基于同伴互助学习的病例汇报在心内科住院医师规范化培训中的应用研究

Application of case reporting based on Peer-assisted learning in residents’ standardized training of cardiology

目的评估基于同伴互助学习(peer-assisted learning,PAL)的病例汇报在心内科住院医师规范化培训中的应用效果。方法选择2021年2月—2022年3月在内蒙古医科大学附属医院心血管内科轮转时间不少于3个月的内科学住院医师规范化培训学员及并轨内科学专业型硕士研究生共70人,根据学员意愿分为对照组(n=30)和试验组(n=40)。对照组采用传统教学法进行教学,试验组采用传统带教联合同伴互助学习的病例汇报进行教学。比较两组学员在出科时的理论成绩、技能成绩以及带教教师的综合评价成绩,并使用李克特五级量表对试验组学员及教学督导进行问卷调查,评价其对PAL病例汇报的认知态度。结果①试验组学员理论成绩高于对照组(86.13±7.314 vs.81.47±10.054,P<0.05),并且试验组学员收到带教教师的综合评分更高(90.43±3.720 vs.85.60±4.980,P<0.001),而两组的技能成绩并没有显著性差异(87.58±6.059 vs.86.20±7.146,P=0.387)。②大部分试验组学员对PAL病例汇报模式持积极认可态度,尤其是当学员以同伴导师的身份参与项目时的认可度更高(91.67%)。学员一致认为PAL病例汇报可以促进团队合作,提高管理能力、表达能力、自信心及主动思考能力(李克特分值均大于4.00分),他们也愿意向其他学员推荐PAL病例汇报项目。③90%的教学督导认为学生应该学习如何进行教学[李克特分值:(4.10±0.568)分],并且大部分的教学督导认为学生可以从PAL病例汇报中获益[李克特分值:(4.00±0.471)分]。通过PAL病例汇报可以让教学督导更加了解学生[李克特分值:(4.10±0.994)分],建立更加紧密的师生关系[李克特分值:(4.00±0.816)分]。结论PAL病例汇报模式可以提高住院医师规范化培训学员的学习成绩,增强其综合能力,甚至对学员未来的职业认知和选择也产生了积极影响。PAL病例汇报受到了学员和传统教师的广泛认可,是对传统教学模式的有效补充。

Objective To evaluate the application effect of case reporting based on peer-assisted learning(PAL)in the standardized training of residents in the Department of Cardiology.Methods 70 postgraduates majoring in professional degree of Internal Medicine,who participated in the standardized training of Internal Medicine for not less than three months of rotation in Depart-ment of Cardiology of the Affiliated Hospital of Inner Mongolia Medical University from February 2021 to March 2022 as residents,were selected and divided into the control group(n=30)and the experimental group(n=40)according to their wills,with traditional teaching method used in the teaching of the control group and traditional teaching method combined with case reporting based on PAL adopted in the teaching of the experimental group.The theoretical test scores,skill test scores and comprehensive evaluation given by the teachers of the two groups were compared after at the end of the training,and questionnaire survey,made by Lister scale,was given to students in the experimental group and teaching supervisors to evaluate their cognitive attitude to PAL case reporting.Results①The theoretical scores of the students in the experimental group were higher than those in the control group(86.13±7.314 VS.81.47±10.054,P<0.05),and the students in the experimental group received a higher comprehensive score from the teacher(90.43±3.720 VS.85.60±4.980,P<0.001).There was no significant difference in skill test scores between the two groups(87.58±6.059 VS 86.20±7.146,P=0.387).②Most students in the experimental group have a positive attitude towards PAL case reporting,especially when the students participated in the project as peer mentors(91.67%).The trainees agreed that PAL case reporting can promote teamwork,improve the ability of management,expression,self-confidence and active thinking(the Liszt score≥4.00),and they were willing to recommend PAL case repor-ting project to other trainees.③90%of the teaching supervisors believed that students should learn how to teach(Lister score:4.10±0.568),and most teaching supervisors believed that students could benefit from PAL case reporting(Lister score:4.00±0.471).Through PAL case reporting,teaching supervisors could easily understand students(Lister score:4.10±0.994),and establish a closer teacher-student relationship(Lister score:4.00±0.816).Conclusions PAL case reporting can improve the academic performance of the resident who participated in standardized training,enhance their comprehensive ability,and even has a positive impact on the residents career cognition and choice.PAL case report is also widely recognized by students and traditional teachers,and it is an effective supplement to the traditional teaching mode.