中华医学教育杂志

中华医学教育杂志 ›› 2026, Vol. 46 ›› Issue (8): 610-614.DOI: 10.3760/cma.j.cn115259-20250424-00465

• 住院医师规范化培训 • 上一篇    下一篇

结构化病史采集工具在住院医师风湿类疾病病史采集教学实践中的应用

蔡剑飞1, 孙秦陇1, 鲍华芳1, 汪玲2   

  1. 1复旦大学附属华东医院风湿免疫科,上海 200040;
    2复旦大学医学教育研究所,上海 200032
  • 收稿日期:2025-04-24 发布日期:2026-07-29
  • 通讯作者: 汪玲, Email: lingwang@fudan.edu.cn

Application of a structured interview tools-taking tool in the teaching practice of medical history collection for rheumatic diseases among residents

Cai Jianfei1, Sun Qinlong1, Bao Huafang1, Wang Ling 2   

  1. 1Department of Rheumatology and Immunology, Huadong Hospital Affiliated to Fudan University, Shanghai 200040, China;
    2Institute of Medical Education, Fudan University, Shanghai 200032, China
  • Received:2025-04-24 Published:2026-07-29
  • Contact: Wang Ling, Email: lingwang@fudan.edu.cn

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摘要： 目的 探索结构化病史采集工具在住院医师风湿类疾病病史采集教学实践中的应用价值。方法 采用试验对照方法。选取2022年8月至2024年12月在复旦大学附属华东医院风湿免疫科轮转的3个年级批次共96名住院医师作为研究对象,以随机数字表法分为试验组和对照组各48名住院医师。试验组采用基于14项国内风湿病权威指南诊断路径所设计的结构化病史采集工具,覆盖现病史、既往史、个人史、婚育史、家族史5个维度,并通过小班化教学(每班2人)结合真实病例进行培训;对照组沿用传统病史采集教学方法。以两组医师病史采集完整性评分的学习曲线为主要指标评价教学效果。采用线性混合效应模型分析两组学习曲线变化。结果 两组医师共完成病史采集完整性评分共计26次。统计结果显示,教学分组与训练周期的交互效应具有统计学意义(χ2=643.778,df=4,P<0.001)。试验组医师学习速度参数k为0.187,高于对照组的0.120;试验组达80分合格线较对照组提前8次。结论 结构化病史采集工具有助于改善住院医师病史采集学习曲线,为风湿类疾病等依赖分类诊断的临床专科教学提供了可供参考的范式。

关键词: 风湿病学, 结构化病史采集工具, 住院医师, 病史采集教学

Abstract: Objective To explore the value of structured history-taking tools in teaching history-taking for rheumatic diseases during residency training. Methods A controlled trial was conducted. A total of 96 residents rotating through the Department of Rheumatology and Immunology at Huadong Hospital Affiliated to Fudan University from August 2022 to December 2024 were enrolled and randomly assigned to either the experimental group (n=48) or the control group (n=48) by random number table method. The experimental group received a structured history-taking tool designed based on the diagnostic pathways of 14 domestic authoritative guidelines for rheumatic diseases, covering five dimensions: present illness, past medical history, personal history, marital and reproductive history, and family history, with small-class teaching (two residents per class) combined with real clinical cases. The control group received traditional history-taking instruction. The learning curves of history-taking completeness scores of residents in both groups were used as the primary outcome to evaluate teaching effectiveness. Linear mixed-effects models were employed to analyze the changes in the learning curves between the two groups. Results A total of 26 history-taking completeness assessments were completed by residents in both groups. Statistical analysis revealed a statistically significant interaction effect between teaching group and training cycle (χ2=643.778, df=4, P<0.001). The learning rate parameter k was higher in the experimental group than in the control group (0.187 vs. 0.120), and the experimental group reached the 80-point proficiency threshold approximately 8 training cycles earlier than the control group. Conclusions The structured history-taking tool helps to improve the learning curve of history-taking, providing a referable paradigm for clinical specialties that rely on classification-based diagnosis, such as rheumatic diseases.

Key words: Rheumatology, Structured interview tools, Residents, Disease history collection

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