“动物病人”在内科学临床基础技能培训中的实践探索

Practical exploration of"animal patients"in basic clinical skills training in internal medicine

目的探讨“动物病人”在内科学临床基础技能培训中的应用价值。方法选取2019年1—12月于广州医科大学附属第二医院已完成诊断学临床基础技能培训并进入临床实践的46名医学生作为研究对象,采用新西兰兔构建“动物病人”,每4名医学生为一组,分为12组,每组1名“动物病人”,采用互动式病例讨论等方式完成病例介绍,进行相关体格检查,并开展后续“动物病人”培训。采用问卷调查医学生对临床基础技能实践机会评价、医学生对“动物病人”培训必要性的评价。结果医学生对内科学临床操作技能培训满意占比37.0%、基本满意占比34.7%、不满意占比28.3%、非常不满意占比0.00%;影响内科学临床操作技能培训效果的主要原因自身专业不足占比10.9%、带教教师水平不足占比6.5%、带教师资不重视占比15.2%、临床实践机会不足占比56.5%、其他占比10.9%。医学生普遍对临床基础技能实践机会不足或严重不足,其中腹腔穿刺术、胸腔穿刺术、腰椎穿刺、动脉穿刺取血及导尿术实践机会不足、严重不足的比例均>55%。医学生对“动物病人”培训的总体满意度为95.6%、对教师满意度为95.7%;针对是否有必要在临床实际操作前采用“动物病人”培训,在腹腔穿刺术、血糖检测、动脉取血和导尿术四项技能中,选择有必要占比分别为91.3%、78.3%、93.5%和82.6%;全部医学生均表示能从“动物病人”临床技能培训中获益。在最大获益方面,41.3%选择有助于发现操作中的问题,39.1%选择有助于熟练操作,其他人员依次选择有助于培训临床思维和树立操作信心。培训设施不完善和学生参与程度不足是医学生认为本次培训的主要不足之处。结论“动物病人”培训作为现有技能培训与真实临床实践的桥梁,为医学生提供分层递进式技能操作培训,有利于提高医学生的实际临床技能操作水平,推动内科学临床基础技能教学改革,具有研究和推广价值。

Objective To explore the application value of"animal patients"on clinical basic skills training in Internal Medicine.Methods 46 medical students who had completed the basic clinical skills training in diagnostics and entered clinical practice at the Second Hospital of Guang-zhou Medical University from January to December 2019 were selected as the study subjects,New Zealand rabbits were used to construct"animal patients",and every four medical students were divided into 12 groups,with one"animal patient"in each group,interactive case discussions were used to complete case presentations,relevant physical examinations,and follow-ups."Animal patient"training.A questionnaire was used to assess the medical students'evaluation of the opportunity to practice basic clinical skills and their evaluation of the need for"animal patient"training.Results Medical students were satisfied with clinical operation skills training in internal medicine 37.0%,basically satisfied 34.7%,dissatisfied 28.3%,and very dissatisfied 0.00%;the main reasons affecting the effect of clinical operation skills training in internal medicine were insufficient of their own specialties 10.9%,insufficient level of the leading teachers 6.5%,lack of attention of the leading teachers'qualifications 15.2%,and insuffi-cient opportunities for clinical practice 56.5%,others accounted for 10.9%.Medical students in general medical students on the basic clinical skills practice opportunities practice opportunities are insufficient or seriously insufficient,of which laparotomy,thoracentesis,lumbar puncture,arterial puncture blood and catheterization practice opportunities were insufficient,seriously insufficient proportion were>55%.The overall satisfaction rate of medical students with the training of"animal patients"was 95.6%,and the satisfaction rate of teachers was 95.7%.Regarding whether it was nec-essary to use the training of"animal patients"before clinical practice,91.3%of the medical students chose"animal patients"as necessary for four clinical skills,namely,laparotomy,blood glucose testing,arterial blood sampling and catheterization,and 82.6%chosed"animal patients"as neces-sary.Regarding whether it was necessary to use"animal patient"training before clinical operation,the percentages of those who chose"necessary"in the four skills of laparotomy,blood glucose testing,arterial blood sampling and urinary catheterization were 91.3%,78.3%,93.5%and 82.6%,respec-tively;and all the medical students indicated that they could benefit from"animal patient"training in clinical skills.In terms of the greatest benefit,41.3%chosed that it would help identify problems in operation,39.1%chosed that it would help them to become proficient in operation,and the oth-ers chosed that it would help them to train clinical thinking and build up their confidence in operation,in that order.Inadequate training facilities and lack of student participation were the main shortcomings of the training as perceived by the medical students.Conclusion As a bridge between the existing skills training and real clinical practice,the"animal patient"training provides medical students with hierarchical progressive skills training,which is conducive to improving the actual clinical skills of medical students and promoting the reform of the teaching of basic clinical skills in inter-nal medicine,and has the value of further research and promotion.