原位模拟教学对医学生状态焦虑及临床胜任力影响的研究

Study on influence of in situ simulation teaching on state anxiety and clinical competence of medical students

目的探讨原位模拟教学对医学生状态焦虑及临床胜任力的影响,以及状态焦虑与临床胜任力的相关性。方法选择蚌埠医科大学2024届临床医学专业24名实习医生作为研究对象,分组培训,每组2人,共进行2轮24次创伤相关原位模拟教学。记录培训中学生操作技能直接评估量表(direct observation of procedural skills,DOPS)、创伤非技术技能量表(Trauma-Nontechnical Skills,T-NOTECHS)得分,以及每次培训结束后学生状态焦虑量表(state-anxiety inventory,S-AI)得分,比较第1轮和第2轮培训学生得分情况,并进行相关性分析。所有培训结束后,收集模拟培训调查问卷,用于评价教学效果。结果第2轮培训学生DOPS、T-NOTECHS得分高于第1轮培训,差异有统计学意义(P<0.05);第2轮培训学生S-AI得分低于第1轮培训,差异有统计学意义(P<0.05);第1轮培训DOPS、T-NOTECHS得分与S-AI得分成显著负相关,相关系数分别为(r=-0.813,P=0.001)和(r=-0.767,P=0.004),DOPS得分与T-NOTECHS得分成显著正相关,相关系数为(r=0.691,P=0.013);第2轮培训DOPS、T-NOTECHS得分与S-AI得分成显著负相关,相关系数分别为(r=-0.818,P=0.001)和(r=-0.780,P=0.003),DOPS得分与T-NOTECHS得分无显著相关,相关系数为(r=0.566,P=0.055);模拟培训调查问卷有10个问题(90.9%)均值大于3分,8个问题(72.7%)均值大于4分。结论原位模拟教学可以提高学生的技术及非技术技能,降低学生的状态焦虑,教学效果良好。同时状态焦虑会损害学生临床胜任力,有必要为学生提供压力管理的心理技能培训。

Objective To explore the effect of in situ simulation teaching on medical students'state anxiety and clinical competence,and the correlation between state anxiety and clinical competence.Methods A total of 24 interns of Grade 2024 majoring in clinical medicine from Bengbu Medical University,those participated clinical practice in our hospital were selected as the research objects and trained in small groups,two in each group,to conduct 2 rounds and 24 times of trauma-related in situ simulation teaching.The scores of students'direct observation of procedural skills(DOPS)and Trauma-Nontechnical Skills(T-NOTECHS),and the scores of students'state-anxiety inventory(S-AI)after each training were recorded.The scores of students in the first and second training rounds were compared,and the correlation analysis was conducted.After all training,the simulated training questionnaire was collected to evaluate the teaching effect.Results The scores of DOPS and T-NOTECHS of the second round of training were higher than those of the first round,and the difference was statistically significant(P<0.05).The S-AI score of the students in the second round of training was lower than that in the first round,and the difference was statistically significant(P<0.05).DOPS and T-NOTECHS scores were significantly negatively correlated with S-AI scores in the first round of training,the correlation coefficient were(r=-0.813,P=0.001)and(r=-0.767,P=0.004),respectively.There was a significant positive correlation between DOPS and T-NOTECHS scores and S-AI score in the first round of training(r=0.691,P=0.013).DOPS and T-NOTECHS scores were significantly negatively correlated with S-AI scores in the second round of training(r=-0.818,P=0.001;r=-0.780,P=0.003).DOPS scores were not significantly correlated with T-NOTECHS scores,and the correlation coefficient was(r=0.566,P=0.055).There were 10 questions(90.9%)with a mean value greater than 3 points,and 8 questions(72.7%)with a mean value greater than 4 points.Conclusions In situ simulation teaching can improve students'technical and non-technical skills,reduce students'state anxiety and achieve good teaching effect.At the same time,state anxiety may damage the clinical competence of students,so it is necessary to provide students with psychological skills training for stress management.