基于病案的教学查房结合PACS在影像科医师培养中的应用

Application of case based learning rounds with PACS in the training of radiology clinicians

目的探讨在影像科医师培养中,基于病案(CBL)的教学查房结合医学影像存储与通讯系统(PACS)对医师影像诊断能力培养的价值。方法对2018年在北京大学第三医院放射科轮转CT的41名培训医师,应用PACS对其进行CBL教学查房,对照组为2017年轮转CT的39名培训医师(未进行CBL教学)。从PACS随机抽取每名医师书写的10份报告(报告时间为培训最后1个月),对开展CBL教学前后培训医师的报告书写质量评分并计算优良率。评分标准包括病灶征象描述全面准确、报告内容条理清晰规范、诊断结论逻辑清晰合理、能回答临床提出的问题、提出的下一步诊疗建议合理准确以及无漏诊。同时采用调查问卷的方式评价培训医师对CBL教学查房的主观感受,包括全面系统的认识疾病、提高临床思维能力、读片能力和学习兴趣、PACS对学习的帮助5方面,采用百分比表示。结果1)进行CBL教学查房后,培训医师报告质量评分提高(P<0.01)。2)培训医师对调查问卷5方面满意率分别为90.2%、68.3%、80.5%、75.6%和80.5%。结论应用PACS进行CBL教学查房是培养影像科医师诊断能力的有效方法。

Objective To explore the value of case-based learning rounds(CBL) with application of PACS in the training of diagnostic capacity of radiology clinicians. Methods Peking University third hospital radiology department carried out the CBL rounds with application of PACS for 41 CT training clinicians in 2018, then compared with 39 CT training clinicians(without CBL rounds) in 2017. Ten reports written by each clinician(reported during the last training monthes) were randomly inspected from the PACS report system before and after the CBL rounds.These reports were scored, the excellent and good rate was calculated. The scoring criteria include accurate description of lesion imaging features, standardized report content, reasonable diagnosis logic, answering questions from clinical application form, making reasonable suggestions for further diagnosis and treatment, and no missed diagnosis. At the same time, questionnaires were used to evaluate the subjective feelings of training clinicians for CBL rounds, including comprehensive understanding of diseases, improvement of clinical analysis ability, reading images ability, and learning interest, and help of PACS for learning, expressed by percentage. Results 1)After CBL teaching, the report quality scores of clinicians increased(P<0.01). 2)Satisfaction rate of clinicians was 90.2%,68.3%,80.5%, 75.6% and 80.5% respectively.Conclusions CBL rounds with application of PACS system is an effective method to train the diagnosis capacity of radiology clinicians.