基于虚拟病人的阶梯式护理问诊训练模式的设计与应用

doi:10.3760/cma.j.cn115259-20250124-00096

中华医学教育杂志 ›› 2026, Vol. 46 ›› Issue (1): 47-52.DOI: 10.3760/cma.j.cn115259-20250124-00096

基于虚拟病人的阶梯式护理问诊训练模式的设计与应用

杜景榕¹, 王娟², 王子文³, 郑晶⁴, 朱晓雯⁵, 赵娟娟⁶, 李琨⁶

¹广州市第一人民医院眼科,广州 510180;
²广州中医药大学护理学院基础护理学教研室,广州 510006;
³暨南大学护理学院护理人文与社会学教研室,广州 510632;
⁴广东药科大学护理学院临床护理学教研室,广州 510006;
⁵暨南大学护理学院内科护理学教研室,广州 510632;
⁶中山大学护理学院内科护理学教研室,广州 510080

收稿日期:2025-01-24 出版日期:2026-01-01 发布日期:2025-12-31
通讯作者: 李琨, Email: likun22@mail.sysu.edu.cn
基金资助:
2019年国家自然科学基金面上项目(71974213);2022年广东省本科高校教学质量与教学改革工程建设项目(粤教高函〔2023〕4号)

Design and application of a stepwise nursing history-taking training model based on virtual patients

Du Jingrong¹, Wang Juan², Wang Ziwen³, Zheng Jing⁴, Zhu Xiaowen⁵, Zhao Juanjuan⁶, Li Kun⁶

¹Ophthalmology Department, Guangzhou First People's Hospital, Guangzhou 510180, China;
²Department of Basic Nursing, School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou 510006, China;
³Department of Nursing Humanities and Sociology, School of Nursing, Jinan University, Guangzhou 510632, China;
⁴Department of Clinical Nursing, School of Nursing, Guangdong Pharmaceutical University, Guangzhou 510006, China;
⁵Department of Internal Medicine Nursing, School of Nursing, Jinan University, Guangzhou 510632, China;
⁶Department of Internal Medicine Nursing, School of Nursing, Sun Yat-sen University, Guangzhou 510080, China

Received:2025-01-24 Online:2026-01-01 Published:2025-12-31
Contact: Li Kun, Email: likun22@mail.sysu.edu.cn
Supported by:
2019 National Natural Science Foundation of China (Grant No. 71974213); 2022 Undergraduate Teaching Quality and Teaching Reform Engineering Construction Project of Guangdong Province (Guangdong Education High Letter〔2023〕4)

摘要/Abstract

摘要： 目的构建基于虚拟病人(virtual patient, VP)的阶梯式护理问诊训练模式并评价其应用效果。方法 基于护理问诊的培养规律,本研究构建了一种从单一症状问诊过渡到综合病例问诊的阶梯式VP训练模式。3所大学护理学专业392名本科生于2020年3月至2022年6月参与本研究。2019级206名学生作为试验组接受阶梯式VP问诊训练模式教学,首先在基础课程,即健康评估课程阶段进行VP症状问诊练习,后续在专业课程,即内科护理学课程阶段进行VP病例问诊练习。2018级186名学生作为对照组接受传统问诊教学。数据收集分别在健康评估课程初期(T₀)、健康评估课程结束(T₁)和内科护理学课程结束(T₂)时进行。采用广义估计方程对结局指标进行统计分析。结果 试验组学生自评问诊能力评分在T₁和T₂时分别提高2.24分和3.28分,与对照组相比,其评分变化差异均具有统计学意义(T₁:P=0.04,T₂:P=0.03)。试验组学生评判性思维评分在T₁和T₂时分别提高3.26分和4.60分,与对照组相比,其评分变化差异仅在T₂时有统计学意义(T₁:P>0.05,T₂:P<0.001)。两组学生支持性沟通评分变化在T₁、T₂时差异均无统计学意义(均P>0.05)。结论 阶梯式VP问诊训练模式可以显著提高学生的问诊能力和评判性思维水平。

关键词: 护理学, 虚拟病人, 阶梯式教学, 问诊能力, 沟通能力, 评判性思维

Abstract: Objective To design a virtual patient (VP)-based stepwise history-taking training model and to evaluate its effectiveness. Methods Based on the natural progression of history-taking ability training, this study developed a VP-based stepwise training model that transitions from single-symptom history to comprehensive case history. A total of 392 nursing undergraduates participated from March 2020 to June 2022. The grade 2019 of 206 students formed the experimental group and underwent stepwise VP history-taking training: symptom history-taking during the basic health assessment course and case history-taking during the professional internal medicine nursing course. The grade 2018 of 186 students received traditional teaching. Data were collected at the beginning of the health assessment course (T₀), the end of the health assessment course (T₁), and internal medicine nursing courses (T₂). Due to the data not following a normal distribution, Generalized Estimating Equations were used to conduct statistical analysis on the outcome indicators. Results The experimental group's self-assessed history-taking scores increased by 2.24 points at T₁ and 3.28 points at T₂; the between-group differences in score change were statistically significant at both time points (T₁:P =0.04; T₂: P=0.03). The experimental group's critical thinking scores increased by 3.26 points at T₁ and 4.60 points at T₂; the between-group difference in score change was statistically significant only at T₂ (T₁: P>0.05; T₂: P< 0.001). The difference in supportive communication score changes of two groups was not significant at T₁ and T₂ (P>0.05). Conclusions The stepwise VP history-taking training model can significantly improve students' history-taking skills and critical thinking abilities.

Key words: Nursing, Virtual patient, Stepwise teaching, History-taking skill, Communication skill, Critical thinking

中图分类号:

R-05

杜景榕, 王娟, 王子文, 郑晶, 朱晓雯, 赵娟娟, 李琨. 基于虚拟病人的阶梯式护理问诊训练模式的设计与应用[J]. 中华医学教育杂志, 2026, 46(1): 47-52.

Du Jingrong, Wang Juan, Wang Ziwen, Zheng Jing, Zhu Xiaowen, Zhao Juanjuan, Li Kun. Design and application of a stepwise nursing history-taking training model based on virtual patients[J]. Chinese Journal of Medical Education, 2026, 46(1): 47-52.

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基于虚拟病人的阶梯式护理问诊训练模式的设计与应用

Design and application of a stepwise nursing history-taking training model based on virtual patients

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