情景模拟教学应用于临床实习的模式探索和效果评价  

Model exploration and effect evaluation of application of situational simulation teaching in clinical clerkship

作　　者：熊静[1] 张婕[1] 李馨蕊[1] Xiong Jing;Zhang Jie;Li Xinrui(Department of Neurology,the Second Affiliated Hospital,Kunming Medical University,Kunming 650101,China)

机构地区：[1]昆明医科大学第二附属医院神经内科,昆明650101

出　　处：《医学教育管理》2023年第2期191-200,共10页Medical Education Management

基　　金：中华医学会医学教育分会中国高等教育学会医学教育专业委员会医学教育研究课题(20B0430);昆明医科大学教研教改课题(2021-JY-Y-070)。

摘　　要：目的探讨情景模拟教学应用于临床实习的模式,能否提高实习医师的迷你临床测试量表(Mini-CEX)成绩,提升实习医师的岗位胜任力。方法2021年2月-2022年2月年在昆明医科大学第二附属医院90名实习医师参加了此项研究。在神经内科实习期间,有45名实习医师入科时先参加为期2 d的情景模拟训练,包括临床情景模拟、角色扮演、神经疾病的病史询问和体格检查技能培训,之后跟随带教老师进行临床实习。另外45名实习医师作为对照组,入科即开始跟随带教老师临床实习。两组医师均在入科当天和出科当天进行两次Mini-CEX评价。结果入科时两组实习医师的Mini-CEX成绩均无显著差异。两组实习医师出科时Mini-CEX成绩比较,试验组在病史询问、体格检查、人文关怀、临床判断、卫教咨询和组织效能的综合表现优于对照组,试验组达到优秀率的学生多于对照组。结论以岗位胜任力为目标、有组织的情景模拟教学,以及反复进行临床实践,能够使总体临床技能在短期内发生显著提升。Objective To investigate whether application of the situational simulation teaching model in clinical clerkship improves Mini-CEX scores and post competencies of interns.Methods Ninety interns of the Second Affiliated Hospital,Kunming Medical University participated in this study.During their clerkship in the Department of Neurology,a group of 45 interns undertook a 2-day situational simulation training course consisting of clinical simulations,role-playing,neurology history taking,physical examination skills training,then followed their teachers for clinical practice.The control group of another 45 interns began clinical practice by accompanying their teachers upon entering the Department of Neurology.Both the intervention and control groups took comprehensive Mini-CEX evaluations,the first on the day of admission,and the second on the day of completion.Results There was no significant difference in Mini-CEX scores between the two groups when they entered the department.Mini-CEX evaluation performed at clerkship completion showed significant differences between the two groups,with intervention group scores being higher than those of the control group in history taking,physical examination,clinical judgment,health education consultation and organizational effectiveness.Conclusion The organized situational simulation teaching with the goal of post competency,followed by repeated clinical practice,can significantly improre the overall clinical skills in a short time.

关 键 词：本科医学教育 临床见习 病人模拟 模拟训练 角色扮演 结果评估 

分 类 号：R741[医药卫生—神经病学与精神病学] G642[医药卫生—临床医学]