探讨诊断教学实践中临床操作技能直接观察法(DOPS)的评价效果。

2017年至2019年每年的8～12月秋季学期，在临床诊断技能教学实践中，对每个项目采用"教师示教-训练-DOPS评价-再训练(反馈-改进)-再DOPS评价"模式，对青岛大学医学院临床医学专业本科卓越医生班91名学生(2014级、2016级各30名，2015级31名)的临床操作技能进行教学与评价，分析第1次、第3次、第5次DOPS评价的教学效果和师生满意度。

各操作项目3次DOPS评分，手术区皮肤消毒与铺无菌巾单[(44.54±12.12)分、(65.79±13.70)分、(72.57±14.33)分]、换药术[(44.38±14.90)分、(54.74±11.52)分、(74.90±15.26)分]、切开与缝合术[(39.50±22.44)分、(45.17±17.01)分、(67.65±13.72)分]、胸膜腔穿刺术[(37.71±12.23)分、(63.53±14.55)分、(74.18±15.02)分]、腹膜腔穿刺术[(37.93±19.87)分、(57.77±12.71)分、(72.41±14.37)分]、腰椎穿刺术[(34.52±11.93)分、(48.90±10.24)分、(71.05±15.48)分]、骨髓穿刺术[(32.20±10.75)分、(48.51±9.57)分、(68.94±14.11)分]评分均逐渐增高(F＝72.42，84.33，91.31，74.18，79.30，82.74，79.36；均P<0.01)。学生胸膜腔穿刺术3次操作总体表现优异的比例[12.09%(11/91)、42.86%(39/91)、51.65%(47/91)]逐渐升高(χ²＝71.64，P<0.01)。但经过多次DOPS评价，仍有部分学生在技能操作熟练程度(18.68%，17/91)、严格无菌观念(15.38%，14/91)，以及医患沟通(7.69%，7/91)、人文关怀(7.69%，7/91)等方面的表现不符合要求。对3次DOPS评价的满意度评分，教师[(3.68±0.98)分、(5.63±1.22)分、(7.38±1.31)分]、学生[(3.72±1.04)分、(5.74±1.21)分、(7.72±1.25)分]逐渐升高(F＝140.20，116.96；均P<0.01)，但师生之间满意度评分比较，均差异无统计学意义(t＝0.29，1.81，0.94；均P>0.05)。

DOPS作为一种有效的形成性评价方法，能显著提高临床操作技能的教学效果。

To explore the evaluation effect of direct observation of procedural skills (DOPS) during the teaching practice of diagnostics.

In the teaching practice of clinical diagnostic skills, the mode of " teaching-training-DOPS evaluation-retraining (feedback-improvement)-reevaluation" was adopted to teach and evaluate 91 students (30 students from each grade of 2014, 2016, and 31 students from grade 2015) in the class of outstanding doctors in clinical medicine specialty from the Fall Semester from August to December each year from 2017 to 2019 in Medical College of Qingdao University, and the teaching effect and teachers′ and students′ satisfaction of the first, third and fifth DOPS evaluation were discussed.

The DOPS scores of operation disinfection and applying sterile towel [(44.54±12.12)points, (65.79±13.70)points, (72.57±14.33)points], dressing change [(44.38±14.90)points, (54.74±11.52)points, (74.90±15.26)points], cut up and suture [(39.50±22.44)points, (45.17±17.01)points, (67.65±13.72)points], thoracentesis[(37.71±12.23)points, (63.53±14.55)points, (74.18±15.02)points], abdominocentesis [(37.93±19.87)points, (57.77±12.71)points, (72.41±14.37)points], lumbar puncture [(34.52±11.93)points, (48.90±10.24)points, (71.05±15.48)points], bone marrow puncture [(32.20±10.75)points, (48.51±9.57)points, (68.94±14.11)points] were gradually increased (F=72.42, 84.33, 91.31, 74.18, 79.30, 82.74, 79.36, all P<0.01). The proportions of students with excellent clinical operation skills were gradually increased [12.09%(11/91), 42.86%(39/91), 51.65%(47/91)] in thoracentesis (χ²=71.64, P<0.01). However, after multiple DOPS evaluation, some students still fail to meet the requirements in terms of skill proficiency (18.68%, 17/91), strict aseptic concept (15.38%, 14/91), doctor-patient communication (7.69%, 7/91), humanistic care (7.69%, 7/91) and other aspects. The satisfaction scores of teachers [(3.68±0.98)points, (5.63±1.22)points, (7.38±1.31)points] and students [(3.72±1.04)points, (5.74±1.21)points, (7.72±1.25)points] on multiple DOPS evaluation increased gradually (F=140.20, 116.96, all P<0.01), but there were no differences in the satisfaction scores between teachers and students (t=0.29, 1.81, 0.94, all P>0.05).

As an effective formative evaluation method, DOPS can significantly improve the teaching effect of clinical operation skills.