基于标准化病人的医学实习生无创呼吸机考核方法的改进研究  

Research on Continuous Improvement of the Clinical Medical Students'Noninvasive Ventilator Examination Based on the Standardized Patient

作　　者：陈宏凡 张志坚[1,2] 游承劲 张清华[3] 高琴 CHEN Hongfan;ZHANG Zhijian;YOU Chengjin;ZHANG Qinghua;GAO Qin(Department of Emergency Medicine,People’s Hospital of Chongqing Ba’nan District,Chongqing 401320,China;Department of Critical Care Medicine,People’s Hospital of Chongqing Ba’nan District,Chongqing 401320,China;Department of Science and Education,People’s Hospital of Chongqing Ba’nan District,Chongqing 401320,China)

机构地区：[1]重庆市巴南区人民医院急诊科,重庆401320 [2]重庆市巴南区人民医院重症医学科,重庆401320 [3]重庆市巴南区人民医院科教科,重庆401320

出　　处：《中国继续医学教育》2022年第19期150-154,共5页China Continuing Medical Education

基　　金：重庆医科大学教育教学研究项目(JY180333);重庆医科大学教育教学研究重点项目(JY190207)。

摘　　要：目的在医学实习生培训的无创呼吸机考核中采用标准化病人(standardized patient,SP),以期将单纯技能操作考核转化为基于临床胜任力的考试。方法选择2019年6月—2020年6月重庆市巴南区人民医院的53名参加无创呼吸机考核的医学实习生、3名考官和3名SP为研究对象。在考核中设立模拟使用无创呼吸机的考站,设计SP模拟临床情境,应用考核评价量表对考核进行评价。比较考官与SP对医学实习生的评分结果,并做相关性分析。同时采用客观测量方法检验无创呼吸机使用效果。结果53名医学实习生对Ⅱ型呼吸衰竭的诊断过程及评估无创呼吸机治疗的实际有较大差异。考官与SP对医学实习生的多项评分上差异有统计学意义(P<0.05)。SP的评分在操作结果和操作后随访成绩间存在较高相关性(r=0.638,P=0.001),而考官的评分无相关性(r=-0.176,P=0.283);在操作后随访的各项成绩间,考官和SP的评分存在中等程度相关。结论在无创呼吸机考核中采用SP可以增加考核的真实性和可靠性,能够更有效地反映医学实习生的临床胜任力和实际操作结果。Objective To adopt standardized patients(SP)to participate in noninvasive ventilator assesment,in order to simulate the more realistic clinical situation,make the simple skill test turn to a comprehensive assesment which can communication skills.Methods A total of 53 clinical medical students who had been trained in the in the People’s Hospital of Chongqing Ba’nan District between June 2019 and June 2020 were enrolled in the study.And the research objects were three couples of examiner and SP.A test station of noninvasive ventilator was set up to simulate typeⅡrespiratory failure.SP was designed to simulate clinical situation and the assessment evaluation scale was applied to evaluate the assessment.The scoring results of medical interns by the examiner and SP were compared,and correlation analysis was performed.At the same time,the objective measurement method was used to test the effect of noninvasive ventilator.Results The Diagnostic procedures and time to treatment of noninvasive ventilator in the 53 clinical medical students were significantly.There were significant differences between examiners and SP on scores(P<0.05).There was a high correlation between the scores of the operation results and the followup results in SP evaluation,but the scores of the examiners were not relevant.The scores of the examiners and SP had moderate relationship in the postoperative follow-up results.Conclusion Using SP to simulate in the examination of typeⅡrespiratory failure can increase the authenticity and reliability of the test.It is more effective to reflect the clinical competency of clinical medical students and the comprehensive ability of actual operation results.

关 键 词：医学实习生 标准化病人 无创呼吸机 考核 Ⅱ型呼吸衰竭 评估 

分 类 号：G642[文化科学—高等教育学]