the basic conditions of clinical graduated medical students indicate that the gender,interest in learning,stress level,quality of sleep,age and students' usual grades are the factors influencing the results of OSCE test(P<0.05).In terms of "two person communication,conference discussion and speech",medical students in low fear communication group had better performance than those in high fear group in "inquiry skills",and the difference was statistically significant.The impact of these factors on the clinical performance of students is prevalent,and for each medical graduate the existence of these influencing factors leads to their different clinical manifestations.Conclusions:1.Overall,the SP test station in OSCE in this study is a reliable and valid.2.In terms of difficulty,in addition to interrogation techniques,exam questions in each test station are moderately difficult and some of them need to be adjusted accordingly.3.OSCE in the SP test station assessment and analysis of the results can be accurately and effectively identify the students at the test station and the clinical capabilities.4.For the first time using the S-P table analysis of typical cases of calculation and analysis,to accurately grasp the overall situation of students as well as test questions existing problems.5.The results of the study showed that gender,learning interest,clinical grades,stress,quality of sleep,age and communication apprehension had a significant impact on OSCE scores.6.It is suggested that schools should give priority to training and educationaccording to the short comings shown by the students during the examination so as to provide constructive suggestions for the cultivation of outstanding talents in the future.At the same time,the specific problems of the test standard are fed back to provide more suggestions for the test standard of the OSCE evaluation in our school in the future.