目的 探讨混合教学模式在脊柱内镜手术培训中的应用效果。方法 采用问卷调查方法,选择2020年1月至6月在北京大学第三医院疼痛科进修脊柱内镜手术技术的21位学员为研究对象,对其进行随访调查,探讨混合教学模式的效果、学员的满意度和疫情对进修学习的影响程度。结果 调查发现,经过3个月的进修学习并返回原单位工作之后,42.9%(9/21)的学员可以独立开展脊柱内镜手术,57.1%(12/21)的学员未能独立开展手术,其原因从高到低排列依次为:手术器械缺乏、科室不支持、患者缺乏信任以及缺乏病源,在未能独立开展手术的学员中有10名学员有信心独立开展内镜手术。所有学员对疫情期间混合教学模式满意度高,90.5%(19/21)学员认为疫情对本次学习未造成较大影响,57.2%(12/21)的学员认为观摩手术视频帮助最大。结论 混合教学模式在脊柱内镜手术培训中取得很好的效果,具有受疫情影响小、学员满意度高和可重复学习的特点,是一种值得借鉴和推广的教学模式。
Objective To explore the effect of a hybrid teaching mode in the training of endoscopic spinal surgery. Methods A questionnaire survey was adopted. Twenty-one learners, who were trained for endoscopic spinal surgery skills in pain medicine department of Peking University Third Hospital from January to June in 2020, were included in this survey to investigate the teaching effect of the hybrid teaching mode, the satisfaction of learners, and the impact of COVID-19's pandemic on the training. Results The hybrid teaching methods consisted of invasive surgery video, online teaching, simulating training and clinical practices of minimally invasive surgery. The results of survey showed that 42.9%(9/21) of the trainees were able to carry out endoscopic spinal surgery independently, and the remaining 57.1%(12/21) of the learners failed to do that even after 3 months of training. The reasons to explain this result limited resources of surgical instruments support from director of department, poor trust from patients and less clinical cases. Among the trainees who were not able to perform the surgery independently, ten of them do have the confidence to carry out endoscopic surgery on their own. All the trainees were satisfied with the hybrid training mode and 90.5%(19/21) of them thought that the COVID-19's pandemic had no significant impact on this training. Among the four teaching methods, 57.2%(12/21) of trainees thought that observation of surgery videos was the most helpful method. Conclusions The hybrid training mode during COVID-19's pandemic achieved a good result in endoscopic spinal surgery training. It was characterized by few negative impacts from COVID-19 pandemic, high satisfaction from trainees and repeatable training method.
[1] Huang Y, Yin J, Sun Z, et al. Percutaneous endoscopic lumbar discectomy for LDH via a transforaminal approach versus an interlaminar approach: a meta-analysis[J]. Orthopade, 2020,49(4):338-349. DOI: 10.1007/s00132-019-03710-z.
[2] 李彦, 商澜镨, 刘晓光, 等. 经皮脊柱内镜手术教学培训模式的探索[J].中国疼痛医学杂志,2019,25(3):199-203. DOI: 10.3969/j.issn.1006-9852.2019.03.010.
[3] Chang AY, Cullen MR, Harrington RA, et al. The impact of novel coronavirus COVID-19 on noncommunicable disease patients and health systems: a review[J]. J Intern Med, 2021,289(4):450-462. DOI: 10.1111/joim.13184.
[4] Palmer K, Monaco A, Kivipelto M, et al. The potential long-term impact of the COVID-19 outbreak on patients with non-communicable diseases in Europe: consequences for healthy ageing[J]. Aging Clin Exp Res, 2020,32(7):1189-1194. DOI: 10.1007/s40520-020-01601-4.
[5] 吕卓敏, 翟丽娜, 李超, 等. 疼痛微创介入治疗临床教学方法初探[J].医学影像学杂志,2018,28(6):1036-1038.
[6] Grech S, Borg JN, Cuschieri S. Back pain: an aftermath of Covid-19 pandemic? A Malta perspective[J]. Musculoskeletal Care, 2021:1-6.DOI: 10.1002/msc.1574.
[7] 董新春, 杨纯生, 贾杰, 等. 多元化教学模式在《康复疗法学》教学中的应用[J].中国康复医学杂志,2009,24(12):1126-1127. DOI: 10.3969/j.issn.1001-1242.2009.12.021.
[8] 张晓滨, 苏巧斌, 曾诚, 等. 多元化教学模式在肌骨超声教学中的应用[J].中国继续医学教育,2020,12(32):42-45. DOI: 10.3969/j.issn.1674-9308.2020.32.012.
[9] 刘敏杰, 于淑梅, 张涛. 浅谈多元化教学在老年护理学课程中的应用[J]. 试题与研究, 2020(31):100-101.
[10] 马琳, 梁沛枫, 潘东峰, 等. 新冠肺炎疫情期间某互联网医院诊疗现状及患者满意度分析[J].宁夏医学杂志,2020,42(7):631-633. DOI: 10.13621/j.1001-5949.2020.07.0631.
[11] 卢永平, 张勤, 杨萍, 等. 新冠肺炎疫情防控期间北京协和医学院在线教学调查与分析[J].高校医学教学研究(电子版),2020,10(3):8-14. DOI: 10.3868/j.issn.2095-1582.2020.03.002.
[12] 桂士良, 崔腾腾, 赵健, 等. 新型冠状病毒肺炎疫情下临床医学线上教学面临问题的初步探讨[J].广东化工,2020,47(16):221-222.
[13] 徐小琴,兰羽,王运武. 新冠肺炎疫情下在线教育的机遇与挑战[J]. 现代商贸工业,2020,41(32):129-130. DOI:10.19311/j.cnki.1672-3198.2020.32.057.
[14] 梅虹霞, 胡明品, 黄葱葱, 等. 线上线下混合式教学方法在临床麻醉学教学中的应用研究[J].中华医学教育杂志,2019,39(11):843-846. DOI: 10.3760/cma.j.issn.1673-677X.2019.11.010.
[15] 苏海红,林僖. 高校"翻转课堂"教学模式改革的探索和应用研究[J]. 上海管理科学,2020,42(5):122-125.
[16] Wang H, Huang B, Li C, et al. Learning curve for percutaneous endoscopic lumbar discectomy depending on the surgeon's training level of minimally invasive spine surgery[J]. Clin Neurol Neurosurg, 2013,115(10):1987-1991. DOI: 10.1016/j.clineuro.2013.06.008.
[17] Vallée A, Blacher J, Cariou A, et al. Blended learning compared to traditional learning in medical education: systematic review and meta-analysis [J]. J Med Internet Res, 2020, 22(8):e16504. DOI: 10.2196/16504.
