追踪方法学联合CBS模式在住培医师病历书写岗前培训中的应用研究

Application of tracer methodology combined case-based study model in the pre-job training of medical record writing for residents

目的探讨追踪方法学联合以病案为基础的培训模式(case-based study,CBS)在住院医师规范化培训病历书写中的应用价值。方法将中山大学附属第六医院2019年7月新入职的拟进行病历书写岗前培训的临床科室(内、外、妇、儿)住培学员91名,随机分为对照组(n=44)和实验组(n=47);分别采用传统培训模式及追踪方法学联合CBS培训模式;观察两组学员病历书写相关知识知晓情况、病历书写考核成绩及对教学反馈情况。应用SPSS 21.0进行t检验和卡方检验。结果两组培训前后病历书写相关知识回答各指标正确率均有提高,差异有统计学意义(P<0.05)。在病历规范性评分和完整性评分上,培训后评分高于培训前,而实验组规范性评分和完整性评分分别为(90.3±3.5)和(91.3±3.2),高于对照组的(88.6±3.5)和(89.8±3.0),差异有统计学意义(P<0.05)。在自主学习能力[97.8%(44/45)vs.82.90%(34/41)]、医患沟通能力[95.6%(43/45)vs.78.0%(32/41)]和授课形式[97.8%(44/45)vs.82.9%(34/41)]接受度方面,实验组优于对照组且差异有统计学意义(P<0.05)。结论追踪方法学联合CBS模式是良好的岗前培训病历书写的方法,能够有效调动学员和教师的主观能动性,更好地完成教学任务,获得更优的教学价值。

Objective:To observe the value of tracer methodology combined case-based study(CBS)model in the standardized residency training of medical record writing.Methods:A total of 91 residents who were newly recruited from The Sixth Affiliated Hospital of Sun Yat-sen University in July 2019 were selected as the subjects and randomly divided into test group(n=47)and control group(n=44).The tracer methodology combined CBS model was used for test group while the traditional model was used for control group to compare the knowledge of medical record writing,performance of medical record writing and feedback to teaching in two groups.SPSS 21.0 was used for t test and chi-square test.Results:The correct response rate in knowledge of medical record writing,the normative scores and integrity scores after training were significantly higher than those before training(P<0.05).The normative and integrity scores were significantly increased after training,and those in the test group were significantly higher than those in the control group[(90.3±3.5)and(91.3±3.2)vs.(88.6±3.5)and(89.8±3.0),P<0.05,respectively].The test group was significantly superior to the control group in the autonomous learning ability[97.8%(44/45)vs.82.9%(34/41)],communication ability[95.6%(43/45)vs.78.0%(32/41)]and acceptance of teaching form[97.8%(44/45)vs.82.9%(34/41)](P<0.05).Conclusion:The tracer methodology combined CBS model is a good way in the pre-job training of medical record writing for residents,which can mobilize the subjective initiative of the trainees and teachers,complete the teaching tasks and obtain better teaching value.