SP与乳房视诊触诊模拟系统在乳腺外科临床见习中的应用  

Application of standardized patient and breast visual palpation simulation system in clinical probation of breast surgery

作　　者：高博 张菊馨 李治荣 陈懿 张莉霜 罗东林 Gao Bo;Zhang Juxin;Li Zhirong;Chen Yi;Zhang Lishuang;Luo Donglin(Department of Breast and Thyroid Surgery,Army Medical Center of PLA,Chongqing 400042,China;Office of Educational Administration,Army Medical Center of PLA,Chongqing 400042,China)

机构地区：[1]陆军军医大学第三附属医院乳腺甲状腺外科,重庆400042 [2]陆军军医大学第三附属医院教务科,重庆400042

出　　处：《中华医学教育探索杂志》2022年第5期545-549,共5页Chinese Journal of Medical Education Research

基　　金：重庆市科卫联合医学科研项目(2021MSXM338);陆军军医大学人文社科基金项目(2020XRW03)

摘　　要：目的 探讨将标准化病人(standardized patient,SP)与乳房视诊触诊模拟系统应用于医学生乳腺外科临床见习中对教学效果的影响。 方法 将110名学员分为试验、对照两组,每组再分为5个亚组。试验组见习前结合教学大纲设计乳腺外科5种常见病的SP剧本并对教员培训。见习时首先串讲疾病诊疗特点,随后5个亚组分别针对上述不同病种的SP采集病史,对乳房视诊触诊模拟系统上对应的病变查体。查体中SP对学员的提问做出应答。对照组见习时同样先串讲上述5种疾病,随后5个亚组分别针对在院具体患者进行病史采集与查体。通过病历书写、理论考核、体格检查考核及学员评价分析教学效果。采用SPSS 26.0进行卡方检验(或Fisher精确检验)、Mann-Whitney U 检验。 结果 两组在理论考核上差异无统计学意义。试验组通过对SP进行病史采集,其病史采集信息全面、采集过程流畅,特别是在主要症状及其特点、诱因、加重缓解因素、伴随与鉴别症状等方面正确率高于对照组。通过对乳腺视诊触诊模拟系统进行体格检查操作,试验组在乳房、乳头及腋窝淋巴结触诊的正确率方面高于对照组。学员教学评价分析提示,试验组教学效率提高,学员满意度提升(满意率:92.73% vs. 76.36%)。 结论 将SP及乳房视诊触诊模拟系统相结合应用于乳腺外科见习教学,既可保护临床患者的隐私性,又可提升教学效果,可在乳腺外科的临床教学中推广应用。Objective To explore the application effects of standardized patient(SP)and breast visual palpation simulation system on clinical probation of breast surgery for medical students.Methods A total of 110 students were randomly divided into experimental group and control group,and each group was further divided into 5 subgroups.In the experimental group,SP scripts of five common diseases in breast surgery department were designed according to the syllabus before probation,and the teachers were trained.During the probation,we first talked about the characteristics of disease diagnosis and treatment,and then the five subgroups collected the history of the disease according to the SP of different diseases mentioned above,and checked the corresponding lesions on the breast visual palpation simulation system.In the physical examination,SP responded to the students'questions.The control group also talked about the above-mentioned five diseases during the probation,and then the five subgroups carried out history collection and physical examination for specific patients in the hospital.Finally,the teaching effects were analyzed through medical record writing,theoretical examination,physical examination and student evaluation.SPSS 26.0 was used for chi-square test(or Fisher exact test)and Mann-Whitney U test.Results There was no significant difference in the theoretical examination between the two groups.It was demonstrated that the correct rate of experimental group was significantly higher than that of the control group in medical history collection,especially in the main symptoms,incentives,aggravation and remission factors,accompanying and differential symptoms and so on.And the positive results of breast,nipple and axillary lymph node palpation in the experimental group were significantly higher than those in the control group through the physical examination operation of breast visual palpation simulation system.The analysis of students'evaluation showed that the teaching efficiency of the experimental group increased,

关 键 词：标准化病人 乳房视诊触诊模拟系统 乳腺外科 见习 

分 类 号：R6[医药卫生—外科学]