国家临床医师资格理论考试实证效度研究
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摘要
前言
临床医师资格考试作为行业准入性考试,是对执业医师临床思维过程和实际工作能力的综合评价。考试必须具有较高的信度和效度,才能准确地反映所要测量研究对象所具有的知识和技能。在观察考试的效度时我们不仅应看到分数本身的可靠性,也应该考虑研究对象在考试中的表现与其在其他情境下(现实工作中)表现的关系。
临床医师资格考试的实证效度(Demonstrative Validity,或Empirical Validity)研究,重要的是确定实证效度的效标。考试成绩效度高低的评判标准,可以是其它相关考试的成绩,也可以是研究对象在实践中的表现。比如参加临床医师资格考试的研究对象在比较短的时间内又参加了其它与临床医师资格考试相似的理论与实践考试。如果两次考试成绩的一致性较高,则证明两者的效度都高。反之,两次考试成绩的一致性较低,而又无法判定作为效标的考试是否具有理想的考试信度和效度时,就需要进行进一步研究。实证效度的研究主要是通过确定的效标与考试成绩相比较,分析研究医师考试的效度,因此又被称为效标关联效度(Criterion-related Validity)。要建立一个标准化考试,实证效度是重要的检验手段。
本研究从客观实践角度评价临床医师资格考试结果反映真实情况的程度。通过收集并分析实证性资料,以研究对象的其他实际表现(工作中表现和其它考试成绩)为效标评价临床医师资格考试的效度,从而促进临床医师资格考试的完善和提高。
对象与方法
对象：从12家医学院校附属医院选取163名本科学历住院医师为研究对象,专业包括内科,外科、妇科、儿科。
方法：根据临床专业医师资格考试的内容、方式和技术特点,在临床医师资格考试之后较短的时间内,组织参加研究的考生进行一次理论考试和OSCE,作为与临床医师资格考试的对照考试。比较临床医师资格考试成绩同这些考试成绩的一致性程度,进行分析研究。
临床专业医师资格考试实证资料的收集。整理3600调查表和临床能力综合评价表,对他们的职业精神、专业知识和临床能力进行评价,并采用综合评价方法进行量化分级。
结果
一、年度考核基本情况
理论试卷平均分为57.34,标准差7.03,信度采用分半法计算所得为0.903。试卷平均难度0.573,平均区分度0.529。OSCE平均分69.66,标准差7.45,信度0.712,难度0.697,区分度0.411。二、日常工作表现基本情况
360°评价表得分平均分95.78；临床能力综合评价表六大核心能力评价得分平均分90.61、总体评价(9分制)8.19。各项目评分结果均较高,评分间未发现显著差异,服从正态分布。
三、临床医师资格考试实证效度的分析
临床医师资格考试与年度考核理论部分在总成绩、基础知识部分的成绩、专业知识部分及公共知识部分的成绩均相关。与OSCE考试部分的相关具有显著的统计学意义。日常工作表现计量评分的相关性分析显示临床医师资格考试的成绩与研究对象日常工作中的表现相关性显著。
讨论
一、年度考核评价结果的教育测量学分析
年度考核理论考试的信度较高,表面效度和内容效度较好、难度适中,区分度良好。试卷质量非常高,考生成绩可以作为本次医师资格考试实证效度研究的效标。
年度考核OSCE考试整体信度较高,难度和区分度也在一个非常适度的区间内,其总成绩作为医师资格考试的效标可以较好的反应医师资格考试的效度。
二、临床医师资格考试的实证效度分析
1、医师资格考试与住院医师理论考试高度相关。
2、医师资格考试与住院医师OSCE考试中度相关。
3、医师资格考试与360°评价低度相关,与临床能力综合评价不相关。
结论
1、年度考核理论考试和OSCE考试质量分析结果较好,考生的成绩作为医师资格考试的效标能够较好反应出医师资格考试的有效性。
2、2009年临床医师资格理论考试的实证效度研究结果较为理想,证明了临床医师资格理论考试能够较好的考察出考生的真实情况。
Introduction
As a medical access examination, The Clinical Physician Qualification Examination is a comprehensive evaluation for doctors'practical thought process and the ability of work. The reliability and validity of the examination must be high so that the exam could accurately reflect their knowledge and skills. At the same time of observing the validity of the exam, we should not only focus on the reliability of the score, but also consider the performance of the objects in the test of other situations and the performance in daily work.
The most important factor to the clinical physician qualification examination is that how to determine the criterion of the empirical validity. The standard of the validity may be another similar examination or the performance from working. Physicians compared by the qualifying examination with a similar test time, content and structure, could be analyzed as a total with two degrees. Some physician could be chose to take part in the research of the examination in short time later and also take part in an objective and a practical exam. If both of the tests get high scores, we can say both of the test has high validity. On the contrast, if the scores of the two consistent are really low level test we can not determine the effect of the subjects as an ideal examination. The reliability and validity needs further study. Empirical validity of the study is to determine the criterion, compared with the examination results, analysis of the validity of physician examination; it is also known as criterion-related validity (Criterion-related Validity). To establish a standardized examination, empirical validity is so important.
The research shows that the perspective from an objective evaluation of the practice of doctors qualifying examination results reflects the extent of the real situation. According to collecting and analysing the empirical data, the research studies the actual performances(work or other examinations) of research objects for physician evaluation criterion validity of the qualifying clinicians, and then it can improve and perfect the examination of qualified.
Subjects and Methods
163 residents graduated are used as the research subjects, including 97 residents are male and 66 are female. The test has been taken during September 16 2009 to September 26,2009. The test consists of OSCE and Theory Examination. All statistics and psychometrics analysis, including difficulty, differentiation, reliability, validity and reliability, were done with SPSS 12.0.
Results
1、The basic situation of the annual assessment
Theory test part of the annual assessment reliability was 0.903. The theory test is divided into the average 57.34, standard deviation of 7.03. Results and comparison between men and women were no significant differences; between the various hospitals has also been no significant difference.
OSCE test average 69.66, standard deviation of 7.45. The average degree of difficulty is 0.697. To distinguish between an average of 0.411, to illustrate the distinction between the majority of cases a better degree.
2、Clinician's empirical validity of the qualifying examination of the analysis
Clinicians qualifying examination and annual examination of a total score of the theory, basic knowledge of some of the achievements, expertise and public knowledge of some part of the results are relevant. Skills assessment and annual examinations of the relevant part has a significant statistical significance.
Discussion
1、The assessment of annual exam of the reliability the difficulty and the discrimination
(1) the annual assessment
Annual assessment of the reliability of better reliability coefficient was 0.903 can think better reliability.
(2) OSCE test
OSCE test can be considered good quality of the cases.
2、The empirical analysis of the clinicians qualifying examination validity
(1) Qualifying Examination clinicians has highly correlation ship with the theory assessment.
(2) Qualifying Examination clinicians has moderate correlation ship with the OSCE test.
(3) Qualifying Examination clinicians has low correlation ship with the assessment of daily performance.
Conclusion
1、The results of annual assessment of evaluation is reliable and effective.
2、Clinician qualifying examination and the annual examination has significant correlation ship.
3、The qualified clinicians objective test and the clinical skill competence evaluation has no significant correlation.
临床医师资格考试作为行业准入性考试,是对执业医师临床思维过程和实际工作能力的综合评价。考试必须具有较高的信度和效度,才能准确地反映所要测量研究对象所具有的知识和技能。在观察考试的效度时我们不仅应看到分数本身的可靠性,也应该考虑研究对象在考试中的表现与其在其他情境下(现实工作中)表现的关系。
临床医师资格考试的实证效度(Demonstrative Validity,或Empirical Validity)研究,重要的是确定实证效度的效标。考试成绩效度高低的评判标准,可以是其它相关考试的成绩,也可以是研究对象在实践中的表现。比如参加临床医师资格考试的研究对象在比较短的时间内又参加了其它与临床医师资格考试相似的理论与实践考试。如果两次考试成绩的一致性较高,则证明两者的效度都高。反之,两次考试成绩的一致性较低,而又无法判定作为效标的考试是否具有理想的考试信度和效度时,就需要进行进一步研究。实证效度的研究主要是通过确定的效标与考试成绩相比较,分析研究医师考试的效度,因此又被称为效标关联效度(Criterion-related Validity)。要建立一个标准化考试,实证效度是重要的检验手段。
本研究从客观实践角度评价临床医师资格考试结果反映真实情况的程度。通过收集并分析实证性资料,以研究对象的其他实际表现(工作中表现和其它考试成绩)为效标评价临床医师资格考试的效度,从而促进临床医师资格考试的完善和提高。
对象与方法
对象：从12家医学院校附属医院选取163名本科学历住院医师为研究对象,专业包括内科,外科、妇科、儿科。
方法：根据临床专业医师资格考试的内容、方式和技术特点,在临床医师资格考试之后较短的时间内,组织参加研究的考生进行一次理论考试和OSCE,作为与临床医师资格考试的对照考试。比较临床医师资格考试成绩同这些考试成绩的一致性程度,进行分析研究。
临床专业医师资格考试实证资料的收集。整理3600调查表和临床能力综合评价表,对他们的职业精神、专业知识和临床能力进行评价,并采用综合评价方法进行量化分级。
结果
一、年度考核基本情况
理论试卷平均分为57.34,标准差7.03,信度采用分半法计算所得为0.903。试卷平均难度0.573,平均区分度0.529。OSCE平均分69.66,标准差7.45,信度0.712,难度0.697,区分度0.411。二、日常工作表现基本情况
360°评价表得分平均分95.78；临床能力综合评价表六大核心能力评价得分平均分90.61、总体评价(9分制)8.19。各项目评分结果均较高,评分间未发现显著差异,服从正态分布。
三、临床医师资格考试实证效度的分析
临床医师资格考试与年度考核理论部分在总成绩、基础知识部分的成绩、专业知识部分及公共知识部分的成绩均相关。与OSCE考试部分的相关具有显著的统计学意义。日常工作表现计量评分的相关性分析显示临床医师资格考试的成绩与研究对象日常工作中的表现相关性显著。
讨论
一、年度考核评价结果的教育测量学分析
年度考核理论考试的信度较高,表面效度和内容效度较好、难度适中,区分度良好。试卷质量非常高,考生成绩可以作为本次医师资格考试实证效度研究的效标。
年度考核OSCE考试整体信度较高,难度和区分度也在一个非常适度的区间内,其总成绩作为医师资格考试的效标可以较好的反应医师资格考试的效度。
二、临床医师资格考试的实证效度分析
1、医师资格考试与住院医师理论考试高度相关。
2、医师资格考试与住院医师OSCE考试中度相关。
3、医师资格考试与360°评价低度相关,与临床能力综合评价不相关。
结论
1、年度考核理论考试和OSCE考试质量分析结果较好,考生的成绩作为医师资格考试的效标能够较好反应出医师资格考试的有效性。
2、2009年临床医师资格理论考试的实证效度研究结果较为理想,证明了临床医师资格理论考试能够较好的考察出考生的真实情况。
Introduction
As a medical access examination, The Clinical Physician Qualification Examination is a comprehensive evaluation for doctors'practical thought process and the ability of work. The reliability and validity of the examination must be high so that the exam could accurately reflect their knowledge and skills. At the same time of observing the validity of the exam, we should not only focus on the reliability of the score, but also consider the performance of the objects in the test of other situations and the performance in daily work.
The most important factor to the clinical physician qualification examination is that how to determine the criterion of the empirical validity. The standard of the validity may be another similar examination or the performance from working. Physicians compared by the qualifying examination with a similar test time, content and structure, could be analyzed as a total with two degrees. Some physician could be chose to take part in the research of the examination in short time later and also take part in an objective and a practical exam. If both of the tests get high scores, we can say both of the test has high validity. On the contrast, if the scores of the two consistent are really low level test we can not determine the effect of the subjects as an ideal examination. The reliability and validity needs further study. Empirical validity of the study is to determine the criterion, compared with the examination results, analysis of the validity of physician examination; it is also known as criterion-related validity (Criterion-related Validity). To establish a standardized examination, empirical validity is so important.
The research shows that the perspective from an objective evaluation of the practice of doctors qualifying examination results reflects the extent of the real situation. According to collecting and analysing the empirical data, the research studies the actual performances(work or other examinations) of research objects for physician evaluation criterion validity of the qualifying clinicians, and then it can improve and perfect the examination of qualified.
Subjects and Methods
163 residents graduated are used as the research subjects, including 97 residents are male and 66 are female. The test has been taken during September 16 2009 to September 26,2009. The test consists of OSCE and Theory Examination. All statistics and psychometrics analysis, including difficulty, differentiation, reliability, validity and reliability, were done with SPSS 12.0.
Results
1、The basic situation of the annual assessment
Theory test part of the annual assessment reliability was 0.903. The theory test is divided into the average 57.34, standard deviation of 7.03. Results and comparison between men and women were no significant differences; between the various hospitals has also been no significant difference.
OSCE test average 69.66, standard deviation of 7.45. The average degree of difficulty is 0.697. To distinguish between an average of 0.411, to illustrate the distinction between the majority of cases a better degree.
2、Clinician's empirical validity of the qualifying examination of the analysis
Clinicians qualifying examination and annual examination of a total score of the theory, basic knowledge of some of the achievements, expertise and public knowledge of some part of the results are relevant. Skills assessment and annual examinations of the relevant part has a significant statistical significance.
Discussion
1、The assessment of annual exam of the reliability the difficulty and the discrimination
(1) the annual assessment
Annual assessment of the reliability of better reliability coefficient was 0.903 can think better reliability.
(2) OSCE test
OSCE test can be considered good quality of the cases.
2、The empirical analysis of the clinicians qualifying examination validity
(1) Qualifying Examination clinicians has highly correlation ship with the theory assessment.
(2) Qualifying Examination clinicians has moderate correlation ship with the OSCE test.
(3) Qualifying Examination clinicians has low correlation ship with the assessment of daily performance.
Conclusion
1、The results of annual assessment of evaluation is reliable and effective.
2、Clinician qualifying examination and the annual examination has significant correlation ship.
3、The qualified clinicians objective test and the clinical skill competence evaluation has no significant correlation.
引文
1 于惊涛,我国临床执业医师资格考试的信度和效度研究[J].中国卫生事业管理,2008,5：349-350.
2 张鸣,温吉元.我国医师资格考试制度的建立与完善[J].中华医院管理杂志.2001,17(8)：453-455.
3 汪勤俭,贺加.国外医师资格考试及发展趋势[J].中国医院管理,2005,25(2)：62-64.
4 张文刚.借鉴美国医学教育经验,促进中国住院医师培训[J].医学教育,2005,1：77-80.
5 漆书青.项目反映理论及其应用研究[M].江西高校出版社,1992.
6 Blacklow RS, Goe PP CE, Hojat M. Further psychometric evaluations of a class-ranking model as a predictor of graduates'clinical competence in the first year of residency[J]. Acad Med, 1993,68(4):295-7.
7 Ferrell BG, Thompson BL. Standardized patients:a long-station clinical examination format[J]. Med Educ,1993,27(4):376-81.
8 Donnon T, Paolucci EO, Violato C. The predictive validity of the meat for medical school performance and medical board licensing examinations:a meta analysis of the published research[J]. Acad Med,2005,80(10):910-7
9 Gessaroli ME, Poliquin M. Competency-based certification project. Phase iii:content validity, standard setting and criterion-related validity[J]. Can J Med Radiat Technol,1995,26(1): 17-21.
10 Violato C, Salami L, Muiznieks S. Certification examinations for massage therapists:a psychometric analysis[J]. J Mani Putative Physiologic Theory,2002,25(2):111-5.
11 Julian ER. Validity of the medical college admission test for predicting medical school performance [J]. Adv Health Sci Educ Theory Pract,2002,7(3):191-200.
12 Iain G Martin, Brain Folly. Predictive validity and estimated cut score of an objective structured clinical examination (OSCE) used as an assessment of clinical skills at the end of the first clinical year[J]. Med Educ,2002,36:418-425.
13 Simon SR, Volkan K, Hamann C, Duffey C, Fletcher SW. The relationship between second-year medical students'OSCE scores and USMLE step 1 scores[J]. Adv Health Sci Educ Theory Pract,2000,5(3):207-219.
14 Brailovsky CA, Grand Maison P. Using evidence to improve evaluation:a comprehensive assessment of a sp-based OSCE licensing [J]. Nurse Educ,2001,19(4):172-8.
15 美国教育研究协会.教育与心理测验标准[S].1999.
16 戴海崎等.心理与教育测量[M].暨南大学出版社,2005.
17 孙宝志,金魁和.高等医学教育现代考试方法[M].辽宁科学技术出版社,1996.
18 景汇泉,于晓松等.客观结构化临床考试成绩与认知领域考试成绩关系的统计分析[J].中国 卫生统计.2004,21(3)：172-173.
19于晓松,孙宝志等.临床能力评价的探索与改革[J].中国高等医学教育,2000,5：39-40.
1 方达,姚诠.实行专科医师准入制度的初步探讨[J].中国医院管理,2003,23(1)：2
2 林海波,邓锦娥,严应元等.对提高住院医师规范化培训质量的探讨[J].继续医学教育,2005,6(19)：39-41.
3 岑和,李斌,洪涛等.住院医师规范化培训在毕业后医学教育中的重要作用[J].福建医科大学学报,2002,3(1)：54-56
4 孟群.各国专科医师培训与准入制度[M].中国协和医科大学出版社,2004,2.
5 卫生部办公厅.《关于开展专科医师培训试点工作的通知》.(卫办科教发[2006]27号)
6 Stromski C, Jacoby J, Rammohan G. Short and long term skill retention after resident training in cricothyroidotomy [J]. Annals of Emergency Medicine,2005,46(3):13-15.
7 伍佰玲,胡志,周新发.住院医师规范化培训基地评价指标体系的研究[J].继续医学育,2004,9(24)：48-50.
8 世行贷款中国卫生VI项目赴德、法、英考察团.德国、法国、英国在职教育近况[J].中国高等医学教育,1998,3：59-61.
9 钱卫国,沈义方.德、法、英在职医学教育及全科医学发展考察[J].中国卫生事业管理,1998,9：501-504.
10杨欣,克敏,秦平.妇产科住院医师培训看美国的毕业后教育[J].继续医学教育,2001,15(4)：42-44
11 闵新歌,孙景海.国内外住院医师培训情况浅析[J].解放军医院管理杂志,1997,4(4)：393-394
12 张文刚.借鉴美国医学教育经验,促进中国住院医师培训[J].医学教育.2005,1：77-80.
13 Biernat K, Simpson D, Duthie E, etal. Primary care residents self assessment skills in dementia [J]. Ady Health Sci Educ Theory Pract,2003,8(2); 105-10.
14朱新,王申生.加拿大住院医师培训概况[J].继续医学教育.2000,3(4)：40-42.
15严宏,惠延年,俞兰.英国眼科医师的培训和考核制度[J].眼科新进展,2004；424(2)：156-157.
16孟群.各国专科医师培训与准入制度[M].中国协和医科大学出版社.2004：11.
17唐国瑶,陈建俞.北美住院医师培养模式运行现状与发展趋势[J].国外医学教育,2006,26(1)：88-91.
18裴傲,张亚卓.美国神经外科住院医师培训制度[J].中国微侵袭神经外科杂志,2005；10(3)：142-144.
19 Ronald A. Edelstein etc. A comparative study of measures to evaluate medical students' performances. Academic Medicine,2000,75(8):825-833.
20 Raksha Joshi, Frank W. Ling, Joseph Jaeger. Assessment of 360-Degree Instrument to
Evaluate Residents'Competency in Interpersonal and Communication Skills. Academic Medicine,2004,79(5):458-463.
21 封兴华.李芸梅,陈永进.法国的住院医师培养体系和启示[J].国外医学教育分册.2002.23(2)：12-13.
22郑锦.从法国的医学教育反观我国高等中医教育目前存在的问题[J].中医教育,2002；21(4)：25-26.
23 唐国瑶.我国住院医师培养模式的研究[D].2006.35-37.
24 Kintomo Takakura..Medical education for residents and specialist training in Japan. Global Summit on Medical Education, Shanghai, Apr.6-7,2006.
25 石书玉,孙贺一,王淑娟.日本外科专科医师培养制度的现状分析[J].日本医学介绍.,2005,26(4)：188-190.
26 林海波,邓锦娥,严应元等.对提高住院医师规范化培训质量的探讨[J].继续医学教育,2005,6(19)：39-41
27宋春梅,王克霞.住院医师规范化培训现状分析与建议[J].中华医学教育杂志,2007,27(2)：114-115.
28 欧风荣,赵霞,于晓松等.辽宁省住院医师培训制度的调查与分析[J].人力资源管理.2008,8(6)：15-16.
29 陈春,温建明，张向阳.新型住院医师培训模式初探[J].中国高等医学教育，2007(1)：60-61.
30 刘战培.住院医师规范化培训的改革与实践[J].中华医学教育杂志,2007，27(2)：112-113
31 Ferrell BG, Thompson BL. Standardized patients:a long-station clinical examination format [J]. Med Educ,1993,27(4):376-381.
32 Gessaroli ME, Poliquin M. Competency-Based Certification Project.Phase Ⅲ: content validity, standard setting and criterion-related validity [J]. Can J Med Radiat Technol,1995,26(1):17-21.
33 Violato C, Salami L, Muiznieks S.Certification examinations for massage therapists:a psychometric analysis [J]. Manipulative Physiol Ther,2002,25(2): 111-115.
34 Iain G Martin, Brain Folly. Predictive validity and estimated cut score of an objective structured clinical examination(OSCE) used as an assessment of clinical skills at the end of the first clinical year [J]. Med Edu,2002,36:418-425.
35 A W M Kramer, F F M Fansen, P Zuithoff, et al. Predictive validity of a written knowledge test of skills for an OSCE in postgraduate training for general practice [J].Med Edu.2002.36:812-819.
2 张鸣,温吉元.我国医师资格考试制度的建立与完善[J].中华医院管理杂志.2001,17(8)：453-455.
3 汪勤俭,贺加.国外医师资格考试及发展趋势[J].中国医院管理,2005,25(2)：62-64.
4 张文刚.借鉴美国医学教育经验,促进中国住院医师培训[J].医学教育,2005,1：77-80.
5 漆书青.项目反映理论及其应用研究[M].江西高校出版社,1992.
6 Blacklow RS, Goe PP CE, Hojat M. Further psychometric evaluations of a class-ranking model as a predictor of graduates'clinical competence in the first year of residency[J]. Acad Med, 1993,68(4):295-7.
7 Ferrell BG, Thompson BL. Standardized patients:a long-station clinical examination format[J]. Med Educ,1993,27(4):376-81.
8 Donnon T, Paolucci EO, Violato C. The predictive validity of the meat for medical school performance and medical board licensing examinations:a meta analysis of the published research[J]. Acad Med,2005,80(10):910-7
9 Gessaroli ME, Poliquin M. Competency-based certification project. Phase iii:content validity, standard setting and criterion-related validity[J]. Can J Med Radiat Technol,1995,26(1): 17-21.
10 Violato C, Salami L, Muiznieks S. Certification examinations for massage therapists:a psychometric analysis[J]. J Mani Putative Physiologic Theory,2002,25(2):111-5.
11 Julian ER. Validity of the medical college admission test for predicting medical school performance [J]. Adv Health Sci Educ Theory Pract,2002,7(3):191-200.
12 Iain G Martin, Brain Folly. Predictive validity and estimated cut score of an objective structured clinical examination (OSCE) used as an assessment of clinical skills at the end of the first clinical year[J]. Med Educ,2002,36:418-425.
13 Simon SR, Volkan K, Hamann C, Duffey C, Fletcher SW. The relationship between second-year medical students'OSCE scores and USMLE step 1 scores[J]. Adv Health Sci Educ Theory Pract,2000,5(3):207-219.
14 Brailovsky CA, Grand Maison P. Using evidence to improve evaluation:a comprehensive assessment of a sp-based OSCE licensing [J]. Nurse Educ,2001,19(4):172-8.
15 美国教育研究协会.教育与心理测验标准[S].1999.
16 戴海崎等.心理与教育测量[M].暨南大学出版社,2005.
17 孙宝志,金魁和.高等医学教育现代考试方法[M].辽宁科学技术出版社,1996.
18 景汇泉,于晓松等.客观结构化临床考试成绩与认知领域考试成绩关系的统计分析[J].中国 卫生统计.2004,21(3)：172-173.
19于晓松,孙宝志等.临床能力评价的探索与改革[J].中国高等医学教育,2000,5：39-40.
1 方达,姚诠.实行专科医师准入制度的初步探讨[J].中国医院管理,2003,23(1)：2
2 林海波,邓锦娥,严应元等.对提高住院医师规范化培训质量的探讨[J].继续医学教育,2005,6(19)：39-41.
3 岑和,李斌,洪涛等.住院医师规范化培训在毕业后医学教育中的重要作用[J].福建医科大学学报,2002,3(1)：54-56
4 孟群.各国专科医师培训与准入制度[M].中国协和医科大学出版社,2004,2.
5 卫生部办公厅.《关于开展专科医师培训试点工作的通知》.(卫办科教发[2006]27号)
6 Stromski C, Jacoby J, Rammohan G. Short and long term skill retention after resident training in cricothyroidotomy [J]. Annals of Emergency Medicine,2005,46(3):13-15.
7 伍佰玲,胡志,周新发.住院医师规范化培训基地评价指标体系的研究[J].继续医学育,2004,9(24)：48-50.
8 世行贷款中国卫生VI项目赴德、法、英考察团.德国、法国、英国在职教育近况[J].中国高等医学教育,1998,3：59-61.
9 钱卫国,沈义方.德、法、英在职医学教育及全科医学发展考察[J].中国卫生事业管理,1998,9：501-504.
10杨欣,克敏,秦平.妇产科住院医师培训看美国的毕业后教育[J].继续医学教育,2001,15(4)：42-44
11 闵新歌,孙景海.国内外住院医师培训情况浅析[J].解放军医院管理杂志,1997,4(4)：393-394
12 张文刚.借鉴美国医学教育经验,促进中国住院医师培训[J].医学教育.2005,1：77-80.
13 Biernat K, Simpson D, Duthie E, etal. Primary care residents self assessment skills in dementia [J]. Ady Health Sci Educ Theory Pract,2003,8(2); 105-10.
14朱新,王申生.加拿大住院医师培训概况[J].继续医学教育.2000,3(4)：40-42.
15严宏,惠延年,俞兰.英国眼科医师的培训和考核制度[J].眼科新进展,2004；424(2)：156-157.
16孟群.各国专科医师培训与准入制度[M].中国协和医科大学出版社.2004：11.
17唐国瑶,陈建俞.北美住院医师培养模式运行现状与发展趋势[J].国外医学教育,2006,26(1)：88-91.
18裴傲,张亚卓.美国神经外科住院医师培训制度[J].中国微侵袭神经外科杂志,2005；10(3)：142-144.
19 Ronald A. Edelstein etc. A comparative study of measures to evaluate medical students' performances. Academic Medicine,2000,75(8):825-833.
20 Raksha Joshi, Frank W. Ling, Joseph Jaeger. Assessment of 360-Degree Instrument to
Evaluate Residents'Competency in Interpersonal and Communication Skills. Academic Medicine,2004,79(5):458-463.
21 封兴华.李芸梅,陈永进.法国的住院医师培养体系和启示[J].国外医学教育分册.2002.23(2)：12-13.
22郑锦.从法国的医学教育反观我国高等中医教育目前存在的问题[J].中医教育,2002；21(4)：25-26.
23 唐国瑶.我国住院医师培养模式的研究[D].2006.35-37.
24 Kintomo Takakura..Medical education for residents and specialist training in Japan. Global Summit on Medical Education, Shanghai, Apr.6-7,2006.
25 石书玉,孙贺一,王淑娟.日本外科专科医师培养制度的现状分析[J].日本医学介绍.,2005,26(4)：188-190.
26 林海波,邓锦娥,严应元等.对提高住院医师规范化培训质量的探讨[J].继续医学教育,2005,6(19)：39-41
27宋春梅,王克霞.住院医师规范化培训现状分析与建议[J].中华医学教育杂志,2007,27(2)：114-115.
28 欧风荣,赵霞,于晓松等.辽宁省住院医师培训制度的调查与分析[J].人力资源管理.2008,8(6)：15-16.
29 陈春,温建明，张向阳.新型住院医师培训模式初探[J].中国高等医学教育，2007(1)：60-61.
30 刘战培.住院医师规范化培训的改革与实践[J].中华医学教育杂志,2007，27(2)：112-113
31 Ferrell BG, Thompson BL. Standardized patients:a long-station clinical examination format [J]. Med Educ,1993,27(4):376-381.
32 Gessaroli ME, Poliquin M. Competency-Based Certification Project.Phase Ⅲ: content validity, standard setting and criterion-related validity [J]. Can J Med Radiat Technol,1995,26(1):17-21.
33 Violato C, Salami L, Muiznieks S.Certification examinations for massage therapists:a psychometric analysis [J]. Manipulative Physiol Ther,2002,25(2): 111-115.
34 Iain G Martin, Brain Folly. Predictive validity and estimated cut score of an objective structured clinical examination(OSCE) used as an assessment of clinical skills at the end of the first clinical year [J]. Med Edu,2002,36:418-425.
35 A W M Kramer, F F M Fansen, P Zuithoff, et al. Predictive validity of a written knowledge test of skills for an OSCE in postgraduate training for general practice [J].Med Edu.2002.36:812-819.