四步法带教在初级妇科腹腔镜手术临床教学中的应用

Application of four-step teaching method in clinical training of Primary Gynecological Laparoscopic Surgery

目的探讨四步法带教在初级妇科腹腔镜手术(primary gynecological laparoscopic surgery,PGLS)临床教学中的应用效果。方法以2020年4月—2021年9月完成腹腔镜模拟培训但实操零基础的51名二年级和三年级的规培医师/进修医师为研究对象。按所在的临床组不同分为试验组(n=25,采用四步法带教)和对照组(n=26,采用传统临床带教)进行妇科腹腔镜手术临床教学。为期4个月的带教结束后,分别对两组学员进行腹腔镜实操工作量对比、理论和实操考核及满意度调查,以评价教学效果。结果培训期间,两组学员参与的手术量无明显差异,试验组独立完成腹腔镜下卵巢囊肿剥除术(laparoscopic ovarian cystectomy,LOC)的学员占比和人均完成量均明显高于对照组[72.00%vs 15.38%,P<0.05;(2.48±1.78)vs(0.27±0.67),P<0.05]。试验组学员理论和实操考核成绩均明显高于对照组(P<0.05)。试验组学员对动手机会、带教方式、临床操作能力、自我提高四方面的满意率均明显高于对照组(P<0.05);虽然临床应变能力的满意度高于对照组,但差异无统计学意义(P>0.05)。结论四步法带教在PGLS临床教学中的应用效果良好,值得推广。

Objective To explore the application value of four-step teaching method in the clinical teaching of Primary Gynecological Laparoscopic Surgery(PGLS). Methods 51 clinicians including residents in grade 2 and grade 3 of standardized training or visiting physicians, who had completed laparoscopic simulation training from April 2020 to September 2021 but have no prac-tical experience, were selected as the research objects, divided into the experimental group(n=25, taught by four-step teaching method) and the control group(n=26, taught by traditional teaching method) according to different clinical groups they came from and given clinical teaching of PGLS. After four months of training, theoretical and practical assessment and satisfaction survey were conducted on the two groups of clinicians to evaluate the teaching effect. Results During the training period, there was no significant difference between the number of operations participated by the two groups. The proportion of students in the experimental group who completed laparos-copic cystectomy(LOC) independently and the number of independent LOC per capita were significantly higher than those in the control group [72.00% vs 15.38%,P<0.05;(2.48±1.78) vs(0.27±0.67), P<0.05]. The total scores of theoretical and practical assessment in the experi-mental group were significantly higher than those in the control group(P<0.05). Students’ satisfaction rates of the experimental group on hands-on opportunities, teaching methods, clinical operation ability and self-improvement were significantly higher than those in the control group(P<0.05), and satisfaction on clinical response ability was higher than that in the control group, but there was no statistical difference(P>0.05). Conclusion Four-step teaching method has a good effect in clinical teaching of PGLS and is worthy of promotion.