“贯穿临床诊疗流程”的并轨研究生临床思维课程构建与评价

Construction and evaluation of clinical-thinking patterned curriculum for parallel graduate students with"running through clinical diagnosis and treatment process"

目的探索“贯穿临床诊疗流程”的并轨研究生临床思维课程构建与实施效果。方法本研究选取山西省人民医院2016级、2017级94名临床医学专业学位研究生作为研究对象。将2017级48名并轨研究生作为试验组,采用“贯穿临床诊疗流程”的临床思维课程,除参加学位课程、住培基地课程外,引入提升临床思维能力的系列课程内容;2016级46名并轨研究生作为对照组,采用传统课程内容,仅参加学位课程、住培基地课程。两组分别采用t检验、卡方检验及重复测量方差分析的方法,比较不同课程下两组学生迷你临床演练评估(mini-clinical evaluation exercise,Mini-CEX)评分、临床操作技能评估(direct observation of procedural skills,DOPS)评分、客观结构化临床技能考试(objective structured clinical examination,OSCE)成绩及学生满意度的差异性。结果试验组在MiniCEX评分中,除人文关怀外,其他方面平均得分均高于对照组;且沟通技能得分明显高于对照组[(6.55±0.98)vs.(5.77±1.12)],差异有统计学意义(t=3.62,P<0.001)。试验组在DOPS评分中,除与病人沟通的技巧、是否顾及病人感受并具有职业素养外,其他方面平均得分均高于对照组;且临床技能的实际操作能力得分明显高于对照组[(6.38±1.38)vs.(5.53±1.23)],差异有统计学意义(t=3.12,P=0.002)。在门诊接诊站、急诊处理站、临床思维站①、临床思维站②、专科技能站、辅助检查站、病例书写站方面,试验组不同阶段客观结构化考试各站点成绩均高于对照组;且在临床思维站①方面,实验组得分明显高于对照组,差异有统计学意义(F=6.51,P=0.012)。试验组对课程方面满意率,除有助于未来职业发展项外,其他项目满意率均高于对照组;且在提高逻辑思维能力方面,试验组得分明显高于对照组,差异有统计学意义(χ^(2)=19.18,P<0.001)。结论“贯穿临床诊疗流程”的临床思维课程能增强并轨研究生的临床实践能力,使其尽快达到住院医师标准,有效促进并轨研究生培养质量。

Objective To explore the construction and implementation effect of clinical-thinking patterned curriculum for parallel graduate students with"running through clinical diagnosis and treatment process."Methods In this study,94 Batch 2016-2017 graduate students with clinical medical professional degree in Shanxi Provincial People's Hospital were selected as the research subjects.Among them,48 Batch 2017 parallel graduate students were selected as the experimental group.The curriculum of clinical-thinking patterned training of"running through the clinical diagnosis and treatment process"was used.In addition to participating in the degree courses and residency courses,a series of training to improve the clinical-thinking ability were introduced.And 46 Batch 2016 parallel graduate students were divided in the control group,using a traditional curriculum and only participating in degree courses and residency courses.The differences among mini-clinical evaluation exercise(Mini-CEX)scores,direct observation of procedural skills(DOPS)scores,objective structured clinical examination(OSCE)scores and students'satisfaction were compared by t test,chi-square test and repeated measures analysis of variance.Results The Mini-CEX scores showed the average scores of other aspects except humanistic care were higher than those of the control group,and the score of communication skills was significantly higher than that of the control group[(6.55±0.98)vs.(5.77±1.12)],with significant differences(t=3.62,P<0.001).In the DOPS scores,except for the skills of communication with patients,ability to consider patient's feelings and practice of occupational literacy,the average scores of other aspects of the experimental group were higher than those of the control group,and the real operation-ability score of clinical skills was significantly higher than that of the control group[(6.38±1.38)vs.(5.53±1.23)],with a significant difference(t=3.12,P=0.002).In terms of the outpatient receiving station,the emergency treatment station,the clinical thinking station①,the clinical thinking station②,the specialist skill station,the auxiliary examination station and the case writing station,their OSCE scores at different stages in the experimental group were higher than those in the control group,and in terms of clinical thinking station①,the score of the experimental group was significantly higher than that of the control group,with a significant difference(F=6.51,P=0.012).The satisfaction rate of the experimental group in terms of curriculum was higher than that in the control group except for the future career development,and in improving logical-thinking ability,the score of the experimental group was significantly higher than that of the control group,with a significant difference(χ^(2)=19.18,P<0.001).Conclusion The curriculum of clinicalthinking ability with"running through the clinical diagnosis and treatment process"can enhance the clinical practical ability of parallel graduate students,making them meet the residential academic standards as soon as possible and effectively promoting the training quality of the students.