基于康复胜任力架构对北京市康复治疗师规范化培训效果的分析

doi:10.3969/j.issn.1006-9771.2023.10.017

摘要/Abstract

摘要：

目的以世界卫生组织提出的康复胜任力架构(RCF)为基础框架，结合我国康复特征和规范化培训要求，分析培训前后康复治疗师岗位胜任力和培训效果。
方法 2018年至2022年，于中国康复研究中心完成规范化培训的康复治疗师30例，在培训前后进行闭卷理论考核、迷你临床演练评估量表(Mini-CEX)评估，并向带教老师、同行、患者发放360度评价量表。通过多维度岗位胜任力分析，将量表与基础理论知识、临床实践能力、医学人文素养、科研教学能力、组织管理能力5个维度相结合，分析规范化培训对康复治疗师岗位胜任力的效果。
结果规范化培训后，治疗师在理论考核中基础理论和病例分析成绩提高(Z > 2.716, P < 0.05)。在Mini-CEX方面，治疗师的医学面谈技巧、体格检查、人道关怀/专业素养、临床判断能力和总体临床水平均提高(Z > 2.162, P < 0.05)。在360度评价量表方面，治疗师在医德医风、日常工作、管理能力、社会能力、人际沟通能力、职业基本能力、运筹能力上均提高(Z > 1.978, P < 0.05)。在康复治疗师岗位胜任力分析模型方面，基础理论知识、临床实践能力和医学人文素养3个维度效果明显。
结论康复治疗师规范化培训效果显著，培训后治疗师能够胜任康复日常诊疗工作。

关键词: 康复治疗师, 规范化培训, 胜任力

Abstract:

Objective To analyze the effect of standardized training on post competency of rehabilitation therapists, based on World Health Organization rehabilitation competency framework (RCF), and combined with the characteristics of rehabilitation and the requirements of standardized training in China.
Methods From 2018 to 2022, a total of 30 rehabilitation therapists who participated in the standardized training were selected. Before and after the standardized training, the closed-book theoretical assessment and Mini-clinical Evaluation Exercise (Mini-CEX) assessment were carried out, and a 360-Degree Evaluation scale was distributed to their teachers, peers and patients. Through multi-dimensional post competency analysis, the data obtained from the scales were combined with the five dimensions of basic theoretical knowledge, clinical practice ability, medical humanities literacy, scientific research and teaching ability, and organizational management ability to analyze the effect of standardized training on post competency of rehabilitation therapists.
Results After training, the therapists improved in theory and case analysis (Z > 2.716, P < 0.05). They also improved in medical interview skills, physical examination, humane care/professionalism, clinical judgment ability and overall clinical level (Z > 2.162, P < 0.05) according to Mini-CEX. The medical ethics, daily work, management ability, social ability, interpersonal communication ability, basic professional ability and operation ability improved (Z > 1.978, P < 0.05) according to the 360-Degree Evaluation scale. The effect of standardized training was significant in basic theoretical knowledge, clinical practice ability and medical humanities literacy by the post competency analysis model.
Conclusion The effect of standardized training of rehabilitation therapists is significant, and the therapists can be competent for daily work in diagnosis and treatment after training.

Key words: rehabilitation therapist, standardized training, competency

中图分类号:

R49-4
G726

叶淼, 梁一雄, 黄秋晨, 于丽丽, 胡春英, 张皓. 基于康复胜任力架构对北京市康复治疗师规范化培训效果的分析[J]. 《中国康复理论与实践》, 2023, 29(10): 1233-1240.

YE Miao, LIANG Yixiong, HUANG Qiuchen, YU Lili, HU Chunying, ZHANG Hao. Effect of standardized training of rehabilitation therapists in Beijing based on rehabilitation competency framework[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(10): 1233-1240.

图/表 7

表1

表2

表3

表4

表5

表6

图1

参考文献 36

[1]	中共中央国务院印发«"健康中国2030"规划纲要»[EB/OL]. (2016-10-25)[2023-02-25]. http://www.gov.cn/xinwen/2016-10/25/content_5124174.htm.
[2]	李欣, 邱卓英, 杨剑, 等. 康复2030:扩大康复规模以满足日益增长的康复需求[J]. 中国康复理论与实践, 2017, 23(4): 380-384. doi: 10.3969/j.issn.1006-9771.2017.04.003
	LI X, QIU Z Y, YANG J, et al. Rehabilitation 2030: meet ever-increasing rehabilitation needs[J]. Chin J Rehabil Theory Pract, 2017, 23(4): 380-384.
[3]	World Health Organization. Rehabilitation 2030: a call for action[EB/OL]. (2017-02-06)[2022-01-30]. https://www.who.int/news-room/events/detail/2017/02/06/default-calendar/rehabilitation-2030-a-call-for-action.
[4]	World Confederation for Physical Therapy. Policy statement: description of physical therapy[EB/OL]. (2014-06-18)[2015-04-10]. https://www.wcpt.org/policy/ps-descriptionPT.
[5]	张琦, 李洪霞, 马婷婷. 世界物理治疗联盟国际课程认证背景下物理治疗专业教改初探:以首都医科大学康复医学院为例[J]. 中国康复理论与实践, 2019, 25(12): 1480-1484. doi: 10.3969/j.issn.1006-9771.2019.12.019
	ZHANG Q, LI H X, MA T T. Reform of professional education in physical therapy in perspectives of World Confederation for Physical Therapy International Course Accreditation: case of Capital Medical University School of Rehabilitation Medicine[J]. Chin J Rehabil Theory Pract, 2019, 25(12): 1480-1484.
[6]	CARSWELL A. Minimum Standards for the Education of Occupational Therapists: building occupational therapy communities in WFOT member countries[J]. Asian J Occup Ther, 2009, 7(1): 23-26. doi: 10.11596/asiajot.7.23
[7]	世界卫生组织. 康复胜任力架构[M]. 邱卓英,郭键勋,孙宏伟,等,译. 香港: 香港复康会, 2021.
	World Health Organization. Rehabilitation competency framework (Chinese Version)[M]. [2022-02-27]. https://apps.who.int/iris/handle/10665/338782.
[8]	邱卓英, 郭键勋, 孙宏伟, 等. 世界卫生组织康复胜任力架构及其在康复领域的系统应用:理论架构、方法和应用领域[J]. 中国康复理论与实践, 2022, 28(3): 265-274. doi: 10.3969/j.issn.1006-9771.2022.03.002
	QIU Z Y, KWOK J K F, SUN H W, et al. Systematic implementation of World Health Organization rehabilitation competency framework in rehabilitation: conceptual framework, approaches and application[J]. Chin J Rehabil Theory Pract, 2022, 28(3): 265-274.
[9]	周朝生, 唐维桢, 徐刚, 等. 临床路径结合SOAP评估在临床康复教学中的应用[J]. 中国康复, 2017, 32(2): 172-173.
	ZHOU C S, TANG W Z, XU G, et al. Application of clinical pathway combined with SOAP assessment in clinical rehabilitation teaching[J]. Chin Rehabil, 2017, 32(2): 172-173.
[10]	燕铁斌, 章马兰, 于佳妮, 等. 国际功能、残疾和健康分类(ICF)专家共识[J]. 中国康复医学杂志, 2021, 36(1): 4-9.
[11]	燕铁斌. 进一步拓展«国际功能、残疾和健康分类»的临床应用[J]. 中国康复医学杂志, 2021, 36(3): 257-259.
[12]	渠彦红, 王芳, 李雅, 等. 360度评价在我国住院医师规范化培训中的应用情况分析[J]. 中国高等医学教育, 2022(9): 47-48.
	QU Y H, WANG F, LI Y, et al. Analysis of the application of 360 Degree Evaluation in standardized training of resident physicians in China[J]. Chin High Med Educ, 2022(9): 47-48.
[13]	杨帅, 李秋洁, 范宇莹, 等. Mini-CEX 的应用现状及展望[J]. 中国高等医学教育, 2015(2): 87, 143.
	YANG S, LI Q J, FAN Y Y, et al. Application status and prospect of Mini-CEX[J]. Chin Higher Med Educ, 2015(2): 87, 143.
[14]	JOSHI M K, SINGH T, BADYAL D K. Acceptability and feasibility of mini-clinical evaluation exercise as a formative assessment tool for workplace-based assessment for surgical postgraduate students[J]. J Post Med, 2017, 63(2): 100-105.
[15]	CORMACK C L, DUMAS B, DURHAM C O, et al. The 360-Degree Evaluation model: a method for assessing competency in graduate nursing students. A pilot research study[J]. Nurs Educ Today, 2018, 64: 132-137. doi: S0260-6917(18)30054-6 pmid: 29476959
[16]	刘黎黎, 钟以琳, 于果, 等. 360度评估在以胜任力为导向的儿科住院医师规范化培训中的应用[J]. 中华医学教育杂志, 2021, 41(3): 251-255.
	LIU L L, ZHONG Y L, YU G, et al. The application of 360-Degree Assessment in the competency-oriented standardized training of pediatric residents[J]. Chin J Med Educ, 2021, 41(3): 251-255.
[17]	GONZÁLEZ-GIL M T, PARRO-MORENO A I, OTER-QUINTANA C, et al. 360-Degree Evaluation: towards a comprehensive, integrated assessment of performance on clinical placement in nursing degrees: a descriptive observational study[J]. Nurse Educ Today, 2020, 95: 104594. doi: 10.1016/j.nedt.2020.104594
[18]	KORDAHL L. Facilitating awareness of philosophy of science, ethics and communication through manual skills training in undergraduate education[J]. Physiother Theory Pract, 2017, 33(3): 206-217. doi: 10.1080/09593985.2016.1277289 pmid: 28095097
[19]	中国康复医学会康复治疗专业委员会. 中国康复治疗师规范化培训专家共识[J]. 中国康复医学杂志, 2017, 32(10): 1095-1097.
[20]	陈文华, 燕铁斌. «中国康复治疗师岗位标准编制指南»专家共识[J]. 中国康复医学杂志, 2022, 37(1): 10-13.
[21]	萧敦武, 王詠, 伊丽奇. 物理治疗师胜任特征研究现状[J]. 中国康复理论与实践, 2016, 22(2): 168-171.
	XIAO D W, WANG Y, YI L Q. Research status of competency for physical therapist (review)[J]. Chin J Rehabil Theory Pract, 2016, 22(2): 168-171.
[22]	孙然, 段周瑛, 阚世锋, 等. 上海市5家康复医学科专科医师规范化培训基地的现状调查[J]. 中国康复医学杂志, 2021, 36(9): 1134-1137.
	SUN R, DUAN Z Y, KAN S F, et al. Investigation on the current situation of five standardized training bases for rehabilitation medicine specialists in Shanghai[J]. Chin J Rehabil Med, 2021, 36(9): 1134-1137.
[23]	顾泽龙, 王君, 宋玫, 等. 北京市住院医师规范化培训工作横断面调查[J]. 中华医院管理杂志, 2015, 31(12): 900-904.
	GU Z L, WANG J, SONG M, et al. A cross-sectional survey of standardized training for resident physicians in Beijing[J]. Chin J Hosp Man, 2015, 31(12): 900-904.
[24]	张皓, 王晓艳, 张婷婷, 等. 北京市康复医学科住院医师规范化培训结业考核结果分析[J]. 中国康复理论与实践, 2017, 23(4): 494-496. doi: 10.3969/j.issn.1006-9771.2017.04.028
	ZHANG H, WANG X Y, ZHANG T T, et al. Analysis of the results of the completion assessment of standardized training for residents in Beijing rehabilitation medicine department[J]. Chin J Rehabil Theory Pract, 2017, 23(4): 494-496.
[25]	王芗斌, 何坚, 陶静, 等. 美国物理治疗教育对临床推理能力培养的启示[J]. 中国康复理论与实践, 2017, 23(12): 1486-1488. doi: 10.3969/j.issn.1006-9771.2017.12.022
	WANG X B, HE J, TAO J, et al. Clinical reasoning training learned from physical therapy programs in the USA[J]. Chin J Rehabil Theory Pract, 2017, 23(12): 1486-1488.
[26]	SCANLAN J N, MEREDITH P J, HARACZ K, et al. Mental health education in occupational therapy professional preparation programs: alignment between clinician priorities and coverage in university curricula[J]. Aust Occup Ther J, 2017, 64(6): 436-447. doi: 10.1111/1440-1630.12397 pmid: 28660711
[27]	李海军. 临床医学专业认证视角下医学人文教育改革的路径探讨[J]. 中华医学教育杂志, 2017, 37(6): 853-857.
	LI H J. Discussion on the path of medical humanities education reform from the perspective of clinical medical professional certification[J]. Chin J Med Educ, 2017, 37(6): 853-857.
[28]	张海英, 钱风华. 住院医师规范化培训职业精神和人文素养评价体系建设实践与探索[J]. 中国医院管理, 2020, 40(10): 94-96.
	ZHANG H Y, QIAN F H. Practice and exploration of the construction of professional spirit and humanistic quality evaluation system for standardized resident training[J]. Chin Hosp Man, 2020, 40(10): 94-96.
[29]	冯晓云, 马宇航, 顾鸣宇, 等. 住院医师规范化培训阶段加强人文素养的策略[J]. 继续医学教育, 2022, 36(5): 73-76.
	FENG X Y, MA Y H, GU M Y, et al. Strategies for strengthening humanistic quality in the standardized training stage of residents[J]. Cont Med Educ, 2022, 36(5): 73-76.
[30]	蒋天裕, 王丽丽. 文献讨论组与康复治疗师继续教育浅谈[J]. 现代职业教育, 2019(12): 50-52.
	JIANG T Y, WANG L L. Literature discussion group and rehabilitation therapist continuing education[J]. Mod Voc Educ, 2019(12): 50-52.
[31]	曲歌乐, 魏占云, 张仲迎. 住院医师规范化培训中科研能力的培养[J]. 中国病案, 2023, 24(1): 78-79, 112.
	QU G L, WEI Z Y, ZHANG Z Y. Cultivation of scientific research ability in standardized resident training[J]. Chin Med Rec, 2023, 24(1): 78-79, 112.
[32]	彭奕华, 许红雁, 范文茂, 等. 住培教学中临床模拟参与式教学法的应用效果分析[J]. 中国继续医学教育, 2021, 13(32): 13-17.
	PENG Y H, XU H Y, FAN W M, et al. Analysis of the application effect of clinical simulation participatory teaching method in residential training teaching[J]. Chin Cont Med Educ, 2021, 13(32): 13-17.
[33]	唐凯, 徐倍, 孙营营, 等. 医院视角下医生情绪管理能力的问题与对策[J]. 现代医院管理, 2017, 15(6): 75-77.
	TANG K, XU B, SUN Y Y, et al. Problems and countermeasures of doctors' emotional management ability from the perspective of hospital[J]. Mod Hosp Man, 2017, 15(6): 75-77.
[34]	王怡凡, 周典, 姚辰欢, 等. 面向重大突发公共卫生事件的医院应急管理弹性能力研究[J]. 中国医院管理, 2021, 41(6): 12-15.
	WANG Y F, ZHOU D, YAO C H, et al. Research on hospital emergency management flexibility for major public health emergencies[J]. Chin Hosp Man, 2021, 41(6): 12-15.
[35]	容榕, 李礼安, 丘成, 等. 医院突发公共卫生事件应急管理实践的伦理探索[J]. 医学与哲学, 2022, 43(20): 30-32.
	RONG R, LI L A, QIU C, et al. Ethical exploration of emergency management practice of public health emergencies in hospitals[J]. Med Philos, 2022, 43(20): 30-32.
[36]	王颖, 朱昭锦, 朱毅. 7国物理治疗师职业状况分析[J]. 中国康复理论与实践, 2018, 24(5): 615-620. doi: 10.3969/j.issn.1006-9771.2018.05.024
	WANG Y, ZHU Z J, ZHU Y. Analysis of occupational status of physical therapists in 7 countries[J]. Chin J Rehabil Theory Pract, 2018, 24(5): 615-620.

项目		n	项目		n
性别	男	12	生源地	北京	20
	女	18		外地	10
学历	本科	24	医院性质	三级	8
	硕士	6		二级	12
年龄/岁	20~25	28		一级	10
	26~30	2	有无初级职称证	有无	3
	26~30	2	有无初级职称证	有无	27

时间	n	基础理论	病例分析
规培前	30	38.00(34.75, 39.25)	36.00(35.00, 37.00)
规培后	30	38.50(35.75, 40.00)	39.00(37.00, 40.00)
Z值		2.716	4.272
P值		0.007	< 0.001

时间	n	医学面谈技巧	体格检查技巧	人道关怀/ 专业素养	临床判断能力	咨询、建议/交流沟通能力	组织能力和效率	总体临床能力
规培前	30	4.50(4.00, 6.00)	3.00(3.00, 6.00)	4.00(3.00, 6.00)	4.00(3.00, 6.25)	5.00(3.00, 6.00)	5.00(4.75, 6.00)	5.00(3.00, 6.00)
规培后	30	6.00(4.00, 6.25)	6.00(5.00, 7.00)	6.00(5.00, 7.00)	6.00(4.00, 6.00)	6.00(4.00, 6.00)	6.00(4.75, 6.25)	6.00(5.00, 7.00)
Z值		2.162	4.344	2.605	2.302	1.408	0.534	2.796
P值		0.031	< 0.001	0.009	0.021	0.159	0.593	0.005

时间	n	医德医风	日常工作	管理能力	科研能力
规培前	30	18.00(17.00, 19.00)	18.00(17.00, 20.00)	5.00(4.00, 5.25)	6.00(4.00, 7.00)
规培后	30	19.00(18.00, 20.00)	29.00(28.00, 31.00)	6.00(5.00, 6.25)	6.00(5.00, 7.25)
Z值		2.258	4.794	2.744	1.524
P值		0.024	< 0.001	0.006	0.127

时间	n	社会能力	人际沟通能力	职业基本能力	职业素养	运筹能力	工作表现
规培前	30	4.50(3.00, 5.00)	5.50(4.75, 6.00)	8.50(7.00, 11.00)	10.50(9.00, 12.00)	5.00(4.00, 6.00)	16.50(16.00, 17.00)
规培后	30	7.00(5.00, 8.00)	6.00(5.00, 7.00)	12.00(10.00, 15.00)	12.00(9.50, 14.00)	7.00(5.00, 8.00)	17.00(16.00, 17.00)
Z值		3.929	1.978	4.214	1.760	2.907	1.355
P值		< 0.001	0.048	< 0.001	0.078	0.004	0.176