Interventions to improve communication between nurses and physicians in the intensive care unit: An integrative literature review

Effective communication among healthcare professionals in the intensive care unit (ICU) is a particular imperative,with accurate and efficient interdisciplinary communication being a critical prerequisite for high-quality care.Nurses and physicians are highly important parts of the healthcare system workforce.Thus,identifying strategies that would improve communication between these two groups can provide evidence for practical improvement in the ICU,which will ultimately improve patient outcomes.This integrative literature review aimed to identify interventions that improve communication between nurses and physicians in ICUs.Three databases (Medline,CINAHL,and Science Direct) were searched between September 2014 and June 2016 using 11 search terms,namely,nurse,doctor,physician,resident,clinician,ICU,intensive care unit,communication,teamwork,collaboration,and relationship.A manual search of the reference lists of found papers was also conducted.Eleven articles met the inclusion criteria.These studies reported on the use of communication tools/checklists,team training,multidisciplinary structured work shift evaluation,and electronic situation-background-assessment -recommendation documentation templates to improve communication.Although which intervention strategies are most effective remains unclear,this review suggests that these strategies improve communication to some extent.Future studies should be rigorously designed and outcome measures should be specific and validated to capture and reflect the effects of effective communication.

Evaluation of progressive early rehabilitation training mode in intensive care unit patients with mechanical ventilation

BACKGROUND Mechanical ventilation is a common resuscitation method in the intensive care unit(ICU).Unfortunately,this treatment process prolongs the ICU stay of patients with an increased incidence of delirium,which ultimately affects the prognosis.AIM To evaluate the effect of progressive early rehabilitation training on treatment and prognosis of patients with mechanical ventilation in ICU.METHODS The convenience sampling method selected 190 patients with mechanical ventilation admitted to the Fourth Hospital of Hebei Medical University from March 2020 to March 2021.According to the random number table method,they were divided into the control and intervention groups.The control group received routine nursing and rehabilitation measures,whereas the intervention group received progressive early rehabilitation training.In addition,the incidence and duration of delirium were compared for the two groups along with mechanical ventilation time,ICU hospitalization time,functional independence measure(FIM)score,Barthel index,and the incidence of complications(deep venous thrombosis,pressure sores,and acquired muscle weakness).RESULTS In the intervention group,the incidence of delirium was significantly lower than in the control group(28%vs 52%,P<0.001).In the intervention group,the duration of delirium,mechanical ventilation time,and ICU stay were shorter than in the control group(P<0.001).The FIM and Barthel index scores were significantly higher in the intervention group than the control group(P<0.001).The total incidence of complications in the intervention group was 3.15%,which was lower than 17.89%in the control group(P<0.001).CONCLUSION Progressive early rehabilitation training reduced the incidence of delirium and complications in ICU patients with mechanical ventilation,which improved prognosis and quality of life.

Remote nursing training model combined with proceduralization in the intensive care unit dealing with patients with COVID-19

The shortage of personal protective equipment and lack of proper nursing training have been endangering health care workers dealing with coronavirus disease 2019(COVID-19).In our treatment center,the implementation of a holistic care model of time-sharing management for severe and critical COVID-19 patients has further aggravated the shortage of intensive care unit(ICU)professional nurses.Therefore,we developed a short-term specialized and targeted nursing training program to help ICU nurses to cope with stress and become more efficient,thus reducing the number of nurses required in the ICU.In order to avoid possible human-to-human spread,small teaching classes and remote training were applied.The procedural training mode included four steps:preparation,plan,implementation,and evaluation.An evaluation was conducted throughout the process of nursing training.In this study,we documented and shared experiences in transitioning from traditional face-to-face programs to remote combined with proceduralization nursing training mode from our daily work experiences during the COVID-19 pandemic,which has shown to be helpful for nurses working in the ICU.

Physician staffing pattern in intensive care units:Have we cracked the code?

Intensive care is slowly being recognized as a separate medical specialization. Physicians, called intensivists, are being specially trained to manage intensive care units(ICUs) and provide focused, high quality care to critically ill patients. However, these ICUs were traditionally managed by primary physicians who used to admit patients in ICUs under their own care. The presence of specially trained intensivists in these ICUs has started a "turf" war. In spite of the availability of overwhelming evidence that intensivists-based ICUs can provide better patient care leading to improved outcome, there is hesitancy among hospital administrators and other policy makers towards adopting such a model. Major critical care societies and workgroups have recommended intensivists-based ICU models to care for critically ill patients, but even in developed countries, on-site intensivist coverage is lacking in a great majority of hospitals. Lack of funds and unavailability of skilled intensivists are commonly cited as the main reasons for not implementing intensivist-led ICU care in most of the ICUs. To provide optimal, comprehensive and skilled care to this severely ill patient population, it is imperative that a multi-disciplinary team approach must be adopted with intensivists as in-charge. Even though ICU organization and staffingmay be determined by hospital policies and other local factors, all efforts must be made to attain the goal of having round-the-clock onsite intensivist coverage to ensure continuity of specialized care for all critically ill patients.

Generalizable items and modular structure for computerised physician staffing calculation on intensive care units

Intensive care medicine remains one of the most costdriving areas within hospitals with high personnel costs. Under the scope of limited budgets and reimbursement, realistic needs are essential to justify personnel staffing. Unfortunately, all existing staffing models are top-down calculations with a high variability in results. We present a workload-oriented model, integrating quality of care, efficiency of processes, legal, educational, controlling, local, organisational and economic aspects. In our model, the physician's workload solely related to the intensive care unit depends on three tasks: Patient-oriented tasks, divided in basic tasks(performed in every patient) and additional tasks(necessary in patients with specific diagnostic and therapeutic requirements depending on their specific illness, only), and non patient-oriented tasks. All three tasks have to be taken into account for calculating the required number of physicians. The calculation tool further allows to determine minimal personnel staffing, distribution of calculated personnel demand regarding type of employee due to working hours per year, shift work or standby duty. This model was introduced and described first by the German Board of Anesthesiologists and the German Society ofAnesthesiology and Intensive Care Medicine in 2008 and since has been implemented and updated 2012 in Germany. The modular, flexible nature of the Excel-based calculation tool should allow adaption to the respective legal and organizational demands of different countries. After 8 years of experience with this calculation, we report the generalizable key aspects which may help physicians all around the world to justify realistic workload-oriented personnel staffing needs.

National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic

The coronavirus disease pandemic caught many pediatric hospitals unpreparedand has forced pediatric healthcare systems to scramble as they examine and planfor the optimal allocation of medical resources for the highest priority patients.There is limited data describing pediatric intensive care unit (PICU) preparednessand their health worker protections.AIMTo describe the current coronavirus disease 2019 (COVID-19) preparedness effortsamong a set of PICUs within a simulation-based network nationwide.METHODS A cross-sectional multi-center national survey of PICU medical director(s) fromchildren’s hospitals across the United States. The questionnaire was developedand reviewed by physicians with expertise in pediatric critical care, disasterreadiness, human factors, and survey development. Thirty-five children’shospitals were identified for recruitment through a long-established nationalresearch network. The questions focused on six themes: (1) PICU and medicaldirector demographics;(2) Pediatric patient flow during the pandemic;(3)Changes to the staffing models related to the pandemic;(4) Use of personalprotective equipment (PPE);(5) Changes in clinical practice and innovations;and(6) Current modalities of training including simulation.RESULTSWe report on survey responses from 22 of 35 PICUs (63%). The majority of PICUswere located within children’s hospitals (87%). All PICUs cared for pediatricpatients with COVID-19 at the time of the survey. The majority of PICUs (83.4%)witnessed decreases in non-COVID-19 patients, 43% had COVID-19 dedicatedunits, and 74.6% pivoted to accept adult COVID-19 patients. All PICUsimplemented changes to their staffing models with the most common changesbeing changes in COVID-19 patient room assignment in 50% of surveyed PICUsand introducing remote patient monitoring in 36% of the PICU units. Ninety-fivepercent of PICUs conducted training for donning and doffing of enhanced PPE.Even 6 months into the pandemic, one-third of PICUs across the United Statesreported shortages in PPE. The most common training formats for PPE werehands-on training (73%) and video-based content (82%). The most commonconcerns related to COVID-19 practice were changes in clinical protocols andguidelines (50%). The majority of PICUs implemented significant changes in theirairway management (82%) and cardiac arrest management protocols in COVID-19patients (68%). Simulation-based training was the most commonly utilizedtraining modality (82%), whereas team training (73%) and team dynamics (77%)were the most common training objectives.CONCLUSIONSA substantial proportion of surveyed PICUs reported on large changes in theirpreparedness and training efforts before and during the pandemic. PICUsimplemented broad strategies including modifications to staffing, PPE usage,workflow, and clinical practice, while using simulation as the preferred trainingmodality. Further research is needed to advance the level of preparedness,support staff assuredness, and support deep learning about which preparednessactions were effective and what lessons are needed to improve PICU care andstaff protection for the next COVID-19 patient waves.

Effect of Training Nurses in ICU in Immediate Care Post Cardiac Surgery

The specialty of cardiovascular surgical nursing has advanced patient care significantly both before and after surgery, and it is now a well-established field. The primary goal of cardiovascular surgical nursing is to optimize the patient's recovery and prevent complications. Immediate nursing care for post-operative cardiac patients in a state of controlled shock due to fluid shift and varying vascular tone. Aim of the Study: Assessment of nurse’s knowledge and performance after the training program of nursing care immediately after a patient arrives from cardiac surgery. Methods: This pre and post-intervention study was conducted at cardiac centers in Sudan Alshaab and Ahmed Gasim Cardiac Center. The aim of the study was to evaluate the impact on nurses’ performance after training program post open-heart surgery. In the initial phase of the study, all 98 nurses working in the intensive care units at Alshaab and Ahmed Gasim cardiac centers were designated as the study group and evaluated before the intervention. Subsequently, the same group was reassessed after the intervention (phase 2), allowing for a comparison of the pre- and post-intervention results. The assessment involved the use of a specifically designed questionnaire and an observation checklist developed in accordance with the standards recommended by the American Nurses Association (phase 3). Result: Descriptive analysis was performed using the Chi-square test, the difference in the performance between the study group before intervention and after the intervention was assessed by the mean of chi-square significantly was taken as p < 0.05.

Demands of experiential training for ICU nurses in Hunan of China

Objective:To assess intensive care unit(ICU)nurses’demands for specialized experiential training and to provide inputs for developing an experiential training program for ICU nurses.Methods:A questionnaire for assessing ICU nurses’demands for experiential specialty training was distributed to 360 ICU nurses,selected through purposive sampling from two secondary hospitals and six tertiary hospitals in Hunan Province,China.Results:Of the survey participants,63.6%had undergone a specialty training program for ICU nurses.Of these individuals,53.0%were satisfied with the training.Certification as a qualified nurse was considered an essential criterion for admission of trainees into the program by 81.8%of respondents,while 77.1%of respondents considered clinical working experience to be a critical requirement for selecting trainers.A total of 48.1%of the respondents preferred part-time training,and 36.1%considered a training cycle of 9 e12 weeks to be reasonable.Moreover,they felt that the training methods should be tailored to different stages of the experiential learning cycle.Demands for experiential training among ICU nurses were quantified,with high demand reflected in an overall score of 4.41±0.48.The“intensive care technology”experiential training module was ranked highest in terms of demand,with the top five sub-modules being specialty operating technology(4.67±0.53),care of critically ill patients(4.66±0.55),critical patient rescue procedures(4.65±0.56),assessing monitoring indexes(4.63±0.56),and the application of relevant instruments(4.61±0.57).Conclusion:Nearly half of the respondents indicated that their experiences of specialty training programs were not satisfactory,and they had high demands for experiential training.Thus,to optimize training outcomes,continuous updating of training methods is essential.Moreover,a systematic,comprehensive,and multilevel experiential training program that targets the specific needs of ICU nurses is essential.

Effect of preoperative inspiratory muscle training on postoperative outcomes in patients undergoing cardiac surgery:A systematic review and meta-analysis

BACKGROUND Cardiovascular disease is the most prevalent disease worldwide and places a great burden on the health and economic welfare of patients.Cardiac surgery is an important way to treat cardiovascular disease,but it can prolong mechanical ventilation time,intensive care unit(ICU)stay,and postoperative hospitalization for patients.Previous studies have demonstrated that preoperative inspiratory muscle training could decrease the incidence of postoperative pulmonary complications.AIM To explore the effect of preoperative inspiratory muscle training on mechanical ventilation time,length of ICU stay,and duration of postoperative hospitalization after cardiac surgery.METHODS A literature search of PubMed,Web of Science,Cochrane Library,EMBASE,China National Knowledge Infrastructure,WanFang,and the China Science and Technology journal VIP database was performed on April 13,2022.The data was independently extracted by two authors.The inclusion criteria were:(1)Randomized controlled trial;(2)Accessible as a full paper;(3)Patients who received cardiac surgery;(4)Preoperative inspiratory muscle training was implemented in these patients;(5)The study reported at least one of the following:Mechanical ventilation time,length of ICU stay,and/or duration of postoperative hospitalization;and(6)In English language.RESULTS We analyzed six randomized controlled trials with a total of 925 participants.The pooled mean difference of mechanical ventilation time was-0.45 h[95%confidence interval(CI):-1.59-0.69],which was not statistically significant between the intervention group and the control group.The pooled mean difference of length of ICU stay was 0.44 h(95%CI:-0.58-1.45).The pooled mean difference of postoperative hospitalization was-1.77 d in the intervention group vs the control group[95%CI:-2.41-(-1.12)].CONCLUSION Preoperative inspiratory muscle training may decrease the duration of postoperative hospitalization for patients undergoing cardiac surgery.More high-quality studies are needed to confirm our conclusion.

ICU护士急性皮肤衰竭护理知信行现状及影响因素分析

目的调查ICU护士急性皮肤衰竭护理知信行现状及影响因素,为开展相关教学培训提供依据。方法2023年1月—3月,便利选取山东省和北京市4所三级甲等医院ICU护士作为研究对象,采用自行编制的ICU护士急性皮肤衰竭护理知信行调查问卷进行调查。结果回收有效问卷272份,ICU护士急性皮肤衰竭护理知识维度得分(29.09±7.55)分,态度维度得分为(37.65±5.89)分,行为维度得分(34.62±8.77)分。多元回归分析显示,是否为伤口专科护士、是否接受过急性皮肤衰竭培训、是否护理过急性皮肤衰竭患者是ICU护士急性皮肤衰竭护理知信行的影响因素(P<0.05),学历是ICU护士急性皮肤衰竭护理行为的影响因素(P<0.05)。结论ICU护士对急性皮肤衰竭护理的态度较为积极,但知识和行为水平有待提高。护理管理者应针对ICU护士的特点,建立和完善急性皮肤衰竭培训体系,加强相关培训,提高其对急性皮肤衰竭的知信行水平,提高ICU患者急性皮肤衰竭护理质量。

Healthcare Quality According to ICU Level of Care

Introduction: Little is known about the quality of healthcare in intensive care units (ICUs) in Poland. Data on patients hospitalized in ICUs in Warsaw and the results of their treatment are scarce. This information, crucial for improving the quality of ICU healthcare services, is not collected routinely. Quality indicators are essential in the concept of holistic quality management. Implementation of these indicators in ICUs is a complex and time-consuming process. Systematic increase in demand for quality assessment tools that can reflect real conditions of the practices of ICUs, prompts the search for effective solutions. Methods: The study included 12,155 patients hospitalized in 16 ICUs of Warsaw hospitals (8 ICUs, n = 3293 of the first level of care, and 8 ICUs, n = 8862 of the second level) between 1st January 2017 and 31st December 2018. ICUs in pediatric and oncological hospitals were excluded from the study. Characteristics and demography of patients as well as the structure, treatment and human resources of the ICUs in Warsaw were analyzed. Length of stay, unexpected extubations, nosocomial infections, ICU readmissions and standardized mortality ratios (SMR) were retrieved from National Health Fund, Ministry of Health, and other public databases. Results: In primary level ICUs patients’ age (66.42 vs. 64.43 years;p = 0.005) and comorbidity rate (30.56% vs. 22.78%, p = 0.037) were higher when compared to ICUs of the second level of care. The crude mortality rate in ICUs in Warsaw was significantly higher than in other EU countries and differed between ICUs of the first and the second level (34.77% vs. 24.53%, respectively;p = 0.004). SMRs were however very low: 0.71 and 0.64 (ns), respectively. ICU readmission rate, unexpected extubations, central catheter related infections, and length of stay were identical in both groups. More patients were admitted to ICU form emergency department and/or discharged home in Level 1 ICUs (18.9% vs 12.9%, p Conclusions: There are no major differences in quality of care provided by Level 1 and Level 2 ICUs in Poland, although more rigorous adhesion to admission and discharge policies is needed. Implementation of the instruments for assessing quality of ICUs including benchmarking, self-assessment of departments and evaluation of changes resulting from audits according to the Deming cycle is of utmost importance. Standardization of quality measures and markers, communication, and cooperation in reporting and creation of ICU medical registers is necessary to improve the quality of healthcare.

30所三级医院开展ICU护士入职培训的现况调查

目的:调查三级医院开展ICU护士入职培训现况,为探索更有效的ICU护士入职培训提供参考。方法:2022年7月—8月,采用便利抽样法选取全国11个省份30所三级医院57个ICU的护理管理者及583名ICU护士作为调查对象,使用自行设计的ICU护士入职培训情况调查问卷进行调查。结果:参与调查的57个(100.0%)ICU均制定了新护士入职培训计划并规定经过带教期后方可独立上岗,但培训形式多样、带教期时长尚不统一,仅32个(56.1%)ICU有资质准入制度和相关考核;52名(91.2%)护理管理者将规范化培训后的新护士视为最优选;应届毕业生新护士占总护士人数的比例与非计划性拔管的发生率呈正相关(r=0.341,P<0.05)。参与调查的583名护士中364名(62.4%)认为3~6个月的带教时长最为合适,339名(58.1%)倾向于毕业后先掌握普通患者护理技能,再入职ICU;回归分析显示入职培训期间ICU护士适应工作压力的影响因素为ICU类型、临床实践带教形式与带教时长。结论:目前ICU资质准入制度仍不完善,入职培训尚无统一的方案,带教时长仍需要进一步讨论,未来仍需要制定纲领性文件指导ICU开展护士入职培训工作。

基于《住院医师规范化培训内容与标准(2022年版)》的实践应用——以重症医学科住院医师规范化培训为例

探讨《住院医师规范化培训内容与标准(2022年版)》在住院医师规范化培训中的应用效果。结果表明,《住院医师规范化培训内容与标准(2022年版)》在住院医师规范化培训中应用,能收到较好的教学效果和满意度。

重症监护病房医护沟通现状及需求匹配策略研究

目的:采用混合性研究方法,调查ICU医护沟通实践现状并分析需求匹配策略,为促进医护沟通实践提供依据。方法:采用便利抽样法,对15所医院的435名ICU医护人员医护沟通现状进行问卷调查;采用目的抽样法对5所医院ICU的6名医生及11名护士,进行半结构式访谈。结果:医护沟通评价总分为(73.46±11.38)分;有序Logistic回归分析结果显示,沟通的开放性、沟通的准确性、理解能力、沟通培训经历是医护沟通满意度的影响因素。访谈结果显示医护沟通需求匹配策略主题包括3个:能力需求匹配策略(加强技能培训、强化认知);机会需求匹配策略(建设组织文化、营造沟通环境);内部动机匹配策略(激发职业获得感)。结论:ICU医护沟通实践存在提升空间。管理者可从能力、机会及动机三方面入手,通过加强医护沟通能力及专业培训,优化组织文化及沟通环境,提升医护人员职业获得感和专业价值感,促进ICU医护沟通实践。

ICU患者代理决策者决策冲突现状及影响因素分析

目的调查ICU患者代理决策者决策冲突现状并分析其影响因素。方法采用便利抽样法,选取390名ICU患者代理决策者为研究对象。采用一般资料调查表、决策冲突量表、决策准备量表、决策参与量表及维克森林医师信任量表进行调查。结果ICU患者代理决策者决策冲突得分为(43.33±7.25)分,决策准备得分为(30.62±6.81)分,决策参与得分为(64.46±10.37)分,医师信任得分为(37.95±6.35)分;Pearson相关分析显示,ICU患者代理决策者决策冲突总分与决策准备、决策参与及医师信任总分均呈负相关(均P<0.05);多元线性回归分析显示,是否了解该疾病、代理决策者年龄、决策参与、决策准备、医师信任是ICU代理决策者决策冲突得分的主要影响因素(均P<0.05),可解释总变异的43.1%。结论ICU患者代理决策者决策冲突处于较高水平。建议护理管理者应对决策冲突水平较高的代理决策者进行干预,以减轻其决策困境,提高决策质量,实现患者利益最大化。

基于循证的规范化护理配合针刺与物理康复疗法对重症监护室获得性衰弱病人康复进程的影响

目的:探究基于循证的规范化护理配合针刺与物理康复疗法对重症监护室获得性衰弱(ICU⁃AW)病人康复进程的影响。方法:收集2021年1月—2022年10月在我院重症监护室(ICU)住院诊疗的120例ICU⁃AW病人,随机分为对照组与观察组,各60例。对照组接受基于循证的规范化护理,观察组在对照组方案基础上配合针刺与物理康复疗法,比较两组生命体征及下肢运动功能、机械通气时间、脱管发生率、ICU住院时间、总住院时间、医学研究委员会肌力评分(MRC)、序贯性器官功能障碍评分(SOFA)、急性生理与慢性健康状况评分(APACHEⅡ)和28 d死亡率。结果:观察组血压变异值低于对照组(P<0.05),血氧饱和度、MRC评分和下肢FMA评分高于对照组(P<0.05),机械通气时间、脱管发生率、ICU住院时间、总住院时间、SOFA评分、APACHEⅡ评分以及28 d死亡率均低于对照组(P<0.05)。结论:ICU⁃AW病人住院期间实施基于循证的规范化护理配合针刺与物理康复疗法,有助于平稳病人的生命体征,缩短机械通气时间和ICU住院时间,改善运动功能,缓解病情严重程度。

直立床预康复训练对ICU气管插管患者撤机效果的观察

目的探讨直立床预康复训练对ICU气管插管患者撤机效果的影响。方法回顾性分析2022年2月至2024年1月福建中医药大学附属第二人民医院收治的60例气管插管住院患者临床资料,根据其不同干预方法进行分组,将实施常规撤机干预患者30例纳入对照组,将在常规撤机干预基础上实施直立床预康复训练患者30例纳入试验组。比较两组干预前后的超声下膈肌增厚率、血氧饱和度、氧合指数,观察两组呼吸机使用时间、入住ICU时间、撤机后48 h再插管的比例及两组撤机后并发症发生率。结果干预后,试验组超声下膈肌增厚率高于对照组(P<0.05);撤机后,试验组血氧饱和度、氧合指数高于对照组(P<0.05)。试验组呼吸机使用时间、入住ICU时间、撤机后48 h再插管的比例均低于对照组(P<0.05)。试验组撤机后并发症发生率低于对照组(P<0.05)。结论采用直立床预康复训练可增厚患者膈肌,改善肺通气功能,提高血氧饱和度、氧合指数,为成功撤机提供有利条件,进而缩短呼吸机使用时间、入住ICU时间,还可降低撤机后并发症发生率。

中美重症医学科专科医师规范化培训体系的差异及启示

医学是终身学习不断提高的科学,毕业后教育是医学重要的延续。近年各种公共卫生事件突发,国家层面对危重患者诊疗需求与日俱增,培养高水平重症医学科医师乃大势所趋。住院医师规范化培训(简称作住培)近年来已经逐渐完善成熟,然而专科医师规范化培训(简称专培)仍处于初步探索阶段,培训基地较少,管理及培养目标尚不明确,考核评价机制单一,且专科医师综合能力水平参差不齐。本文旨在分析中美两国重症医学科专培的差异,拟从准入制度、培训目标、培养体系、评价体系、基地管理、师资培训、临床胜任力发展等多方面提出切实可行措施,为我国重症医学科培养卓越医师提供参考。

元认知指导下PBL在重症医学科中医住院医师规范化培训中的应用研究

目的分析在重症医学科住院医师规范化培训中应用元认知指导下以问题为基础的学习(problembased learning,PBL)教学法的效果。方法选取2019年12月—2021年8月在广西中医药大学第一附属医院重症医学科轮转(周期为2个月)的84名住院医师规范化培训学员为研究对象。按照入科顺序分为两组,每组42名学员,教学组实施传统教学,整合组实施元认知指导下PBL教学模式。比较两组理论成绩、技能成绩、临床思维能力、综合印象评分及教学满意度。结果整合组理论成绩、技能成绩、临床思维能力、综合印象评分均优于教学组,差异有统计学意义(P均<0.05)。整合组教学总满意度为95.23%(40/42),高于教学组的76.19%(32/42),差异有统计学意义(χ^(2)=6.222,P<0.05)。结论元知识指导下PBL在重症医学科中医住院医师规范化培训中应用,能提升学员的理论知识和临床综合能力。

微信联合CBL教学对重症医学科住院医师临床思维能力的探索

目的探索微信联合以案例为基础的教学(CBL)方法对重症医学科住院医师临床思维能力的影响和效果。方法选取2022年9月至2023年9月温州医科大学附属第一医院重症医学科接受CBL培训的139名住院医师,随机分为微信联合CBL组(观察组)70人,CBL组(对照组)69人,进行出科考核和住院医师课程满意度调查,比较两组的考核成绩和满意度。结果观察组的理论知识、病史采集、临床思维和实践技能成绩优于对照组,差异有统计学意义(P<0.05)。观察组在提高学习兴趣、增强自主学习能力、提高学习效果、独立解决问题和沟通表达能力方面优于对照组,差异有统计学意义(P<0.01)。结论基于微信联合CBL辅助教学可充分调动学习积极性,提升临床思维能力,并突破时空限制,提高自主学习能力和效果,为不断完善我国重症医学科住培提供理论参考。