不同问诊对象在病史采集教学中的应用效果比较

doi:10.3760/cma.j.cn115259-20220916-01186

摘要/Abstract

摘要： 目的探讨3种不同问诊对象在病史采集实验课教学中的应用效果,为进一步改进教学方法提供依据。方法 2022年3月选取贵州医科大学2019级口腔医学专业的183名学生为研究对象,采用随机数字表法将其分为3组,分别对应以患者作为问诊对象的真实患者(real patient,RP)组、以学生作为问诊对象的学生标准化病人(standardized patient,SP)组和以教师作为问诊对象的教师SP组,病史采集实验课教学后对3组学生进行病史采集和病历书写考核,采用单因素方差分析和卡方检验比较组间差异。结果 3组学生的病史采集理论考核成绩由高到低依次为教师SP组[(81.07±3.66)分]、学生SP组[(79.51±4.25)分]和RP组[(77.62±5.21)分],其差异具有统计学意义(F=9.27,P＜0.001),病历书写成绩由高到低依次为RP组[(75.62±7.19)分]、教师SP组[(75.49±6.65)分]和学生SP组[(74.39±6.04)分],其差异无统计学意义(F=0.63,P=0.534)。结论在病史采集训练中,不同问诊对象学生获益不同。在进行病史采集教案设计时,可以根据需求选择相应的对象。

关键词: 医学生, 病史采集, 标准化病人, 教学方法

Abstract: Objective To study the students′ satisfaction with the training course of medical history collection for different interview subjects, and provided further improvement of teaching methods. Methods 183 students majoring in stomatology in grade 2019 from Guizhou Medical University were divided into 3 groups by random number table method: the real patient (RP) group with real patients as interview objects, the student standardized patient (SP) group with students as interview objects and the teacher SP group with teachers as interview objects. After the course, all groups of students were assessed by medical history collection and medical recond writing.One-way ANOVA and Chi-square test were used to compare the differences between the groups. Results The scores of medical record writing in three groups from high to low were teacher SP group [(81.07±3.66) points], student SP group [(79.51±4.25) points] and RP group [(77.62±5.21) points], and the difference was statistically significant (F=9.27,P＜0.001). Then scores of medical record writing from to low were RP group [(75.62±7.19) points], teacher SP group [(75.49±6.65) points] and student SP group [(74.39±6.04) points], and the difference was not statistically significant (F=0.63,P=0.534). Conclusions Students gain different benefits from medical history training through different interview objects. When designing teaching plans for medical history collection, the corresponding methods can be selected according to their own needs.

Key words: Medical students, Medical history collection, Teacher standard patient, Student standard patient, Real standard patient

中图分类号:

韦盈盈, 廖景峰, 吴代琴, 唐连涛, 郑红梅, 陈炳秀, 张慧玲. 不同问诊对象在病史采集教学中的应用效果比较[J]. 中华医学教育杂志, 2023, 43(7): 513-516.

Wei Yingying, Liao Jingfeng, Wu Daiqin, Tang Liantao, Zheng Hongmei, Chen Bingxiu, Zhang Huiling. Comparison of teaching effect in history taking course with three interview subjects[J]. Chinese Journal of Medical Education, 2023, 43(7): 513-516.

参考文献

[1] Peterson MC, Holbrook JH, Von Hales D, et al. Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses[J]. West J Med, 1992,156(2):163-165.
[2]Sandler G. The importance of the history in the medical clinic and the cost of unnecessary tests[J]. Am Heart J, 1980,100(6 Pt 1):928-931. DOI: 10.1016/0002-8703(80)90076-9.
[3]张振玲, 朱保群. 我国医患关系现状研究综述[J].卫生职业教育,2021,39(5):155-157.
[4]雷晓华, 陈国栋. 健康中国背景下医学生医患沟通能力提升探索[J].中国医药导报,2022,19(6):187-189.
[5]李彩丽, 刘岳, 马进, 等. 三种方式在诊断学问诊见习教学中的比较应用[J].中国高等医学教育,2017,(8):110-111. DOI: 10.3969/j.issn.1002-1701.2017.08.058.
[6]张娇燕, 洪钰龙, 王婧瑶, 等. 我国标准化病人研究的主题分析与热点探索[J].循证护理,2022,8(13):1786-1790. DOI: 10.12102/j.issn.2095-8668.2022.13.017.
[7]Barrows HS. An overview of the uses of standardized patients for teaching and evaluating clinical skills. AAMC[J]. Acad Med, 1993,68(6):443-451; discussion 451-453. DOI: 10.1097/00001888-199306000-00002.
[8]樊慧峰, 郑锐丹, 龚四堂. 标准化病人结合形成性评价教学法在儿科教学中的应用[J].中国实用儿科杂志,2019,34(6):534-536. DOI: 10.19538/j.ek2019060621.
[9]曾满秀, 钟清玲. 标准化病人和简易标准化病人在护理教学中的应用(综述)[J].科学中国人,2017,(4Z)
[10]吴雪. 简易标准化病人在基础护理技术课程教学中的应用研究[J].科技资讯,2017,15(35):152,154. DOI: 10.16661/j.cnki.1672-3791.2017.35.152.
[11]李翠芳, 袁琼婧, 王维, 等. 微课联合教师标准化病人对教学效果的影响[J].中国继续医学教育,2022,14(6):90-93. DOI: 10.3969/j.issn.1674-9308.2022.06.024.
[12]杨秀丽, 孙海燕, 郭康, 等. 教师标准化患者联合迷你临床演练评估在心血管内科临床教学中的应用[J].新乡医学院学报,2019,36(3):299-300. DOI: 10.7683/xxyxyxb.2019.03.024.
[13]安宜沛, 王永霞, 朱初麟, 等. 教师扮演标准化病人在心内科临床带教中的应用[J].卫生职业教育,2019,37(23):89-90.
[14]赵广阳, 曲红玉, 关雪莲, 等. 临床模拟教学系统和参与式教学方法在住院医师规范化培训中的应用[J].中国现代医生,2017,55(13):132-134,138.
[15]Keifenheim KE, Petzold ER, Junne F, et al. Peer-assisted history-taking groups: a subjective assessment of their impact upon medical students′ interview skills[J]. GMS J Med Educ, 2017,34(3):Doc35. DOI: 10.3205/zma001112.
[16]Burgess A, Goulston K, Oates K. Role modelling of clinical tutors: a focus group study among medical students[J]. BMC Med Educ, 2015,15:17. DOI: 10.1186/s12909-015-0303-8.
[17]Lockspeiser TM, O′Sullivan P, Teherani A, et al. Understanding the experience of being taught by peers: the value of social and cognitive congruence[J]. Adv Health Sci Educ Theory Pract, 2008,13(3):361-372. DOI: 10.1007/s10459-006-9049-8.
[18]Nelson AJ, Nelson SV, Linn AM, et al. Tomorrow′s educators … today? Implementing near-peer teaching for medical students[J]. Med Teach, 2013,35(2):156-159. DOI: 10.3109/0142159X.2012.737961.