临床路径在血液科临床教学中的应用评价  

Application Evaluation of Clinical Pathway-based Teaching Methods in Clinical Teaching of Hematology

作　　者：周泽平[1] 杨红[1] 刘月波[1] 刘琳[1] 张铀[1] 

机构地区：[1]昆明医科大学第二附属医院血液科,云南昆明650101

出　　处：《昆明医科大学学报》2014年第1期152-154,共3页Journal of Kunming Medical University

基　　金：国家自然科学基金资助项目(81260091;81170474);云南省教育厅-昆明医科大学联合专项基金资助项目(2013FB152);云南省高层次卫生技术人才培养计划资助项目(D-201216);云南省中青年学术及技术带头人后备人才培养计划资助项目(2013HB)

摘　　要：目的探讨基于临床路径的教学方法在血液科临床带教中的实施效果.方法将在血液科实习的本科生按照来科实习顺序非随机分组,实验组在教学过程中加入特发性血小板减少性紫癜(idiopathic thrombocytopenic purpura,ITP)临床路径作为教学工具,对照组以内科学第七版本科教材为基础进行教学,每组学生实习2周后出科时进行口头考试,并设计调查问卷进行现场调查.结果本研究中接受ITP临床路径培训的实验组共纳入32名实习医生,以内科学第七版教材为基础的对照组共纳入38名实习医生.2组间实习同学对ITP"病史询问要点、诊断标准和鉴别诊断的把握、实验室检查项目的选择"差异有统计学意义(P<0.01),实验组得分优于对照组;2组间关于"首选治疗方案问题"方面差异无统计学意义(P>0.05);但是对于"首选激素治疗2周内血小板计数仍低于20×109/L的患者下一步治疗"方面,对照组得分优于实验组(P=0.0003).调查问卷的结果显示临床路径组实习学生对于ITP临床教学方法的接纳程度为93.8%,开放式问题调查显示临床路径教学更为直观简洁,有利于实现标准化教学.结论将临床路径作为血液科实习医生的教学工具之一有利于学生更为清楚地理解该病种的诊治,具有可操作性,但需要结合教材进行深入讲解.Objective To investigate the effects of clinical pathway-based teaching methods in clinical teaching of hematology. Methods Interns, which studied in department of hematology, were classified non-randomized into two groups. The interns in experimental group received idiopathic thrombocytopenic purpura （ITP） clinical pathway-based teaching. And the interns in the control group received the seventh edition textbook of medicine-based traditional teaching. All interns were oral tested when they finished two weeks period clinical studied of hematology. Meanwhile, a questionnaire designed for clinical pathway-based teaching was included in this test only for the experimental group. Results There were 32 interns recruited in the group of clinical pathway-based teaching and 38 interns in the control group of traditional teaching. There were statistically significant differences between the two groups in the fields of the key points about history of diseases （ P= 0.0017）, assessment of diagnostic criteria and differential diagnosis （ P=0.0074）, selection of laboratory examination items （ P〈0.0001） for ITP. The group of clinical pathway-based teaching achieved higher scores than the control group. However, there was no statistically significant difference between the two groups in the field of selection of first-line treatment measure of ITP （P = 0.1155） . Moreover, the control group achieved higher scores than the group of clinical＆amp;nbsp;pathway-based teaching in the field of how to treat ITP patients with first-line treatment failure （ P=0.0003） . In addition,there were 93.8%interns in the experimental group accepted the new clinical pathway-based teaching tool in the survey. The open-ended question survey showed the clinical pathway teaching method was more simple, intuitive and standardizing than the traditional one. Conclusion The ITP clinical pathway, as an interns teaching tool of hematology, is helpful for understanding more clearly the diagnosis and treatment of ITP. However, an in-d

关 键 词：特发性血小板减少性紫癜 临床路径 教学 

分 类 号：R588.2[医药卫生—内分泌]