急诊医学住院医师规范化培养引入临床决策方法临床能力效果评价

Clinical Ability Effect of Introducing Four Clinical Decision-making Methods in Standardization Training for Emergency Medicine Resident Doctor

目的急诊医学住院医师规范化培养中引入4种临床决策方法 (即模式识别法、假设演绎法、事件驱动法、运用规则法),评价其对急诊医学住院医师的临床能力效果.方法根据是否进行4种决策方法培养把120名住院医师分成实验组和对照组,比较2组的诊断、鉴别诊断、处理患者过程.结果实验组和对照组处理过程差异有统计学意义(P=0.002),实验组和对照组鉴别诊断差异有统计学意义(P=0.001),实验组和对照组诊断情况差异有统计学意义(P=0.007),实验组完成初步评估所用时间(13.10±1.88)min和对照组完成初步评估所用时间(16.01±1.62)min差异有统计学意义(P<0.0019).结论实验组诊断、鉴别诊断、处理病人过程优于对照组,实验组完成病人初步评估时间比对照组短.急诊医学住院医师规范化培养中引入4种临床决策方法可以提高住院医师的临床能力效果,可以把4种临床决策方法运用到以后急诊医学住院医师规范化培训中.

Objective To assess the clinical performance and ability of emergency medicine resident doctors by introducing four clinical decision- making methods（Patter recognition method, Hypothesis deductive method,Event driven method and Using the method of rules） in standardization training. Methods 120 resident doctors were divided into experimental and control groups according to whether or not they have previously completed the decision- making methods strategy training. Furthermore, their process of the diagnosis,differential diagnosis and treatment of patients were compared. Results There were statistically differences in the treatment of patients（P=0.002）, differential diagnosis（P=0.001） and the diagnosis（P=0.007） between the two groups. The time used to complete a preliminary assessment was（13.10±1.88） min and（16.01±1.62） min in the experimental group and control group, respectively, with a statistically significant difference（P〈0.0019）. Conclusions The diagnosis, differential diagnosis and treatment of patients in experimental group are better than those in control group. The time to complete a preliminary assessment in experimental group is shorter than that in control group. The introduction of four clinical decision- making methods in standardization training for emergency medicine resident doctors could improve the ability of clinical effect,and it can be applied in the standardization training for emergency medicine resident doctors in the future.