Assessing the Levels of Clinical Reasoning Skills Using Self-Assessment of Clinical Reflection and Reasoning in Undergraduate Nursing Students: A Descriptive Comparative Study

Background: Clinical reasoning is a critical cognitive skill that enables undergraduate nursing students to make clinically sound decisions. A lapse in clinical reasoning can result in unintended harm to patients. The aim of the study was to assess and compare the levels of clinical reasoning skills between third year and fourth year undergraduate nursing students. Methods: The study utilized a descriptive comparative research design, based on the positivism paradigm. 410 undergraduate nursing students were systematically sampled and recruited into the study. The researchers used the Self-Assessment of Clinical Reflection and Reasoning questionnaire to collect data on clinical reasoning skills from third- and fourth-year nursing students while adhering to ethical principles of human dignity. Descriptive statistics were done to analyse the level of clinical reasoning and an independent sample t-test was performed to compare the clinical reasoning skills of the student. A p value of 0.05 was accepted. Results: The results of the study revealed that the mean clinical reasoning scores of the undergraduate nursing students were knowledge/theory application (M = 3.84;SD = 1.04);decision-making based on experience and evidence (M = 4.09;SD = 1.01);dealing with uncertainty (M = 3.93;SD = 0.87);reflection and reasoning (M = 3.77;SD = 3.88). The mean difference in clinical reasoning skills between third- and fourth-year undergraduate nursing students was not significantly different from an independent sample t-test scores (t = −1.08;p = 0.28);(t = −0.29;p = 0.73);(t = 1.19;p = 0.24);(t = −0.57;p = 0.57). Since the p-value is >0.05, the null hypothesis (H0) “there is no significantno significant difference in clinical reasoning between third year and fourth year undergraduate nursing students”, was accepted. Conclusion: This study has shown that the level of clinical reasoning skills of the undergraduate nursing students was moderate to low. This meant that the teaching methods have not been effective to improve the students clinical reasoning skills. Therefore, the training institutions should revise their curriculum by incorporating new teaching methods like simulation to enhance students’ clinical reasoning skills. In conclusion, evaluating clinical reasoning skills is crucial for addressing healthcare issues, validating teaching methods, and fostering continuous improvement in nursing education.

Exploring the Application Effect of Flipped Classroom Combined with Problem-Based Learning Teaching Method in Clinical Skills Teaching of Standardized Training for Resident Doctors of Traditional Chinese Medicine

Objective: To explore the application effect of flipped classroom combined with problem-based learning teaching method in clinical skills teaching of standardized training for resident doctors of traditional Chinese Medicine. Methods: The study used the experimental control method. The study lasted from September to November 2022. The subjects of this study were 49 students of standardized training for resident doctors of traditional Chinese Medicine from grades 2020, 2021 and 2022 of Dazhou integrated TCM & Western Medicine Hospital. They were randomly divided into experiment group (25) and control group (24). The experiment group adopted flipped classroom combined with problem-based learning teaching method, and the control group adopted traditional teaching method. The teaching content was 4 basic clinical skill projects, including four diagnoses of traditional Chinese Medicine, cardiopulmonary resuscitation, dressing change procedure, acupuncture and massage. The evaluation method was carried out by comparing the students’ performance and a self-designed questionnaire was used to investigate the students’ evaluation of the teaching method. Results: The test scores of total scores in the experimental group (90.12 ± 5.89) were all higher than those in the control group (81.47 ± 7.96) (t = 4.53, P P Conclusions: The teaching process of the flipped classroom combined with problem-based learning teaching method is conducive to improving the efficiency of classroom teaching, cultivating students’ self-learning ability, and enhancing students’ willingness to learn.

Medical simulation-based education improves medicos' clinical skills

Clinical skill is an essential part of clinical medicine and plays quite an important role in bridging medicos and physicians. Due to the realities in China, traditional medical education is facing many challenges. There are few opportunities for students to practice their clinical skills and their dexterities are generally at a low level. Medical simulation-based education is a new teaching modality and helps to improve medicos＇ clinical skills to a large degree. Medical simulation-based education has many significant advantages and will be further developed and applied.

Estimating pressure gradients by auscultation:How technology(echocardiography)can help improve clinical skills

AIM To extend our previously-published experience in estimating pressure gradients(PG) via physical examination in a large patient cohort. METHODS From January 1, 1997 through December 31, 2009, an attending pediatric cardiologist compared clinical examination(EXAM) with Doppler-echo(ECHO), in 1193 patients with pulmonic stenosis(PS, including tetralogy of Fallot), aortic stenosis(AS), and ventricular septal defect(VSD). EXAM PG estimates were based primarily on a murmur's pitch, grade, and length. ECHO peak instantaneous PG was derived from the modified Bernoulli equation. Patients were 0-38.4 years old(median 4.8).RESULTS For all patients, EXAM correlated highly with ECHO: ECHO = 0.99(EXAM) + 3.2 mm Hg; r = +0.89; P < 0.0001. Agreement was excellent(mean difference =-2.9 ± 16.1 mm Hg). In 78% of all patients, agreement between EXAM and ECHO was within 15 mm Hg and within 5 mm Hg in 45%. Clinical estimates of PS PG were more accurate than of AS and VSD. A palpable precordial thrill and increasing loudness of the murmur predicted highergradients(P < 0.0001). Weight did not influence accuracy. A learning curve was evident, such that the most recent quartile of patients showed ECHO = 1.01(EXAM) + 1.9, r = +0.92, P < 0.0001; during this time, the attending pediatric cardiologist had been > 10 years in practice.CONCLUSION Clinical examination can accurately estimate PG in PS, AS, or VSD. Continual correlation of clinical findings with echocardiography can lead to highly accurate diagnostic skills.

The New Clinical Skills Training Module for the Master's Degree in Ophthalmology

This article aims at the principle problems noticed in the process of training postgraduates in ophthalmology for clinical skills (POCs). Alteration of the training objectives and training curricula,.as well as the clinical department training plans,.will allow POCs to obtain a systematic and standardized education to establish their general attitude toward medical life and career plans. This will help to improve their clinical skills and establish professional ethics that will protect the interests of patients and promote the healthy and harmonious development of the Eye Hospital. Furthermore, the Ophthalmology Center could cultivate a number of outstanding postgraduate students that match its tier, to describe the quality of the training for the master's degree in Ophthalmology.

5A教学模式在普通外科住院医师规范化培训中的应用

目的探讨5A教学模式在普通外科住院医师规范化培训中的应用效果。方法采用随机对照研究方法,以2020年1月至2022年12月在解放军总医院第一医学中心普通外科医学部接受住院医师规范化培训并进入本研究团队主诊组轮转学习的学员为研究对象,随机分为试验组和对照组。试验组20名,采用5A教学模式;对照组20名,采用传统教学模式。对2组学员进行理论考核、临床技能考核和综合能力考核,记录考核成绩,并比较2组的教学效果。结果相对于对照组,试验组学员在消毒铺巾、切开缝合和腔镜技能考核3个方面的成绩得到提高,差异有统计学意义(P<0.05);试验组学员在团队协作和科学研究2个方面的成绩高于对照组,差异有统计学意义(P<0.05);试验组学员带教满意度高于对照组,差异有统计学意义(P<0.05)。结论5A教学模式可以显著提高学员的临床实践操作、团队协作和科学研究能力,可作为普通外科住院医师规范化培训的有效教学方法。

基于OSCE考试成绩的临床基本技能教学同质化分析

目的:查找和改进临床医学专业学生临床实践教学中的薄弱环节,提高实践教学质量。方法:以沈阳某医学院校在12个实践教学基地实习的2016级临床医学专业参加毕业技能考试的291名实习学生作为研究对象,采用单因素方差分析和Kruskal-Wallis检验分析其客观结构化临床考试(objective structured clinical examination,OSCE)的临床基本技能成绩。结果:在标准化病人问诊及查体成绩中,H实践教学基地的及格率和平均分均最低,其实习学生的平均分与A、B、F、G、K、L实践教学基地实习学生比较差异有统计学意义(P<0.01)。在技能操作成绩中,H实践教学基地及格率和平均分最低,其实习学生的平均分与A、D、E、F、G、I、J、K实践教学基地实习学生比较差异有统计学意义(P<0.01)。在辅助检查结果判读成绩中,H实践教学基地及格率和平均分最低,A、H基地实习学生的平均分与B、J基地实习学生的平均分比较差异有统计学意义(P<0.01)。结论:不同实践教学基地的学生实习效果存在较大差异,医学院校要加强对实践教学基地的管理,确保临床实践教学质量同质化。

The Effect of Simulation-Based Training on Nursing Students’ Communication Skill, Self-Efficacy and Clinical Competence for Nursing Practice

Background: Simulation-based training is a new strategy in teaching that gives the students good opportunities to learn and apply what they learn in nursing care safely. Aim: This study conducted to evaluate the effects of simulation-based training on nursing students’ communication skill, self-efficacy and clinical competence in practice. Subjects and Methods: Quiz-experimental design was used in this study (pre-posttest intervention), it was carried out on 100 nursing students first semester in 2019 using low and high-fidelity simulators. This study was carried out at College of Applied Medical Sciences-Bshia University. Data Collection: demographic data, communication skill, self-efficacy and clinical competence questionnaires. Analysis is done by SPSS version 20 software. Results: Participants who received the simulation-based training, showed statistical significant improvement in communication skill, self-efficacy, and clinical competence scores after participation in the simulation program (t = &#8722;32.64, p = 0.001;t = &#8722;19.9, p = 0.001;16.4, p = 0.001). Also, there are significant relation between gender and clinical competency (t = 2.768, p Conclusion: Simulation-based training in medical courses is effective in enhancing communication skill, self-efficacy and clinical competence. Multiple-patient simulations as a teaching-learning strategy in the nursing curriculum are highly recommended.

“新医科”背景下“临床技能学”混合式教学改革探索

为适应新时代创新型、综合化的“新医科”建设要求,“临床技能学”作为医学本科生理论知识学习与临床实践相结合的重要桥梁课程,其教育理念及教学方法迫切需要进行新的探索和改革。本研究以临床技能教学为例,结合“临床技能学”外科基础操作知识点,探索在“新医科”建设背景下,引入临床技能训练“六步法”(讲授法、演示法、练习指导法、启发法、温习法、临床实践法)培训模式,将课程思政教育适时融入临床教学工作,采用线上线下、模拟训练与临床见习相结合的混合式教学新模式,进一步提高医学生临床技能水平,培养新时代卓越的实用型临床医生。

CBL+PBL联合SP教学法在神经外科研究生培养中的探索

目的探索案例教学法(case-based learning,CBL)及基于问题的教学法(problem-based learning,PBL)联合标准化病人(standardized patient,SP)教学法在神经外科研究生培养中的应用效果。方法 选取2020年8月—2022年8月昆明医科大学第一附属医院神经外科专业3个年级研究生共60名,按入科顺序分为传统教学组、CBL+PBL组及CBL+PBL+SP组,每组20名。进行3个月的入科培训后对学生的综合考核成绩、临床技能、病历质量、SP评价及自我感知能力进行评价。结果 CBL+PBL组、CBL+PBL+SP组课后的基本理论、病例分析成绩均优于传统教学组,差异有统计学意义(P <0.05)。CBL+PBL+SP组的查体、腰穿及影像资料判读均优于其他2组,差异有统计学意义(P<0.05)。CBL+PBL组与CBL+PBL+SP组的病历书写成绩均优于传统教学组,差异有统计学意义(P <0.05)。CBL+PBL组与CBL+PBL+SP组的SP综合评价成绩、学生满意度、技能和知识吸收能力、医患沟通技巧、学习动机、理解力、师生互动、课程所花时间、课后考试、临床思维能力、自学能力、团队合作能力及完成课题能力均优于传统教学组,差异有统计学意义(P<0.05)。结论 CBL+PBL联合SP教学法在提高研究生临床操作技能、医患沟通技巧、知识理解及吸收能力等方面具有一定优势,是一种更有效的研究生培养方法。

基于多元评价主体的临床技能自主训练评价系统构建与实践

目的完善临床技能自主训练的评价机制,提升技能自主训练的质量和效果。方法基于学评融合的理念,在临床技能自主训练中引入包括训练者本身、多名同伴和教师在内的多元评价主体,自主设计研发临床技能自主训练评价系统。在已完成体格检查学习并考核合格的2021级临床医学专业461名学生中进行教学应用实践,包括教师发布训练任务、系统随机抽签项目、学生录制训练视频、系统随机分配视频,由学生自评、同伴互评和教师抽评训练视频、系统检测评价信息生成反馈报告等系列环节。同时发放调查问卷,了解学生对录制评价视频对自身技能的影响和满意度。结果92.1%的学生表示录制和评价视频对自己的技能有积极影响;54.2%的学生对目前自己体格检查技能的掌握情况表示满意;仅有29.2%的学生使用评语评价。结论系统的构建给学生之间、师生之间提供了更多互动机会,随机抽签项目提高了视频拍摄质量,随机分配消除了人际因素对评价的影响。学生在自评中进行了反思、在同伴互评中吸取了不同评价者的意见,教师在抽评中了解到学生训练情况的同时,也尽量避免教师评价对学生评价的消极影响。大部分学生认为该系统对自身技能有积极影响。

应用型高校临床技能虚拟仿真实验教学中心的建设实践

文章立足于医学特色应用型人才的培养过程,将虚拟仿真实验教学中心建设作为医学实践教学内涵发展的重要补充,从建设理念、建设内涵和实践应用三个方面探讨了临床技能虚拟仿真实验教学中心的建设实践情况,为临床实践教学、线上技能培训和考核提供了丰富的教学资源;丰富了课程内容和教学设计,推动了“以学为中心”的深层次教学;利用平台和虚拟仿真项目更好的反哺优化教学,提升教学效果。

情景模拟教学法在临床基本技能培训中的应用研究

目的基于PDCA循环理论探索情景模拟教学法在临床基本技能培训中的应用模式。方法选取哈尔滨医科大学附属第一医院2019级临床医学专业96名学生作为研究对象,分别设置实验组和对照组,每组48名学生,于2022年3—12月开展技能培训。对照组采用传统方式培训,实验组采用基于PDCA循环的情景模拟教学法培训。比较分析对照组和实验组的培训效果及培训满意度。结果在实验组学生的培训效果调查中,临床基本技能操作中多方面评价结果均高于对照组,差异均有统计学意义(P<0.01)。在适当且安全的操作方式方面,两组比较差异无统计学意义(P>0.05)。在培训满意度调查中,实验组学生对培训满意度明显高于对照组,差异有统计学意义(P<0.01)。结论在临床基本技能培训中应用基于PDCA循环的情景模拟教学法,有助于提升临床基本技能培训质量和学生满意度。

Impact of Non-Clinical Years on Surgery Residents’ Technical Skills: Evaluation of a Technical Skills Refresher Curriculum

We ascertained the opinions of residents and faculty regarding technical skills decay during non-clinical training years and evaluated the effectiveness of a technical skills refresher curriculum (TSRC) offered to residents in the month prior to rejoining clinical training years. 32 faculty and 14 residents completed surveys which gleaned opinions regarding technical skills decay during non-clinical years. Six residents completed a TSRC during the month prior to rejoining clinical training. We compared clinical evaluations of the residents who completed the TSRC to residents who rejoined clinical training prior to the implementation of the curriculum. Surveys indicated that residents and faculty believe that non-clinical years have a slightly negative impact on technical skills and residents who completed dedicated research years would require up to 4 months for technical skills to return to the level of their non-research peers. Residents who completed the TSRC reported having significantly higher comfort levels with their technical skills after the curriculum

基于能力培养导向临床实习轮转模式的应用意义

目的结合国家执业医师考试及全国大学生医学技术技能大赛的考试要求,探讨基于能力导向临床实习轮转模式改革的应用效果。方法选取实习的2017级临床医学“5+3”一体化儿科及临床专业实习生各90名,随机分为试验组和对照组,每组90人。试验组采用调整后实习轮转计划,对照组采用传统实习轮转计划,应用综合考评得分、个人综合能力、自我超越、职业抱负、教学满意度评分量表进行统计比较。结果试验组综合考评、个人综合能力、岗位胜任能力、自我超越、职业抱负、教学满意度明显高于对照组,差异有统计学意义(P<0.05)。结论实习模式改革有助于提高医学生的整体素质,改善医学生的学习环境,激发医学生的临床学习兴趣和主动性,增强医学生的临床实践能力,提高医学生的满意度,同时提升国家执业医师考试通过率以及为全国大学生医学技术技能大赛培养优秀赛手,值得继续深入探索和推广应用。

改良Peyton四步教学法联合DOPS在西藏临床技能培训中的应用

目的探讨基于改良Peyton四步教学法的模拟教学联合操作技能直接观察(direct observation of procedural skills,DOPS)评估方法在西藏临床技能培训中的应用效果。方法选取西藏边坝县人民医院2021年5月—2022年5月参加临床技能培训的51名医护人员为研究对象,随机分为试验组与对照组。试验组采用结合改良Peyton四步教学法进行成人男性导尿术教学,并在培训开始前、培训中期及培训结束后,由带教教师采用DOPS评估方法对学员进行测评。对照组采用传统临床技能培训方法进行教学。在培训结束后发放满意度调查问卷,以了解学员对该教学模式的满意度。结果试验组技能考核平均成绩(90.12±5.50)分,对照组技能考核平均成绩(79.36±6.95)分,两组间成绩比较,其差异具有统计学意义(P<0.001);DOPS评估量表显示,试验组学员在培训结束后临床操作各项能力均较前有显著提高,其差异均具有统计学意义(P<0.05);课后满意度调查结果显示,在赞同“增强相关基础知识”等6个方面,试验组与对照组比较,其差异均具有统计学意义(P<0.001)。结论基于改良Peyton四步教学法的模拟教学联合DOPS评估方法的教学模式可提高西藏藏区医护人员的临床技能操作水平,适合在藏区医护人员临床技能培训中推广。

妇产科临床技能线上教学模式的初探

目的探讨线上教学模式在妇产科临床技能培训中的效果,评价该授课方式的效果。方法选取2021年12月—2022年1月广州医科大学2016、2017级855名临床本科生作为研究对象。将2017级344名学生分为研究组,将2016级511名学生分为对照组。研究组实行线上教学,对学生进行线上妇产科临床技能教学;对照组实行线下教学。比较2组临床技能理论考试成绩,开展针对线上技能教学认可程度的问卷调查,以收集参与线上学习的医学生的反馈意见,分析线上教学模式在妇产科临床技能培训中的应用效果。结果试验组临床技能学理论考试成绩优于对照组,差异有统计学意义(P<0.05)。问卷调查显示,研究组85%(292/344)的学生对线上技能教学感兴趣,75%(258/344)的学生有很大收获,5%(17/344)的学生对线上教学无兴趣,收获不大。结论线上教学模式有利于提高学生的临床技能理论考试成绩,在妇产科临床技能教学中存在一定的局限性,但是切实可行且有一定效果。

临床实习阶段临床技能课程思政改革途径的研究

为了让医学生技能培训与思政教育达到有机融合,实现课程思政在临床技能课程中全方位、全过程、全员立体化育人,文章通过思政内容内涵化——挖掘每门实践课程的思政资源,提炼政治元素;思政标准规范化——开展临床技能课程思政集体备课、试讲等新教学模式;思政环境全渗透——创设良好实习环境,营造良好医德氛围;思政评价立体化——将思政教育考核贯穿到学生临床技能考核全过程4个途径提升课程思政教学质量。课程思政融入临床技能课程强化了医学生的思想建设,培养其高度的责任心、强烈的使命感及对生命的敬畏之情,大大提升了学生的政治素养和职业道德,让医学操作变得更有温度,让医学生日后成为有责任、有道德、有担当的仁心仁术的好医生。

国维班临床课程一体化之临床技能强化课程的研究

为适应医学教育国际化发展要求,促进医教协同,培养知识、能力、职业价值与态度并重的医学人才,广州中医药大学将以“以生为本,实践为重”为指导思想,实施“临床课程一体化”教学改革。其中临床技能强化课程是课程一体化改革中针对学生临床基础技能的重要内容之一,在学生进入实习前开展,主要针对长学制国维班学生,共128学时,包括临床专题讲座和多项临床基本技能的培训和床边带教、考核。实践研究结果初步显示,该项课程改革较以往临床预备课的教学效果有明显提高。

Effect of “Four Passes” Training and Assessment of Nurse Specialty Knowledge on the Cultivation of Core Competence of Clinical Nurses

Background: With the development of high quality nursing service, hospitals put forward higher requirements for nurses’ service level. In recent years, the number and quality of specialized nurses remain to be improved despite the remarkable achievements in the construction of specialized nurses. Objective: This study intended to explore a standardized training mode for nurses oriented by training and assessment of nursespecialty knowledge and to summarize the practical experience of this mode. Methods: The training and assessment program was formulated by starting from the objectives of training clinical front-line nursing staff in our hospital, and the standard training and assessment were carried out from four aspects: the specialized disease knowledge, the condition observation and reporting ability, emergency and severe disease nursing, and perioperative accelerated rehabilitation guidance. These four items are hereinafter referred to as “Four Passes” training and assessment, and it was practiced in the assessment and training of nurses in our hospital from 2020 to 2022. Results: A total of 915 front-line caregivers were surveyed in our study, including 772 nurses and 143 doctors. After two years of implementation, the self-evaluation of nurses increased from (2.96 ± 0.79) points to (3.64 ± 0.78) points, and the evaluation score by doctors increased from (3.94 ± 0.74) points to (4.26 ± 0.72) points. The core competence of specialty increased from (69.22 ± 16.53) points to (85.42 ± 14.44) points. The scores of all dimensions after training were higher than those before training, with statistical significances. Conclusion: The “Four Passes” training and assessment of nurse specialty knowledge can fully mobilize the enthusiasm of managers and nurses in all departments, ensure solid specialty knowledge, improve nurses’ core competence, improve nursing quality, and create a harmonious relationship between nurses and patients as well as between doctors and patients.