应用分层教学法改善硕士研究生在重症医学科的培养效果

Hierarchical training improves the training effect of clinical postgraduates in critical care medicine

目的观察分层教学对住院医师规范化培训硕士研究生在重症医学科轮转期间的临床培养效果。方法纳入2019年6月至2020年1月进入青岛大学附属医院重症医学科轮转的住院医师规范化培训硕士研究生作为研究对象,统一入科培训1周后进行考核,然后按随机数字表法将研究生分为分层教学组和传统教学组。2个月培训结束后,分别行迷你临床演练评量(Mini-CEX)、岗位胜任力评估以及题库考核,并比较两组上述指标的差异。结果最终243名研究生入组,分层教学组119名,传统教学组124名。两组性别、年龄、专业类别及入科考核成绩比较差异均无统计学意义。Mini-CEX结果显示,与传统教学组比较,分层教学组体格检查、沟通技巧、临床辩证思维、临床诊断、能力及效率和整体临床胜任能力方面的成绩均明显提高〔体格检查(分):7.71±0.62比7.51±0.57,沟通技巧(分):7.94±0.83比7.58±0.94,临床辩证思维(分):8.02±0.76比7.71±0.64,临床诊断(分):7.97±0.75比7.74±0.59,能力及效率(分):8.31±0.87比8.09±0.51,整体临床胜任能力(分):8.38±0.79比8.12±0.85,均P<0.05〕;分层教学组和传统教学组问诊技巧及人文关怀方面的成绩比较差异均无统计学意义〔问诊技巧(分):7.20±0.84比7.07±0.59,人文关怀(分):8.27±0.94比8.18±0.83,均P>0.05〕。岗位胜任力评估结果显示:与传统教学组比较,分层教学组临床基本能力、医患沟通能力、医学知识掌握与运用、团队合作能力、信息与管理能力、学术研究能力方面的成绩均明显提高〔临床基本能力(分):89.15±9.12比86.24±10.23,医患沟通能力(分):52.02±3.26比51.98±4.58,医学知识掌握与运用(分):48.37±5.87比46.98±3.68,团队合作能力(分):48.10±3.55比45.96±4.83,信息与管理能力(分):68.52±7.61比66.38±5.54,学术研究能力(分):22.18±0.95比20.87±1.22,均P<0.05〕;分层教学组和传统教学组职业精神与素质、共卫生服务能力方面的成绩差异均无统计学意义〔职业精神与素质(分):95.89±9.25比95.01±9.77,公共卫生服务能力(分):45.89±5.20比45.70±4.29,均P>0.05〕。分层教学组题库考核成绩明显高于传统教学组(分:90.48±12.35比87.57±10.33,P<0.05)。结论分层教学可以提高专业型硕士研究生重症医学科培训期间临床理论、临床综合能力及岗位胜任力。

Objective To observe the clinical education effect of hierarchical training on the master degree clinical postgraduates in the resident standardized training during the rotation in the department of critical care medicine.Methods The clinical postgraduates of resident standardized training who were rotated to the department of critical care medicine of the Affiliated Hospital of Qingdao University from June 2019 to January 2020 were included as the research objects.They were uniformly assessed after 1 week of training,and then divided into a hierarchical teaching group and a traditional teaching group according to the random number table method.After 2 months of training,mini-clinical exercise assessment(mini-CEX),post competency assessment and question bank assessment were conducted respectively,and the differences of the above indicators between the two groups were compared.Results A total of 243 graduate students were enrolled,119 in the hierarchical teaching group and 124 in the traditional teaching group.There were no statistical significant differences in gender,age,specialty category and admission examination results between the two groups.Mini-CEX results showed that compared with the traditional teaching group,the scores of physical examination,communication skills,clinical dialectical thinking,clinical diagnosis,ability and efficiency and overall clinical competency in the hierarchical teaching group were significantly higher(physical examination:7.71±0.62 vs.7.51±0.57,communication skills:7.94±0.83 vs.7.58±0.94,clinical dialectical thinking:8.02±0.76 vs.7.71±0.64,clinical diagnosis:7.97±0.75 vs.7.74±0.59,ability and efficiency:8.31±0.87 vs.8.09±0.51,overall clinical ability:8.38±0.79 vs.8.12±0.85,all P<0.05);There were no significant differences in the scores of interrogation skills and humanistic care between the two groups(interrogation skills:7.20±0.84 vs.7.07±0.59,humanistic care:8.27±0.94 vs.8.18±0.83,both P>0.05).The post competency evaluation results showed that compared with the traditional teaching group,the scores of clinical basic ability,doctor-patient communication ability,application of medical knowledge,teamwork ability,information and management ability and academic research ability in the hierarchical teaching group were significantly higher(clinical basic ability:89.15±9.12 vs.86.24±10.23,doctor-patient communication ability:52.02±3.26 vs.51.98±4.58,application of medical knowledge:48.37±5.87 vs.46.98±3.68,teamwork ability:48.10±3.55 vs.45.96±4.83,information and management ability:68.52±7.61 vs.66.38±5.54,academic research ability:22.18±0.95 vs.20.87±1.22,all P<0.05);there were no significant differences in the scores of professionalism and quality and public health service ability between the two groups(professionalism and quality:95.89±9.25 vs.95.01±9.77,public health service ability:45.89±5.20 vs.45.70±4.29,both P>0.05).The examination results of item bank in hierarchical teaching group was significantly higher than that in traditional teaching group(90.48±12.35 vs.87.57±10.33,P<0.05).Conclusion Hierarchical training can improve the clinical theory,clinical comprehensive ability and job competence of clinical postgraduates in critical care medicine.