关键词: 重症监护, 进阶式教学, 重症医学, 营养支持, 住院医师

Abstract: Objective To explore the application of goal-oriented progressive teaching in the standardized critical care nutrition support training of the Global Leadership Initiative on Malnutrition (GLIM) for resident physicians. Methods From March 2024 to May 2025 at the Sichuan Academy of Medical Sciences, a total of 124 resident physicians on rotation in the intensive care unit (ICU) of Sichuan Provincial People's Hospital were selected as the research subjects. They were randomly divided into the experimental group and the control group, with 62 resident physicians in each group. The targeted-oriented progressive teaching method and the traditional teaching method were respectively adopted for the training of critical care nutrition support. After the teaching, the assessment results, questionnaire survey results, and the evaluation of the nutritional prescriptions issued for the patients under their care were compared to assess the corresponding teaching effects. The relevant data were analyzed using the χ² test, independent sample t-test, or Mann-Whitney U test. Results After the training, the total assessment score of the resident physicians in the experimental group was higher than that in the control group [(85.4±3.4) vs. (82.2±2.8), P<0.001]. The clinical thinking scores of the resident physicians in the advanced group after training were higher than those in the control group [(48.3±1.6) vs. (45.3±1.8), P<0.001]. Among the randomly selected nutritional treatment prescriptions in the Medical Data APP, the percentages of nutritional quality control items in both the advanced group and the control group increased compared with before. Among them, the nutritional screening was 100.0% in both groups. The initiation rate of 48-hour EN (The number of patients who initiated enteral nutrition within 48 hours after admission to the ICU / The total number of patients who met the criteria for enteral nutrition during the same period) in the experimental group was significantly higher than that in the control group (88.7% vs. 62.9%, P=0.007). The initiation rate of PN (The number of patients who started parenteral nutrition within one week after admission to the ICU / The total number of all patients who initiated nutritional support during the same period) support within one week was significantly lower than that of the control group (35.5% vs. 59.7%, P<0.001), while there was no statistically significant difference in the one-week calorie compliance rate (Number of patients who reached the target calorie intake on the 7th day of nutritional support / Total number of patients who received nutritional support during the same period and were supposed to undergo calorie assessment) between the two groups (74.2% vs. 61.3%, P=0.124). In terms of training effectiveness, the scores of knowledge acceptance, clinical thinking ability, training satisfaction, learning initiative, and teamwork ability of the trainees in the experimental group were all higher than those in the control group [(8.8±0.7) vs. (6.9±1.0),(8.8±0.5) vs. (6.9±0.9),(9.6±0.6) vs. (7.0±1.0),(8.7±0.6) vs. (7.2±0.9),(8.6±0.6) vs. (7.2±0.7), all P<0.001]. Conclusions The adoption of a goal-oriented and progressive teaching approach in the standardized training of critical care medicine helps to enhance the clinical thinking and practical skills of resident physicians in critical nutrition support, and improves the training outcome. This provides an effective path for them to systematically master and apply nutrition support techniques in clinical practice.

Key words: Intensive care, Advanced teaching, Critical care medicine, Nutritional support, Resident physicians