高保真情景模拟教学在儿科住院医师规范化培训中的应用

Study on high-fidelity simulation based medical education in the clinical training for residents in pediatrics

目的 探讨高保真情景模拟教学在儿科住院医师规范化培训(简称住培)中的作用及意义。方法选重庆医科大学附属儿童医院2017级和2018级共两届儿科第一年住院医师共168名(每届84名)作为研究对象,随机分配为观察组和对照组,每届每组42人,观察组采用高保真模拟设备教学,对照组采用普通模型教学。采用评分法和迷你临述评估(mini-clinical evaluation exercise,Mini-CEX)对两组住院医师的总体表现和临床思维能力进行评估。培训结束时对两组的指导医师和住院医师发放问卷,进行满意度调查。结果 (1)两组住院医师在模拟教学之前评分无明显差异,模拟教学之后评分均有提高,但观察组评分提高程度明显高于对照组,差异有统计学意义(P<0.05)。(2)观察组Mini-CEX评分提高程度高于对照组,两组比较差异有统计学意义(P<0.05)。观察组住院医师在临床思维能力以及在问诊技巧、人文关怀和沟通技能上得到了显著的提升,对病患的诊疗更加有效。(3)住院医师在临床思维能力提高的满意度方面,观察组得分更高,差异有统计学意义(P<0.05)。结论 高保真情景模拟教学法有利于住院医师临床思维能力的培养,人文关怀和沟通技能提升更显著。

Objective To explore the role and significance of high-fidelity simulation based medical education in improving the clinical thinking ability of resident physicians in pediatrics.Methods A total of 168resident physicians(84 resident physicians for each grade),who in the first year of 2017 grade and 2018 grade in our hospital,were randomly divided into control group(n=42)and study group(n=42).The control group was taught with general model.The overall performance and clinical thinking ability of the two groups of resident physicians were evaluated by scoring method and Mini-CEX.At the end of the training,questionnaires were distributed to teachers and resident physicians in different groups,and a satisfaction survey was conducted.Results There was no significant difference in the scores of resident physicians between the two groups before simulation teaching,but the scores increased after simulation teaching.However,the improvement degree of the study group was significantly higher than the control group,and there was significant difference between the two groups(P<0.05).The improvement of Mini-CEX score in the study group was higher than the control group,and there was significant difference between the two groups(P<0.05).The resident physicians in the study group had signifcantly greater improvement in clinical thinking ability,consultation skills,humanistic care and communication skills,which was more effective for the diagnosis and treatment of patients.In terms of satisfaction with the improvement of clinical thinking ability,the score of the study group was higher,and there was significant difference between the two groups(P<0.05).Conclusion The high-fidelity simulation based medical education is more beneficial to the cultivation of clinical thinking ability of resident physicians,and the improvement of humanistic care and communication skills of resident physicians is more significant.