血管介入模拟器结合案例教学在周围血管介入进修医师培训中的应用

Application of case-based learning （CBL）combined with virtual reality simulator in peripheral vascular intervention training for refresher doctors

目的 探讨血管介入模拟器结合案例教学（case—based learning，CBL）在周围血管介入进修医师培训中的应用效果。方法 选取进修医师30人，随机分为模拟器CBL组（15人）和传统教学组（15人）。模拟器CBL组采用CBL教学并结合使用血管介入模拟器，传统教学组采用固有培训方式。培训后对两组进修医师实施理论考试和真实环境下操作技能考核；并向模拟器CBL组发放调查问卷，了解进修医师对教学方法的认可度。组间比较采用独立样本t检验。结果 模拟器CBL组进修医师理论成绩平均为（84．5±7．7）分，高于传统教学组的（72．6±8．7）分（P=0．024）；模拟器CBL组进修医师技能成绩平均为（85．3±9．3）分，高于传统教学组的（70．2±10．2）分（I^2=-0．013）。模拟器CBL组医师平均操作错误率、术中造影剂平均使用剂量、平均造影时间、术中X线平均透视时间、术中X线平均累计曝光剂量、单位面积X线累计曝光剂量均少于传统教学组，差异有统计学意义（P均〈0．05）。100％（15／15）的模拟器CBL组进修医师认可CBL结合血管介入模拟器的教学方式。结论 血管介入仿真模拟器结合CBL可有效激发进修医师的学习兴趣．使之较快地掌握周围血管介入技术。

Objective To study the effect of case-based learning（CBL） combined with virtual reality simulator in peripheral vascular intervention training for refresher doctors. Methods Total 30 peripheral vascular refresher doctors were selected in department of vascular surgery, Xuanwu Hospital of Capital Medical University and were randomly divided into the observation group（n=15） and control group（n=15）. Doctors in observation group were trained by CBL combined with virtual reality simulator while those in control group were taught by traditional teaching method. Theory examination, skill examination in real environment were performed after the training and achievement differences were compared between 2 groups. Questionnaires were given to the simulator CBL group, to learn refresher doctors＇ recognition of the teaching method and groups were compared using independent samples t test. Results Theory examination average score was （84.5 ± 7.7） in observation group, higher than the score（72.6± 8.7） in control group（P=0.024）. Skill examination average score was（85.3 ± 9.3） in observation group, higher than the score （70.2 ± 10.2） in control group （P=0.013）. Compared with control group, the mean performance errors in training group, the contrast volume, the mean angiog- raphy procedure time, the time of X-ray exposure, the total volume of X-ray exposure and the total volume of X-ray exposure every square meter all decreased significantly and the difference was staffstically significant. P value〈0.05. 100% （15/15） simulator CBL group refresher doctors recognized CBL combined with vascular interventional simulator teaching method. Conclusions Teaching method of CBL combined with virtual reality simulator can stimulate the refresher doctors＇ interest in learning and help them master peripheral vascular interventional techniques.