督导式门诊教学在全科医师血液科规范化培训中的应用效果研究
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摘要
背景门诊教学在医学教育中的地位变得越来越重要,但常规的全科医学门诊教学模式存在局限性,使得全科医师很难将知识积累转化为临床实践,亟待新的教学模式解决这一困难。目的探讨督导式门诊教学在全科医师血液科规范化培训中的有效性和可行性。方法选取2017年12月—2018年8月于某医院血液内科进行规范化培训的全科医师共45人。使用随机数字法将其分为两组,其中对照组22人、研究组23人。对照组医师在血液内科病房进行常规规范化培训,包括常规接诊患者、问诊查体以及制定初步诊疗方案,并监测治疗中的病情变化等;研究组医师在接受病房培训的同时,完成每周2次上午半日的血液内科督导式门诊教学培训。比较两组医师入科、出科考核成绩以及对带教效果的评价。结果血液内科培训2个月结束后,研究组出科临床理论考试成绩为(91.4±2.3)分,高于对照组的(87.8±3.7)分(t=3.933,P<0.05);研究组临床实践技能测试成绩为(88.4±2.4)分,亦高于对照组的(84.5±3.7)分(t=4.267,P<0.05)。研究组在提高学习主动性、加强医患沟通能力等方面的带教效果评价明显优于对照组(P<0.05)。结论血液内科督导式门诊教学能够提高全科医师规范化培训的效果,提高学生对常见病的诊疗思维能力,有助于其全面了解慢性病整体病程,调动学生的学习兴趣,增进师生交流。
Background Outpatient teaching plays an ever-growing role in medical education.However,limitations of the routine general practice teaching mode restrict the transform of learned medical knowledge into clinical practice,so a novel better teaching model is urgently needed.Objective To explore the effectiveness and feasibility of supervised outpatient teaching model in standardized hematology training for general practitioners(GPs).Methods A total of 45 GPs who received standardized training in the hematology department of a hospital from December 2017 to August 2018 were enrolled.They were randomly divided into the control group(n=22)and the study group(n=23),receiving the training about standardized routine care for hematology inpatients(including regular encountering,inquiry,physical examination,development of preliminary diagnosis and treatment plan,monitoring of the condition changes in the treatment,and so on),the training about standardized routine care for hematology inpatients plus the care training for hematology outpatients taught in the morning,twice a week,in a supervised model,respectively.Pre-and post-training clinical theoretical and skills evaluation results,and subjective-assessed teaching effectiveness in both groups were compared.Results After the 2-month training,GPs in the study group obtained a higher mean score in the clinical theoretical examination[(91.4±2.3)vs(87.8±3.7)](t=3.933,P<0.05)than those of the control group,and also achieved a higher mean score in the clinical skill examination[(88.4±2.4)vs(84.5±3.7)](t=4.267,P<0.05).The overall teaching effectiveness score in improving learning initiative and strengthening doctorpatient communication ability and so on assessed by the study group was much better than that assessed by the control group(P<0.05).Conclusion The supervised outpatient teaching model used in standardized hematology training for GPs may improve the training effectiveness,enhance the clinical diagnostic and therapeutic ideas and performance for common diseases,promote the comprehensive understanding of the whole course of a chronic disease,arouse the learning interest,and facilitate the ommunications between trainers and trainees.
Background Outpatient teaching plays an ever-growing role in medical education.However,limitations of the routine general practice teaching mode restrict the transform of learned medical knowledge into clinical practice,so a novel better teaching model is urgently needed.Objective To explore the effectiveness and feasibility of supervised outpatient teaching model in standardized hematology training for general practitioners(GPs).Methods A total of 45 GPs who received standardized training in the hematology department of a hospital from December 2017 to August 2018 were enrolled.They were randomly divided into the control group(n=22)and the study group(n=23),receiving the training about standardized routine care for hematology inpatients(including regular encountering,inquiry,physical examination,development of preliminary diagnosis and treatment plan,monitoring of the condition changes in the treatment,and so on),the training about standardized routine care for hematology inpatients plus the care training for hematology outpatients taught in the morning,twice a week,in a supervised model,respectively.Pre-and post-training clinical theoretical and skills evaluation results,and subjective-assessed teaching effectiveness in both groups were compared.Results After the 2-month training,GPs in the study group obtained a higher mean score in the clinical theoretical examination[(91.4±2.3)vs(87.8±3.7)](t=3.933,P<0.05)than those of the control group,and also achieved a higher mean score in the clinical skill examination[(88.4±2.4)vs(84.5±3.7)](t=4.267,P<0.05).The overall teaching effectiveness score in improving learning initiative and strengthening doctorpatient communication ability and so on assessed by the study group was much better than that assessed by the control group(P<0.05).Conclusion The supervised outpatient teaching model used in standardized hematology training for GPs may improve the training effectiveness,enhance the clinical diagnostic and therapeutic ideas and performance for common diseases,promote the comprehensive understanding of the whole course of a chronic disease,arouse the learning interest,and facilitate the ommunications between trainers and trainees.
引文
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[8]潘天园,杜亚平,李兰娟.浙江省全科医师规范化培训学员对培训制度及工作现状满意度的研究[J].中国全科医学,2015,18(7):801-806.DOI:10.3969/j.issn.1007-9572.2015.07.22.PAN T Y,DU Y P,LI L J.Satisfaction survey on training system and current status of trained general practice residents in Zhejiang Province[J].Chinese General Practice,2015,18(7):801-806.DOI:10.3969/j.issn.1007-9572.2015.07.22.
[9]黄晓明,沙悦,方卫纲,等.北京协和医院普通内科教学改革的初步实践[J].中国高等医学教育,2011,26(8):64-65.DOI:10.3969/j.issn.1002-1701.2011.08.035.HUANG X M,SHA Y,FANG W G,et al.Building up a clinical teaching center in Department of General Internal Medicine in Peking Union Medical College Hospital[J].China Higher Medical Education,2011,26(8):64-65.DOI:10.3969/j.issn.1002-1701.2011.08.035.
[10]李晓.临床血液病学教学经验浅谈[J].浙江医学教育,2014,13(1):20-22.DOI:10.3969/j.issn.1672-0024.2014.01.007.LI X.Teaching experiences on the clinical hematology[J].Zhejiang Medical Education,2014,13(1):20-22.DOI:10.3969/j.issn.1672-0024.2014.01.007.
[11]金肖牧,金诗玮,范青叶,等.血液学教学质量现况的调查和评估[J].诊断学理论与实践,2017,16(2):236-240.DOI:10.16150/j.1671-2870.2017.02.023.JIN X M,JIN S W,FAN Q Y,et al.An investigation on present teaching situation of hematology[J]. Journal of Diagnostics Concepts&Practice,2017,16(2):236-240.DOI:10.16150/j.1671-2870.2017.02.023.
[12]陈刚,玛丽娅·木哈什,袁海龙.PBL联合信息化模式在血液病教学中的应用初探[J].中国卫生产业,2017,14(18):51-52.DOI:10.16659/j.cnki.1672-5654.2017.18.051.CHEN G,MALIYA·M H S,YUAN H L.Preliminary study on the application of PBL combined informatization model in hematology teaching[J].China Health Industry,2017,14(18):51-52.DOI:10.16659/j.cnki.1672-5654.2017.18.051.
[13]张越,周合冰.翻转课堂结合OSCE考核模式在血液科本科教学中的应用[J].中国病案,2018,19(3):89-92.DOI:10.3969/j.issn.1672-2566.2018.03.030.ZHANG Y,ZHOU H B.Application of the flipped classroom and objective structured clinical examination in teaching for hematology undergraduates[J].Chinese Medical Record,2018,19(3):89-92.DOI:10.3969/j.issn.1672-2566.2018.03.030.
[14]HEWSON M G.Clinical teaching in the ambulatory setting[J].JGen Intern Med, 1992,7(1):76-82.DOI:10.1007/bf02599107.
[15]黄晓明,李航,曾学军.什么是教学门诊[J].中华内科杂志,2018,57(2):152-154.DOI:10.3760/cma.j.issn.0578-1426.2018.02.016.HUANG X M,LI H,ZENG X J.What is a teaching clinic[J].Chinese Journal of Internal Medicine,2008,57(2):152-154.DOI:10.3760/cma.j.issn.0578-1426.2018.02.016.
[2]MILLER G E.The assessment of clinical skills/competence/performance[J].Acad Med,1990,65(9 suppl):s63-67.DOI:10.1097/00001888-199510000-00014.
[3]谢涛.时代发展对医学教师素质的要求[J].中国保健营养,2015,25(11):286.XIE T.Requirements of the development of the times on the quality of medical teachers[J].China Health Care&Nutrition,2015,25(11):286.
[4]顾明远.我国教师教育改革的反思[J].教师教育研究,2006,18(6):3-6.DOI:10.3969/j.issn.1672-5905.2006.06.001.GU M Y.Reflection on the reform of Chinese teacher education[J].Teacher Education Research,2006,18(6):3-6.DOI:10.3969/j.issn.1672-5905.2006.06.001.
[5]武宁,程明羕,闫丽娜,等.中国全科医生培养发展报告(2018)[J].中国全科医学,2018,21(10):1135-1142.DOI:10.3969/j.issn.1007-9572.2018.10.001.WU N,CHENG M Y,YAN L N,et al.Training development report of GPs(2018)[J].Chinese General Practice,2018,21(10):1135-1142.DOI:10.3969/j.issn.1007-9572.2018.10.001.
[6]何玲玲,李晓琼,李新毅.良性发作性位置性眩晕与骨质疏松/低骨量关系的Meta分析[J].中国全科医学,2019,22(11):1328-1333.DOI:10.12114/j.issn.1007-9572.2018.00.306.HE L L,LI X Q,LI X Y.Association between benign paroxysmal positional vertigo and osteoporosis/osteopenia:a metaanalysis[J].Chinese General Practice,2019,22(11):1328-1333.DOI:10.12114/j.issn.1007-9572.2018.00.306.
[7]国务院办公厅.国务院关于推进分级诊疗制度建设的指导意见[EB/OL].(2015-09-11)[2019-01-05].http://www.gov.cn/zhengce/content/2015-09/11/content_10158.htm.
[8]潘天园,杜亚平,李兰娟.浙江省全科医师规范化培训学员对培训制度及工作现状满意度的研究[J].中国全科医学,2015,18(7):801-806.DOI:10.3969/j.issn.1007-9572.2015.07.22.PAN T Y,DU Y P,LI L J.Satisfaction survey on training system and current status of trained general practice residents in Zhejiang Province[J].Chinese General Practice,2015,18(7):801-806.DOI:10.3969/j.issn.1007-9572.2015.07.22.
[9]黄晓明,沙悦,方卫纲,等.北京协和医院普通内科教学改革的初步实践[J].中国高等医学教育,2011,26(8):64-65.DOI:10.3969/j.issn.1002-1701.2011.08.035.HUANG X M,SHA Y,FANG W G,et al.Building up a clinical teaching center in Department of General Internal Medicine in Peking Union Medical College Hospital[J].China Higher Medical Education,2011,26(8):64-65.DOI:10.3969/j.issn.1002-1701.2011.08.035.
[10]李晓.临床血液病学教学经验浅谈[J].浙江医学教育,2014,13(1):20-22.DOI:10.3969/j.issn.1672-0024.2014.01.007.LI X.Teaching experiences on the clinical hematology[J].Zhejiang Medical Education,2014,13(1):20-22.DOI:10.3969/j.issn.1672-0024.2014.01.007.
[11]金肖牧,金诗玮,范青叶,等.血液学教学质量现况的调查和评估[J].诊断学理论与实践,2017,16(2):236-240.DOI:10.16150/j.1671-2870.2017.02.023.JIN X M,JIN S W,FAN Q Y,et al.An investigation on present teaching situation of hematology[J]. Journal of Diagnostics Concepts&Practice,2017,16(2):236-240.DOI:10.16150/j.1671-2870.2017.02.023.
[12]陈刚,玛丽娅·木哈什,袁海龙.PBL联合信息化模式在血液病教学中的应用初探[J].中国卫生产业,2017,14(18):51-52.DOI:10.16659/j.cnki.1672-5654.2017.18.051.CHEN G,MALIYA·M H S,YUAN H L.Preliminary study on the application of PBL combined informatization model in hematology teaching[J].China Health Industry,2017,14(18):51-52.DOI:10.16659/j.cnki.1672-5654.2017.18.051.
[13]张越,周合冰.翻转课堂结合OSCE考核模式在血液科本科教学中的应用[J].中国病案,2018,19(3):89-92.DOI:10.3969/j.issn.1672-2566.2018.03.030.ZHANG Y,ZHOU H B.Application of the flipped classroom and objective structured clinical examination in teaching for hematology undergraduates[J].Chinese Medical Record,2018,19(3):89-92.DOI:10.3969/j.issn.1672-2566.2018.03.030.
[14]HEWSON M G.Clinical teaching in the ambulatory setting[J].JGen Intern Med, 1992,7(1):76-82.DOI:10.1007/bf02599107.
[15]黄晓明,李航,曾学军.什么是教学门诊[J].中华内科杂志,2018,57(2):152-154.DOI:10.3760/cma.j.issn.0578-1426.2018.02.016.HUANG X M,LI H,ZENG X J.What is a teaching clinic[J].Chinese Journal of Internal Medicine,2008,57(2):152-154.DOI:10.3760/cma.j.issn.0578-1426.2018.02.016.