探讨临床技能竞赛在诊断学教学中的指导作用。

选择2020年1月参加济宁医学院组织的临床技能竞赛的2015级临床医学专业84名本科生，竞赛分为病史采集、体格检查、临床技能操作及辅助检查结果判读4部分，分析学生每部分的平均分、及格率和得分率，比较三甲医院和非三甲医院来源的参赛学生各竞赛项目成绩的差异，总结诊断学教学中应改进的问题。

竞赛试题的难度属中等难度，试题区分度较好，内在一致性较强。病史采集平均分最高[(71.40±14.49)分]，操作技能平均分最低[(67.16±18.57)分]；体格检查得分率为47.62%；辅助检查结果判读部分学生得分之间的差异最大，其中实验室检查判读及格率仅为42.86%；三甲医院来源的参赛学生的病史采集、体格检查、操作技能及辅助检查结果判读的成绩[(80.48±10.99)分，(78.32±14.31)分，(70.32±18.62)分，(74.55±25.43)分]均高于非三甲医院的参赛学生成绩[(63.16±12.42)分，(59.63±11.35)分；(60.17±20.69)分，(59.77±20.48)分]，均差异有统计学意义(t＝3.37，3.67，4.72，2.08；均P<0.05)；医患沟通及人文素养得分率(34.62%，46.82%)均较低。

临床技能竞赛结果提示诊断学教学过程中应改进的问题，包括规范体格检查及基本技能操作，提高辅助检查结果判读能力，并在各项操作中提升医患沟通能力和人文素养。临床技能竞赛可进一步为诊断学教学质量的提高提供参考。

To explore the guiding effect of clinical skill competition on diagnosis teaching.

A total of 84 undergraduates majoring in clinical medicine of grade 2015 who took part in the clinical skills competition organized by Jining Medical University in January 2020 were selected. The competition comprised 4 parts: medical history collection, physical examination, clinical skill operation, and the interpretation of auxiliary examination result. The average scores, pass rates, and scoring rates for each part of the students were analyzed, and the scores of the students from the upper first-class hospitals and those from non-upper first-class hospitals were compared. The areas requiring improvement in diagnostics teaching were summarized.

The difficulty of the competition questions was moderate, the differentiation degree of the test questions was good, and the internal consistency was strong. The average score of medical history collection was the highest [(71.40±14.49)points], and the average score of operation skill was the lowest [(67.16±18.57)points]. The score rates of physical examination was 47.62%. Among them, the passing rate of laboratory examination was only 42.86%. The scores of medical history collection, physical examination, operation skills and auxiliary examination [(80.48±10.99)points, (78.32±14.31)points, (70.32±18.62)points and (74.55±25.43)points] in upper first-class hospitals were higher than those in non-upper first-class hospitals [(63.16±12.42)points, (59.63±11.35)points, (60.17±20.69)points, (59.77±20.48)points]. The differences were statistically significant (t=3.37, 3.67, 4.72, 2.08, all P<0.05). The scoring rates for doctor-patient communication and humanistic literacy was low at 34.62% and 46.82%, respectively.

The results of clinical skill competition indicate areas that need to be improved in diagnostics teaching, include standardizing physical examination and basic skill operation, improving the ability to interpret auxiliary examination results, and enhancing doctor-patient communication ability and humanistic accomplishment in various operations. Clinical skill competition can offer valuable insights for improving the quality of diagnostics teaching.