中华医学教育杂志 ›› 2018, Vol. 38 ›› Issue (3): 333-336.DOI: 10.3760/cma.j.issn.1673-677X.2018.03.004

• 教育方法 • 上一篇    下一篇

八年制临床医学专业学生肩关节前脱位手法复位学习曲线的研究

王永强, 李楠   

  1. 100191 北京大学第三医院骨科(王永强),流行病学教研室(李楠)
  • 收稿日期:2017-12-25 出版日期:2018-06-01 发布日期:2020-12-08
  • 通讯作者: 李楠,Email:linan917@163.com
  • 基金资助:
    国家自然科学基金项目(81701067)

Learning curves for reduction of shoulder dislocation using Hippocrates method by residents of eight-year program

Wang Yongqiang, Li Nan   

  1. Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China(Wang YQ); Department of Epidemiology, Peking University Third Hospital, Beijing 100191, China(Li N)
  • Received:2017-12-25 Online:2018-06-01 Published:2020-12-08
  • Contact: Li Nan, Email: linan917@163.com
  • Supported by:
    National natural science foundation(81701067)

摘要: 目的 探讨八年制临床医学专业学生采用手拉足蹬(Hippocrates)法整复肩关节前脱位的学习规律。方法 选择2015年12月至2017年12月在北京大学第三医院骨科轮转的北京大学2013级八年制临床医学专业10名学生为研究对象,由同一名高年资主治医师进行理论及实践教学。每名学生在教师指导下,采取Hippocrates法整复20例肩关节前脱位患者,计算每一次手法整复的累积和(CUSUM)值σ,使用R软件作出学习曲线;再采用线性回归过程拟合一元四次回归曲线,并估算该拟合学习曲线的95%置信区间。对该曲线的拟合曲线求导,得到学习曲线拟合线随重复次数变化的规律。采用最大选择检验法,基于实际CUSUM学习曲线,寻找CUSUM的最优分界点。结果 采用最大选择检验发现,操作次数为7次时为CUSUM上升的水平的分界点。结论 八年制临床医学专业学生训练7次后即可熟练掌握Hippocrates法手法整复肩关节前脱位。

关键词: 肩关节脱位, 复位, 医学生, 学习曲线, 研究

Abstract: Objective To determine the learning curve for reduction of shoulder dislocation utilizing Hippocrates method by medical students.Methods 10 residents were selected during their rotation in department of Orthopedics from December 2015 to December 2017.The training were operated by the same senior attending doctor. Each resident was required to reduce 20 dislocation cases. It was calculated the CUSUM(cumulative sum) for each procedure of these students and illustrated the learning curves by using R software. Then fitted regression cure by utilizing linear regression method, and estimated the 95% confidence interval. After taking derivation of the regression curve, it is possible to understand the regularity of learning curve accompany with attempts. At last, it could be identified the cut-off point for CUSUM increasing via the maximum selection test.Results Overall, 200 patients were enrolled in this study. Among these patients, 155 were male, and 45 were female. The age ranged from 16 to 80 years old. 153 patients were diagnosed with primary dislocation, while 47 cases with recurrent dislocation.The maximum selection test indicated the cut-off point for CUSUM increasing was 7.Conclusions It will take about 7 times training for a resident to manage Hippocrates method for reducing shoulder dislocation.

Key words: Dislocation of the shoulder, Reduction, Medical student, Learning curve, Study