重症超声和血流动力学PDCA模式培训对提升内科住院医师临床决策能力的影响

Effect of PDCA style training of severe ultrasound and hemodynamics on improving clinical decision-making ability of internal medicine residents

目的探讨重症超声和血流动力学PDCA[计划(plan)、实施(do)、检查(check)、处理(action)]模式培训在内科专业住院医师规范化培训(住培)中对住院医师临床决策能力提升的实施效果.方法采用回顾性研究方法.选择2017年7月至2023年7月在信阳市中心医院重症医学科轮转的60名内科专业住院医师作为研究对象,并按随机方法分为试验组和对照组,每组30名.试验组在常规入科教育后,采用重症超声和血流动力学PDCA模式培训;对照组采用《内科住院医师规范化培训内容与标准》中重症医学科培养目标与要求实施培训,培训时间均为2个月.在培训期结束后分别对两组住院医师进行考核和问卷调查,比较两组理论知识考核、临床实践技能考核、病例考核成绩和满意度的差异.结果试验组理论知识考核成绩、诊断与鉴别诊断考核成绩、临床决策考核成绩均明显高于对照组[理论知识考核成绩(分):90.5±2.7比85.7±3.8,诊断与鉴别诊断考核成绩(分):92.0±2.4比87.9±3.7,临床决策考核成绩(分):90.3±3.1比85.5±3.9,均P<0.05],教学方式、激发学习兴趣、牢固掌握知识、增强解决问题的能力、提高学习积极性、提高临床思维能力、增强团队意识的满意度亦均明显高于对照组[教学方式:80.0%(24/30)比46.7%(14/30),激发学习兴趣:83.3%(25/30)比56.7%(17/30),牢固掌握知识:80.0%(24/30)比40.0%(12/30),增强解决问题的能力:70.0%(21/30)比43.3%(13/30),提高学习积极性:83.3%(25/30)比50.0%(15/30),提高临床思维能力:60.0%(18/30)比40.0%(12/30),增强团队意识:73.3%(22/30)比46.7%(14/30),均P<0.05].结论应用重症超声和血流动力学PDCA模式培训,能使内科专业住院医师在重症医学科轮转中更快更好地掌握重症基本理论及基本技能,更有利于提升内科专业住院医师临床决策能力.

Objective To explore the implementation effect of PDCA(plan-do-check-action)style training of severe ultrasound and hemodynamics in standardized training(residential training)for residents majoring in internal medicine on improving their clinical decision-making ability.Methods A retrospective research method was conducted,60 residents in Xinyang Central Hospital from July 2017 to July 2023 were selected as the research objects,and patients were randomly divided into experimental group and control group,with 30 residents in each group.After the routine entrance education,the experimental group applied the PDCA mode training of severe ultrasound and hemodynamics.The control group was trained with the training objectives and requirements of the department of critical care medicine in the contents and standards of standardized training for internal medicine residents for 2 months.At the end of the training period,the residents of the two groups were assessed and investigated by questionnaire,and the differences of theoretical knowledge assessment,clinical practice skills assessment,case assessment scores and satisfaction between the two groups were compared.Results The results of theoretical knowledge examination,diagnosis and differential diagnosis,and clinical decision-making in the experimental group were significantly higher than those in the control group(theoretical knowledge examination score:90.5±2.7 vs.85.7±3.8,diagnosis and differential diagnosis score:92.0±2.4 vs.87.9±3.7,clinical decision-making score:90.3±3.1 vs.85.5±3.9,all P<0.05),satisfaction with teaching methods,stimulating learning interest,firmly mastering knowledge,enhancing problem-solving ability,improving learning enthusiasm,improving clinical thinking ability and enhancing team consciousness was also significantly higher than that of the control group[teaching methods:80.0%(24/30)vs.46.7%(14/30),stimulate learning interest:83.3%(25/30)vs.56.7%(17/30),firmly mastering knowledge:80.0%(24/30)vs.40.0%(12/30),enhance problem-solving ability:70.0%(21/30)vs.43.3%(13/30),improving learning enthusiasm:83.3%(25/30)vs.50.0%(15/30),improving clinical thinking ability:60.0%(18/30)vs.40.0%(12/30),enhancing team consciousness:73.3%(22/30)vs.46.7%(14/30),all P<0.05].Conclusion The application of PDCA-style training of severe ultrasound and hemodynamics can help internal medicine residents master the basic theory and skills of severe diseases faster and better in the rotation of critical medicine departments,which is more conducive to improving the clinical decision-making ability of internal medicine residents.