提高重症医学教学查房满意度的教学模式

Survey of ICU teaching rounds:secrets to improve learner satisfaction

目的观察不同教学模式及其引起的学员情绪负荷与教学满意度之间的关系,以求找到教学效果最大满意化的教学模式。方法通过对入组受试者发放问卷,包括住培医师、进修医师和医学研究生等进行调查,记录受试者一般情况,并要求其记录在查房过程中体验感最强、最希望加强的教学模式,应用Likert量表对每个项目进行评分。同时,记录查房过程中受试者情绪的变化,并用Russel情感模型进行描述,明确不同教学模式及其引起的情绪负荷对查房满意度的影响。结果本研究共收到82名受试者的195份问卷。查房者最常应用的教学模式为基于病理生理学的病情分析和决策制定、基于问题的讨论和反馈、基于临床经验的病情分析和决策制定,占比分别为87.18%、61.54%、55.90%。基于问题的讨论和反馈、基于演讲技巧的病情分析和决策制定、基于循证医学的病情分析和决策制定的频次和程度与受试者对查房的满意度呈显著正相关(r=0.210,P=0.003;r=0.185,P=0.010;r=0.166,P=0.020)。受试者期望加强的教学模式为基于问题的讨论和反馈、基于临床经验的病情分析和决策制定、基于病理生理学的病情分析和决策制定、基于演讲技巧的病情分析和决策制定,占比分别为37.44%、35.38%、27.18%、27.18%。查房时受试者情绪负荷与满意度之间的关系显示,受试者是否感到兴奋与查房满意度呈显著正相关(r=0.244,P=0.001)。结论重症医学的教学查房需要通过不同教学模式进行,基于问题的讨论和反馈、基于演讲技巧的病情分析和决策制定、基于循证医学的病情分析和决策制定可以显著提高受试者对查房的满意度。在查房过程中,学员感受到兴奋的情绪可能提高其满意度。

Objective To examine the different teaching patterns and learners'emotion load to achieve learners satisfaction on rounds.Methods Wenjuanxing was used to recruit participants,including residents,visiting doctors,medical postgraduate students.Baseline characteristics of learners were recorded,and learners were asked to share the top three experiences and emotions during the rounding episode,as well as the expectations of further improvement,and responding to each item using a Likert scale.Learners'emotion during rounding were recorded by Russel model,the relationship between teaching patterns and learners'emotion load to achieve learners,satisfaction on rounds was observed.Results A total of 195 questionnaires were collected from 82 subjects.The most common teaching models used by ward rounds were pathophysiology-based disease analysis and decision making,problem-based discussion and feedback,and clinical experience-based disease analysis and decision making,accounting for 87.18%,61.54%,55.90%,respectively.The frequency and degree of problem-based discussion and feedback,condition analysis and decision making based on presentation skills,and condition analysis and decision making based on evidence-based medicine were significantly positively correlated with the subjects'satisfaction with ward rounds(r=0.210,P=0.003;r=0.185,P=0.010;r=0.166,P=0.020).The subjects expected to strengthen discussion and feedback based on problems,analysis and decision making based on clinical experience,pathophysiology-based disease analysis and decision making,condition analysis and decision making based on presentation skills,the proportions were 37.44%,35.38%,27.18%,27.18%,respectively.The relationship between emotional load and satisfaction during ward rounds showed that whether the subjects felt excited was positively correlated with satisfaction during ward rounds(r=0.244,P=0.001).Conclusions Different teaching patterns should be performed in ICU teaching rounds.Problem-based discussion and feedback,interesting and storytelling presentation,evidence-based medicine may significantly improve the learners'satisfaction with emotion of excited.