新型冠状病毒感染疫情对神经内科住院医师规范化培训的影响

The impact of COVID-19 on the standardized training of neurology residents

目的评价新型冠状病毒感染(简称新冠)疫情对以胜任力为导向的神经内科住院医师规范化培训效果的影响。方法纳入2020-2023年间在北京大学第三医院神经内科完成或正在进行住院医师规范化培训的学员,给予问卷调查,获取目前模式下规范化培训的效果评价,评价内容主要为获益较大和最不满意教学方式、知识获取形式和内容、临床技能和人文素质,并采用X^(2)检验或确切概率法与2016-2020年的数据进行对比,评价新冠疫情对培训效果产生的影响。结果本研究共纳入25名住院医师,培训总体的满意度为96%(24/25),与新冠疫情前(85%)对比,差异无统计学意义(P>0.05)。在带教方式方面,新冠疫情后认为以“学生为主体”的病例导入学习获益较大的比例显著降低(32%vs 90%,X^(2)=23.665,P<0.001),同时不满意教师带教意识薄弱的比例显著降低(48%vs 75%,X^(2)=4.905,P=0.027)。在知识获取形式和内容方面,选择神经影像学、内科基础知识和医学人文和伦理知识的比例显著降低(56%vs 83%,32%vs 70%,12%vs 45%;X^(2)=5.396.8.990.7.661,P=0.020.0.003.0.007),而需要临床流行病学和统计培训的比例显著升高(56%vs 25%,X^(2)=6.348,P=0.012)。在临床技能方面,需要提高的技能操作选择腰椎穿刺、神经系统查体和病史采集的比例显著降低(4%vs 45%。16%vs 55%,36%vs 70%,X^(2)=12.502.9.750.7.253,P<0.001.=0.002.=0.007),而选择肌电图和脑电图的结果判读的比例显著升高(96%vs 38%.2-21.938,P<0.001)。获取知识的途径方面也产生了一定的变化,使用中国知网或万方数据库及百度或谷歌学术的人数显著减少(32%vs 63%,4%vs 45%,X^(2)=5.726.12.502;P=0.017.<0.001)。新冠疫情前后人文素质方面无明显变化。结论新冠疫情后神经内科进行住院医师规范化培训的学员对于专业知识和临床技能培训需求的侧重点发生了变化,这对以胜任力为导向的培训有--定的指导作用。

Objective To evaluate the effect of coronavirus disease 2019(COVID-19)on the competency-oriented training effect of neurology residents.Methods Clinicians who completed or are undergoing standardized residency training in the Department of Neurology of Peking University Third Hospital from 2020 to 2023 were included in a questionnaire survey to obtain the effect evaluation of standardized training under the current model,and compared with the data from 2016 to 2020 by x test or exact probability to evaluate whether COVID-19 had an impact on the training effect.The evaluation content mainly includes the most beneficial and the most unsatisfactory teaching methods,the form and content of knowledge acquisition,clinical skills and humanistic quality.ResultsA total of 25 residents were included in this study,and the overall satisfaction rate of training was 96%(24/25),which was not statistically diferent from that before COVID-19(85%).In terms of teaching methods,the proportion of cases that believed that"students as the main body"benefited greatly from learning decreased significantly(32%vs 90%,X^(2)=23.665,P<0.001),while the proportion of dissatisfied with"weak teacherss awareness of teaching"decreased significantly(48%vs 75%,x^(2)=4.905,P=0.027).In terms of the form of knowledge acquisition and content evaluation,the proportion of"neuroimaging","basic knowledge of internal medicine",and"knowledge of medical humanities and ethics"decreased significantly(56%vs 83%,32%vs 70%,12%vs 45%;X^(2)=5.396,8.990,7.661;P=0.020,0.003,0.007),while the proportion of"clinical epidemiology and statistics"increased significantly(56%vs 25%,X=6.348,P=0.012).In terms of clinical skills,the proportion of candidates for lumbar puncture,neurological examination,and medical history collection decreased significantly(4%vs 45%,16%vs 55%,36%vs 70%;X^(2)=12.502,9.750,7.253;P<0.001,=0.002,=0.007),while the proportion of candidates for"interpretation of results of electromyography and electroencephalogram”increased significantly(96%vs 38%,X^(2)=21.938,P<0.001).Access to knowledge has also changed.The number of people using CNKI or Wanfang Database and Baidu or Google Scholar has decreased significantly(32%vs 63%,4%vs 45%;x^(2)=5.726,12.502;P=0.017,<0.001).There was no significant change in human quality before and after COVID-19.Conclusion After COVID-19,the focus of neurology residents for specialized knowledge and skills training has changed,which has a certain guiding effect on competency-oriented training.