目的 探讨体外动态心脏模型与基于案例和问题学习(case and problem-based learning,CPBL)教学方法相结合在心脏超声科住院医师规范化培训(下文简称住培)中的应用效果。方法 采用试验对照研究方法,选取在南京医科大学附属无锡第二医院心脏超声科进行住培的80名学员为研究对象。将2019年9月至2020年8月入科的40名学员设为试验组,2018年9月至2019年8月入科的40名学员设为对照组。试验组接受体外动态心脏模型与CPBL相结合的教学方法,对照组接受常规教具与CPBL相结合的教学方法。比较两组学员出科时的考核成绩,并对两组学员进行教学满意度问卷调查。结果 试验组学员的理论考试成绩、读片成绩、操作考核成绩和人文素养成绩分别为(42.72±1.78)分、(43.00±1.91)分、(44.27±2.24)分、(43.37±2.35)分均高于对照组学员的(41.82±1.75)分、(41.55±2.26)分、(43.05±2.64)分、(41.57±2.48)分,其差异均具有统计学意义(均P<0.05)。问卷调查结果显示,试验组学员比对照组学员在“加深理论知识理解”[92.5%(37/40)比75.0%(30/40)]、“培养临床思维能力”[90.0%(36/40)比70.0%(28/40)]、“提高影像读片能力”[92.5%(37/40)比72.5%(29/40)]、“提高上机操作能力”[90.0%(36/40)比67.5%(27/40)]、“提高学习兴趣”[90.0%(36/40)比72.5%(29/40)]和“提高学习效率”[92.5%(37/40)比75.0%(30/40)]方面的选择比例高,差异均具有统计学意义(均P<0.05)。结论 体外动态心脏模型与CPBL相结合的教学方法用于心脏超声科住培,能够调动住院医师的主观能动性,有助于完成住培培养目标、提高住培的教学效果。

Objective To evaluate the effect of an in vitro dynamic cardiac model combined with CPBL(case and problem-based learning) in the residents' training of echocardiography. Methods Eighty residents who received standardized training in the department of echocardiography of Wuxi No.2 People's Hospital, Nanjing Medical University were selected as research objects. Experimental control method was used in this study. A total of 40 trainees recruited from September 2019 to August 2020 were selected as the experimental group and 40 trainees recruited from September 2018 to August 2019 were selected as the control group. The experimental group received in vitro dynamic cardiac model combined with CPBL, while the control group received traditional model combined with CPBL. After the training, students' examination scores of theory, image interpretation, practice skill and humanities were compared, and the investigation questionnaire on teaching satisfaction from students were evaluated. Results Examination scores of theory[(42.72±1.78)vs.(41.82±1.75)], image interpretation[(43.00±1.91)vs.(41.55±2.26)], practice skill[(44.27±2.24)vs.(43.05±2.64)] and humanities[(43.37±2.35)vs.(41.57±2.48)] in the experimental group were all significantly higher than those in the control group (all P<0.05). The results of questionnaire showed that the feedback of students on “deepen the understanding of theoretical knowledge” [92.5%(37/40)vs. 75.0%(30/40)],“cultivate clinical reasoning capacity”[90.0%(36/40)vs. 70.0%(28/40)], “improve image reading”[92.5%(37/40)vs. 72.5%(29/40)], “improve operation skill”[90.0%(36/40)vs. 67.5%(27/40)], “improve learning interest”[90.0%(36/40)vs. 72.5%(29/40)] and“improve learning efficiency”[92.5%(37/40)vs. 75.0%(30/40)] were significantly different (all P<0.05). Conclusion The teaching method of CPBL combined with the in vitro dynamic cardiac model used in the residents' training of echocardiography can mobilize the student's initiative, reach the goal of training with high quality and improve the outcomes of residents' standardized training.