重症医学科轮转住院医师培训效果的调查

Investigation on residency training effect in intensive care unit rotations

目的对住院医师在重症监护病房(ICU)的培训效果进行调查与分析,探讨住院医师在ICU培训过程中的常见问题与应对策略。方法选择2018年9月-2019年2月在ICU轮转的住院医师为研究对象,出科前进行理论测试,同时采用问卷调查ICU轮转期间的体会及建议等相关内容。结果最终入选60名住院医师。重症医学专业理论测试中成绩为"差"的医师比例明显大于重症医学基础理论的医师41.7%vs 3.3%(P<0.001),而成绩为"中"及"良"的医师比例明显小于重症医学基础理论的医师,分别为50.0%vs 73.3%(P=0.014)、8.3%vs 23.3%(P=0.043)。调查结果显示:100%被调查者认为重症医学具有"专业性强、知识点多,其理论及技能在短时间内难以掌握"的特点。对于在ICU轮转的收获,被调查者选择"培养临床诊断思维"占100%,选择"扩展视野、接触更多疾病"占66.7%。对于"在ICU应该主要学习的内容",被调查者选择"基本理论"为83.3%,选择"基本急救技能"及"基本抢救药物"均为66.7%。结论针对重症医学科专业特点,需要制订合理的培训计划,临床教学应围绕重症医学基础理论与临床诊断思维进行培养,辅以具有多学科共性的急救基本技能的训练。

Objective This study investigated and analyzed the residency training effect in intensive care unit(ICU)rotations,and discussed the common problems and coping strategies.Methods Subjects were resident physicians who were transferred to ICU from September 2018 to February 2019,and theoretical tests were conducted before the end of rotation,and the thoughts and suggestions during ICU rotation were investigated by questionnaire.Results A total of 60 resident physicians were enrolled.Compared with the results of the basic theory test of critical care medicine(CCM),the proportion of physicians with"low"marks in the professional theory test of CCM was increased significantly by 41.7%vs 3.3%(P<0.001),while the proportions with"medium"and"high"marks decreased significantly,50.0%vs 73.3%(P=0.014),and 8.3%vs 23.3%(P=0.043),respectively.The results of the questionnaire survey showed that 100%of the respondents believed that critical care medicine has the characteristics of"hard to acquire with highly specialized and complex knowledge and skills in a short time".For the harvest of ICU rotation,100%of respondents chose"cultivating clinical diagnostic thinking",and 66.7%chose"expanding their horizons and contacting with more patients with severe diseases".In terms of"which contents should be learned in ICU?""basic theory""basic first aid skills"and"basic usage of rescue drugs"were chose,accounting for 83.3%,66.7%and 66.7%respectively.Conclusion According to the characteristics of the specialty of critical care medicine,it is necessary to make reasonable training plans.And clinical teaching should focus on the basic theory of critical care medicine and the cultivation of clinical diagnostic thinking,supplemented by the training of basic first-aid skills with multi-disciplinary commonality.