执业医师技能标准下口腔医学实习教学质量同质化评价研究OA

Objective Employing a mixed-methods approach based on cross-sectional survey data,this study constructs a three-dimensional theoretical model for the homogenization of teaching quality in dental internship programs.Utilizing this model,the current state of teach-ing quality across different types of internship bases is evaluated.The analysis examines the level of homogeneity in teaching quality and core dental practitioner skills instruction across three categories of internship bases:public directly-affiliated hospitals,public non-direct-ly-affiliated hospitals,and private hospitals.It identifies areas of differentiation to establish pathways for enhancing the homogenization of public non-affiliated hospitals,and private hospitals in terms of teaching quality and instruction of core skills for dental practitioners.This study identifies areas of divergence to inform pathways for enhancing the homogeneity of dental internship teaching quality and improving the pass rate of the National Dental Practitioner Qualification Examination.Methods A cross-sectional survey design was employed with inductive theory construction.Data were collected from 119 fifth-year undergraduate interns in the Class of 2020 at a university's stomatol-ogy college through a digital platform featuring an embedded questionnaire behavior management system.This platform utilized the self-developed"Dental Internship Teaching Quality Assessment Scale,"which underwent rigorous reliability and validity testing(Cron-bach's α=0.927,KMO=0.862).Participants were categorized by hospital affiliation policy into three groups:directly affiliated public hospi-tals(n=38),non-directly affiliated public hospitals(n=70),and private hospitals(n=11).They were further grouped by departmental struc-ture into those with secondary specialty departments(n=53)and those without(n=55).The assessment scale comprised three major mod-ules:comprehensive clinical teaching evaluation(3 dimensions,5-point Likert scale),implementation of secondary department internship syllabi(4-point scale),and self-assessment of mastery in 14 clinical skills(4-point scale).Indicator selection was based on Bronfen-brenner's ecological systems theory(macro-meso-micro levels)and Miller's pyramid competency assessment model,aligned with the mod-ule requirements of the Practical Skills Examination Syllabus for the National Dental Licensing Examination.SPSS 26.0 software was used to perform Kruskal-Wallis H tests,Dunn-Bonferroni post-hoc multiple comparisons,and Mann-Whitney U tests,with a significance level of α=0.05.Results The comprehensive evaluation of clinical teaching showed high homogeneity,with no statistically significant dif-ferences among the three hospital types across all three dimensions:clinical learning outcomes,instructor competency,and rotation arrange-ment rationality(H values ranging from 0.20 to 1.74,P>0.05).All hospitals achieved a good level of performance.Significant heterogene-ity existed in the implementation of secondary department curricula:differences among the three hospital types were highly significant(H=14.29,P<0.001),with directly affiliated public hospitals significantly outperforming the other two types(adjusted P<0.05).Hospitals with secondary specialty departments scored significantly higher than those without(P=0.017).Mastery of clinical skills exhibited a"11+3"structural differentiation:while 11 of the 14 skills showed no significant differences across hospital types,significant disparities were ob-served in:intraoral suturing(H=7.86,P=0.020),and maxillofacial bandaging techniques(H=18.89,P<0.001).Private hospitals excelled in the first two skills,while directly affiliated public hospitals demonstrated a clear advantage in the third.The secondary specialty hospital structure exerted a significant positive moderating effect on three skills:toothbrushing instruction,intraoral suturing,and maxillofacial ban-daging(P<0.05).Conclusion The foundational framework for dental internship training in China has achieved preliminary standardization at the macro-management level.However,disparities persist in the implementation of departmental curricula at the meso-level and in the mastery of specific clinical skills at the micro-level,revealing a three-tiered quality gap characterized by superficial homogeneity and deep-seated heterogeneity.Within the formation mechanism of differentiated skills,private hospitals leverage market-driven operational models,abundant case resources,and efficient clinical rotation systems to gain an advantage in prosthodontic and surgical skill training.Public hospitals,through their teaching systems and simulation training compensation mechanisms,enforce standardized training for low-frequency emergency skills.The secondary specialty department structure enhances mastery of specific skills by utilizing specialized teaching resources and supervisory responsibilities.