以临床案例为导向培养急诊科住培医师临床思维能力的探索与实践  

Exploration and practice of cultivating clinical thinking ability of emergency department resident physicians guided by clinical cases

作　　者：连洁[1] 吴斌[1] 赵光举[1] 陈隆望[1] 唐亚慧[1] 王逸平 胡系意 卢中秋[1] Lian Jie;Wu Bin;Zhao Guang-ju;Chen Long-wang;Tang Ya-hui;Wang Yi-ping;Hu Xi-yi;Lu Zhong-qiu(Emergency Department,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院急诊科,浙江温州325000

出　　处：《中国急救医学》2023年第5期416-420,共5页Chinese Journal of Critical Care Medicine

基　　金：国家住院医师规范化培训急诊科重点专业基地。

摘　　要：目的 以临床案例为导向,探索提升急诊科住培医师临床思维能力的教学方法。方法 选取温州医科大学附属第一医院急诊科专业基地培训的2017~2022届住院医师104名,根据是否通过临床案例教学法培训分为未培训组(n=63),培训组(n=41)。分析两组住培医师自主学习能力、写作能力、临床思维能力及年度考核、结业考核成绩。结果 住培第一年末及结业后住培医师自我感知自主学习能力、写作能力、病史采集能力、体格检查能力及技能操作能力均有所提升,且差异有统计学意义(t值分别为18.19、14.68、11.61、20.82、19.59,P<0.001)。没有通过临床案例教学法培训的已结业住培医师自我感知自主学习能力、写作能力、病史采集能力、体格检查能力及技能操作能力较通过临床案例教学法培训的已结业住培医师差。培训第二年年度考核临床思维能力成绩较第一年好(分:82.23±1.69 vs.80.70±1.52;t=2.71,P=0.016),结业考核临床思维能力成绩较第二年好(分:84.20±2.60 vs.82.23±1.69;t=2.22,P=0.043)。结论 以临床案例为导向的教学方法在一定程度上有助于提升急诊科住培医师的临床思维能力,为不断完善我国急诊科住院医师规范化培训提供参考,推动我国住院医师规范化培训工作不断走向进步。Objective To explore the teaching methods to improve clinical thinking ability of emergency department resident doctors based on clinical cases.Methods A total of 104 resident physicians from 2017 to 2022 who were trained in the professional base of the emergency department of the First Affiliated Hospital of Wenzhou Medical University were selected and divided into the untrained group(n=63) and the trained group(n=41) according to whether they were trained by the clinical case teaching method.The independent learning ability,writing ability,clinical thinking ability,annual assessment and final examination results of resident physicians in the two groups were analyzed.Results At the end of the first year of residential training and after the completion of residential training,the self-perception self-learning ability,writing ability,medical history collection ability,physical examination ability and skill operation ability of residential training physicians were improved,and the differences were statistically significant(t values were 18.19,14.68,11.61,20.82,19.59,P<0.001).The self-perception self-learning ability,writing ability,medical history collection ability,physical examination ability and skill operation ability of the completed residential training physicians without the clinical case teaching method were worse than those with the clinical case teaching method.The results of clinical thinking ability in the annual assessment of the second year of training were better than those in the annual assessment of the first year(scores:82.23±1.69 vs.80.70±1.52,t=2.71,P=0.016),and the results of clinical thinking ability in the assessment of completion were better than those in the annual assessment of the second year(scores:84.20±2.60 vs.82.23±1.69,t=2.22,P=0.043).Conclusions The clinical case-oriented teaching method can help to improve the clinical thinking ability of emergency department resident doctors to a certain extent,provide the references for the continuous improvement of standardized training for

关 键 词：临床案例 急诊科 临床思维 住院医师规范化培训 

分 类 号：R-4[医药卫生] C975[经济管理—劳动经济]