以住院医师为主导的临床查房的实践与探索

Construction and practice of clinical rounds centered on resident doctors

目的探索以住院医师为主导的临床查房的建设及其教学效果。方法选取2022年1月—2023年4月在中山大学附属第一医院康复医学科参加住院医师规范化培训的一、二、三年级住院医师22人为研究对象,构建以住院医师为主导的临床查房,每位住院医师均参加3次该模式的临床查房培训。每次以住院医师为主导的临床查房培训结束时,指导医师采用Mini-CEX量表评估每名住院医师的诊疗综合能力,并进行对比分析。完成3次以住院医师为主导的临床查房培训后,向22名住院医师发放满意度调查问卷以评估教学效果。结果经过3次以住院医师为主导的临床查房培训后,22名住院医师在病史采集、体格检查、专业素养、临床判断、医患交流、组织效能,以及整体能力7个方面得分均较参加该模式临床查房前更高,且每次得分均高于前1次,差异具有统计学意义(P<0.05)。满意度调查结果显示,22名住院医师在完善知识结构、强化接诊能力、提高沟通能力、增强诊疗思维能力、提升专业素养、激发学习兴趣、增强进行诊疗工作的信心,以及提高领导能力等8个方面的满意度均为100%。结论开展以住院医师为主导的临床查房,可提高住院医师的职业素养和领导能力,进一步保障医疗质量,教学成果显著,适合在住院医师规范化培训的教学实践中推广应用。

Objective This study aimed to explore the construction of clinical rounds centered on resident doctors and evaluate its teaching effectiveness.Methods A total of 22 resident doctors in grades one to three who received standardized training in the Department of Rehabilitation Medicine at the First Affiliated Hospital of Sun Yat-sen University from January 2022 to April 2023 were selected as research subjects.Clinical rounds centered on resident doctors were constructed,and each resident doctor participated in this mode of clinical rounds three times.At the end of each round,the attending physician used the Mini-CEX scale to evaluate the comprehensive diagnosis and treatment ability of each resident doctor,and comparative analysis was conducted.After completing three clinical rounds centered on resident doctors,satisfaction survey questionnaires were issued to the 22 resident doctors to evaluate the teaching effect.Results After three clinical rounds centered on resident doctors,the scores of the 22resident doctors in our department in seven aspects,including medical history collection,physical examination skills,professional quality,clinical judgment,communication skills,organizational efficiency and clinical comprehensive ability,were higher than their performance before participating in this mode of clinical rounds,and higher than their performance in the previous round.The differences were statistically significant(P<0.05).The satisfaction survey results showed that the satisfaction of resident doctors in eight aspects,including improving knowledge structure,strengthening reception ability,improving communication ability,enhancing diagnosis and treatment thinking ability,enhancing professional quality,stimulating learning interest,enhancing confidence in diagnosis and treatment work,and improving leadership ability,was 100%.Conclusion Conducting clinical rounds centered on resident doctors can improve their professional quality and leadership ability,further guarantee medical quality,achieve significant teaching results,and is suitable for promotion and application in the standardized training of resident physicians.