消化内科带教中应用标准化病人与实施代理住院医师制度的探索

Exploration on the application of standardized patients and implementation of agency resident system in digestion medical clinical practice

目的：探讨标准化病人应用与代理住院医师制度的实施在消化内科实习带教中的效果。方法选取2008至2009学年进入消化内科实习的五年制临床医学专业150名学生为研究对象，随机分为教改组和对照组，每组75人；同时，经教改组学生自愿并通过选拔后，确定其中69人为代理住院医师。教改组带教中应用标准化病人和进行代理住院医师模拟诊疗培训；对照组采用常规带教方法。通过评分表分别评定教改组和对照组学生在问诊技能、体检技能与病例分析等方面成绩，采用SPSS 11.0对计量资料行独立样本t检验、方差不齐采用秩和检验。结果教改组学生的问诊内容和技巧成绩各项目均高于对照组，且在时间顺序、过渡语言、问诊进度、重复提问、小结记录、引证核实、仪表礼节、友善行为、赞扬鼓励、引出病人看法、关切疾病影响、关心支持与帮助方面评分差异有统计学意义（P〈0.05）；第3次实习结束后两组病历作业成绩相比，教改组的病史采集、体检技巧得分优良率更高（P值分别为0.002、0.001）；3次实习后，教改组学生在医德风范、问诊技巧、体检技巧、病例分析方面的评分及格率高于对照组，差异有统计学意义（P〈0.05）。结论消化内科实习带教中应用标准化病人与实施代理住院医师模拟诊疗培训取得很好的实践效果。

Objective To study the application of standardized patients practice and agent physician system in digestion medical clinical practice. Methods One hundred and fifty five-year-clinical medical students who began digestion medical clinical practice from 2008 to 2009 were selected and randomly divided into teaching reform group and control group, each group containing 75 people. According to teaching reform group students＆#39; willingness and through the selection, 69 were identified as agent physician. Standardized patients and agent physician simulation clinical training were applied in the teaching reform group while conventional teaching methods were used in the control group. Sta-tistical analysis of the experimental data was conducted using SPSS 11.0 statistical package. Measure-ment data use independent-samples t test and rank sum test was used for heterogeneity of variance. Results Teaching reform group students＆#39; inquiry contents and skills scores for each project were higher than those of control group and the score difference was statistically significant （P〈0.05） in chronological order, the transition language, interrogation schedule, repeated questions, summary records, citing verification, instrumentation courtesy, friendly behavior, praise and encouragement, eliciting the patient＆#39;s views, concerns about the effects of disease, care and support and assistance aspects. After the end of the third internship, two groups were compared in operation results, reform history collection, physical examination skills group score and the excellent and good rate being higher （P=0.002, 0.001）. After three times＆#39; practice, teaching group students＆#39; scoring pass rate in medical ethics demeanor, interrogation techniques and physical examination skills, case analysis is higher than that of the control group students, and the difference was statistically significant（P〈0.05）. Conclusion Application of standardized patients and implementing agency resident simulation clinical training in the guide teaching of digestion department of internal medicine has achieved good effect.