探讨集束化教学在重症医学科住院医师规范化培训中的应用效果

Application of the bundle method to improve the effect of critical care medicine training for residents

目的探讨集束化教学在重症医学科住院医师规范化培训(简称住培)中的应用效果。方法选取参加重症医学科住培的住院医师180人,随机分为观察组(90人)和对照组(90人)。观察组采用主题讲座、按查房清单进行查房、以问题为导向的教学相结合的集束化教学法;对照组采用传统教学法。培训结束后采用多元化临床能力考核和调查问卷对两种培训方法进行效果评估。结果题库考核成绩方面,两组比较差异无统计学意义(P>0.05);技能考核方面,观察组优于对照组,差异有统计学意义(P<0.05);在临床能力等12项内容方面,观察组均好于对照组,差异有统计学意义(P<0.05);在乐于帮助同事、尊重他人并有团队精神和遵纪守时、工作努力、行为端正、衣着整洁、符合职业要求等方面,观察组和对照组差异无统计学意义(P>0.05)。在住院医师对指导医师的评价中,3项内容观察组明显好于对照组,差异有统计学意义(P<0.05);其余7项两组之间差异无统计学意义(P>0.05)。结论在重症医学科实施集束化教学可行,有利于提高住培效果。

Objective To evaluate the application of the bundle method in critical care medicine standardized residency training.Methods 180 residents were randomly divided into the observation group(n=90)and the control group(n=90).The observation group received bundle process of theme lectures,checklist guiding ward rounds and problem-based medical record teaching during clinical case analysis,while the control group learned completely through the traditional teaching method.The residents>clinical competence was assessed by multiple scale mixed methods,including question bank examination(QBE),etc.And Likert-type scale questionnaire was used to evaluate the feedback of training residents.Results There was no significent difference between the two groups in the examination results of QBE(P>0.05).The observation group was better than the control group in skill examination with statistically significent difference(P<0.05).In the evaluation of residents by guiding physicians,the observation group performed better than the control group in 12 aspects such as clinical ability with statistically significent difference(P<0.05).There was no statistically significant difference between the observation group and the control group in the willingness to help colleagues,respectation,team spirits,discipline and punctuality,hard work,proper behavior,neat dress,and professional requirements.In the evaluation of tutors by residents,the observation group was much better than the control group in three items(P<0.05).And there were no significant differences in the other 7 evaluation items.Conclusion The bundle method can improve the training effects in critical care medicine standardized residency training.