Mini-CEX联合DOPS在新生儿科临床教学中的应用评价

Application and Value of Mini-CEX and DOPS in Neonatal Clinical Teaching

目的探讨迷你临床演练评估(Mini-CEX)联合操作技能直接观察评估(DOPS)在新生儿科临床教学中的应用效果。方法选择2016年1月至2018年1月在青岛大学附属医院新生儿科进行住院医师规范化培训的轮转医师68名为研究对象,对照组采用传统教学法,实验组采用Mini-CEX联合DOPS教学法,并在入科时和培训完成后应用Mini-CEX和DOPS量表对两组学生进行考核评价。结果①Mini-CEX量表:培训后对照组人文关怀、沟通能力与培训前比较差异无统计学意义(均P>0.05),临床问诊、体格检查、临床诊断、组织能力、总体评价这5项评分均高于培训前(t值分别为4.670、4.990、6.010、5.320、5.210,均P<0.05);培训后实验组临床问诊、体格检查、人文关怀、临床诊断、沟通能力、组织能力、总体评价这7项评分均高于培训前(t值分别为4.870、5.650、4.010、6.640、4.430、5.910、5.790,均P<0.05),且优于培训后对照组(t值分别为2.210、2.480、5.010、2.110、4.810、2.040、2.610,均P<0.05)。②DOPS量表:培训后对照组沟通能力、人文关怀与培训前比较差异无统计学意义(均P>0.05),解剖知识、知情同意、术前准备、无菌操作、寻求帮助、术后处理和总体表现这7项评分均高于培训前(t值分别为5.850、6.090、4.840、5.660、4.450、4.760、4.690,均P<0.05);实验组培训后解剖知识、知情同意、术前准备、无菌操作、寻求帮助、术后处理、沟通能力、人文关怀、总体表现这9项评分均高于培训前(t值分别为5.910、6.860、5.420、5.840、5.090、5.230、5.280、4.720、5.140,均P<0.05),且优于培训后对照组(t值分别为2.250、2.030、2.890、2.960、2.450、3.250、5.510、4.890、2.480,均P<0.05)。结论 Mini-CEX联合DOPS教学法在新生儿科教学中较传统教学法更具有优越性,这种新的教学法能够使学生的临床综合能力尤其是人文关怀和沟通能力得到提升,值得推广。

Objective To study the effect of Mini-CEX(mini-clinical evaluation exercise) and DOPS(direct observation of procedural skills) on clinical teaching of neonatal diseases.Methods 68 training residents from January 2016 to January 2018 in Neonatology Department were selected as subjects.The control group used the traditional teaching method,and the observation group received Mini-CEX/DOPS teaching training.Each student was evaluated by Mini-CEX and DOPS before and after the training.Results 1) Mini-CEX:In the control group,there was no significant improvement in humanistic care and doctor-patient communication(P>0.05 for all) after the training,while in medical interview,physical examination,clinical interview,organizational effectiveness and overall performance,the scores were significantly higher than those before the practice(t=4.670,4.990,6.010,5.320,5.210,respectively,P<0.05).In the observation group after the training,the scores in medical interview,physical examination,humanistic care,clinical judgment,doctor-patient communication,organizational effectiveness and overall performance increased(t=4.870,5.650,4.010,6.640,4.430,5.910,5.790,respectively,P<0.05),and were higher than those of the control group(t=2.210,2.480,5.010,2.110,4.810,2.040,2.610,respectively,P<0.05).2) DOPS:In the control group,there was no significant improvement in doctor-patient communication and humanistic care(P>0.05) after the training,while in anatomical knowledge,informed consent,preoperative preparation,asepsis operation,asking for assistance,postoperative management and overall performance,the scores were significantly higher than those before the practice(t=5.850,6.090,4.840,5.660,4.450,4.760,4.690,P<0.05).In the observation group after the training,the scores in anatomical knowledge,informed consent,preoperative preparation,asepsis operation,asking for assistance,postoperative management,doctor-patient communication,humanistic care and overall performance all increased(t=5.910,6.860,5.420,5.840,5.090,5.230,5.280,4.720,5.140,respectively,P<0.05),and were higher than those of the control group(t=2.250,2.030,2.890,2.960,2.450,3.250,5.510,4.890,2.480,respectively,P<0.05).Conclusion Compared with traditional teaching method,Mini-CEX/DOPS method in clinical teaching of neonatal diseases brought about a better teaching effect.This new teaching method can improve the clinical comprehensive ability,particularly the humanistic care and doctor-patient communication abilities,of students,and is worth of being promoted.