医学本科生腰椎穿刺模拟训练学习曲线研究  

Investigation of the learning curves of simulation-based lumbar puncture training for medical undergraduates

作　　者：张毅[1] 余永胜[1] 王洁玲[1] 唐余燕[1] 陶然[1] 汤正好[1] 江红[1] 奚敏[1] 臧国庆[1] 

机构地区：[1]上海交通大学附属第六人民医院感染病科,上海200233

出　　处：《中华全科医学》2016年第1期140-143,共4页Chinese Journal of General Practice

基　　金：2013年度上海交通大学医学院医学教育研究项目(YB130910)

摘　　要：目的探讨医学本科生应用模拟人进行腰椎穿刺模拟训练的学习曲线并评价模拟训练的远期效果,从而为医学本科生腰椎穿刺模拟训练的安排和效果评估提供依据。方法 25名未接受过腰椎穿刺相关培训、无任何腰椎穿刺临床经验的医学本科生进行腰椎穿刺模拟训练,每位学生2周内在模拟人上进行7次模拟训练,对每次操作的操作错误(operation mistake,OM)、操作时间(operation time,OT)和操作信心(operation confidence,OC)进行评价,并根据上述3个变量分别绘制学习曲线。6个月后所有接受腰椎穿刺模拟训练的学生再接受1次模拟腰椎穿刺考核以评价腰椎穿刺模拟训练的远期效果。结果经过4次腰椎穿刺模拟训练,25名医学本科生的OM、OT和OC均明显改善(P<0.05)。在7次腰椎穿刺模拟训练中,OM与OT学习曲线在前5次操作中持续下降,但均在第5次操作后进入平台期;而OC学习曲线在前5次操作中持续上升,但在第5次操作后也进入平台期。6个月后的模拟腰椎穿刺考核结果与第7次腰椎穿刺模拟训练考核结果差异无统计学意义(P>0.05)。结论应用模拟人进行腰椎穿刺模拟训练可以显著提高医学本科生腰椎穿刺的操作技能,OM与OT学习曲线随操作次数的增加而持续下降,而OC学习曲线随操作次数的增加而持续上升,但均在第5次操作后进入平台期,即5次腰椎穿刺模拟训练就可以达到良好的效果。Objective To explore the learning curves of simulation-based lumbar puncture training and evaluate its long- term outcome,which can provide a basis for arrangements and effect assessments of simulated training for medical under- graduates. Methods Twenty-five medical undergraduates who had not received any relevant lumbar puncture training and had no clinical experience of lumbar puncture were enrolled in this study. Each participant performed seven supervised tri- als on the simulator in two weeks. Participants＇ performances were assessed by operation mistake （ OM）, operation time （OT） and operation confidence （ OC ）. Learning curves for each variable were generated. Long-term outcome of the simula- tion-based lumbar puncture training was measured six months later after the initial training on the simulator. Results Ob- vious improvements were noted in OM, OT, and OC among the first four trials（ P 〈 0.05 ）. The learning curves of OM and OT descended in the first five trials. However, the learning curve of OC ascended in the first five trials. Plateaus of OM, OT,and OC in the learning curves occurred in the fifth trial. There was no significant difference between the result of the retest performed six months later and that of the seventh trial（ P 〉 0.05 ）. Conclusion This study demonstrates that sim- ulation-based lumbar puncture training can significantly improve the individual＇ s skill. The learning curves of OM and OT descend with the numbers of operation,while the learning curve of OC ascends with the numbers of operation, but they all reach plateaus in the fifth operation. Good effect can be achieved by five trials.

关 键 词：医学本科生 腰椎穿刺 模拟训练 学习曲线 

分 类 号：R192[医药卫生—卫生事业管理]