情景导入—循证—团队—拓展(situation-evidence-team-development,SETD)教学方式是中南大学湘雅三医院外科学教研室自创的一种教学方式,旨在短学时的技能训练中提高学生的学习兴趣与技能掌握程度。本研究以中南大学湘雅医学院非临床医学专业五年制本科生的外科学创伤止血(stop the bleed,STB)训练为例,阐述了SETD教学方式在STB训练中的设计和实施。通过学生训练后理论考核成绩和课前课后止血操作技能自信度评价教学效果。结果显示,学生STB理论考核优秀率(≥80分)为92.6%(50/54),及格率(≥60分)为100.0%(54/54);采用Wilcoxon符号秩检验比较学生课前课后操作技能自信度,发现学生课后的压迫止血自信度从(3.22±1.21)分提高到(3.96±0.69)分、包扎止血自信度从(2.78±1.22)分提高到(4.07±0.86)分、止血带止血自信度从(2.67±1.33)分提高到(4.09±0.76)分,其差异均具有统计学意义(均P＜0.001)。可见,SETD教学方式能够在保证理论学习效果的基础上,提高学生止血操作技能自信度,进而提升短学时技能训练的整体效果。
Situation-evidence-team-development (SETD) is a new teaching mode created by surgical teaching and research department in The Third Xiangya Hospital of Central South University. The goal of this teaching method was to stimulate students' learning interest and to improve the quality of skill training in a short term course. This study took the stop the bleed (STB) training in surgery for five-year program non-clinical medicine undergraduates as an example. The article described the design and implementation of STB training based on SETD teaching method. The learning outcomes were evaluated by examination score and questionnaires survey before and after the training. The results showed that the excellent rate (≥80 points) of the theoretical examination reached 92.6%(50/54) and the passing rate (≥60 points) was 100.0%(54/54); Wilcoxon signed-rank test was used to compare the differences between students' confidence level on homostasis skill before and after the training. The results showed that students' confidence level raised from (3.96±0.69) to (3.22±1.21) in pressure homostasia, from (4.07±0.86) to (2.78±1.22) in bandage homeostasia and from (4.09±0.76) to (2.67±1.33) in tourniquet homostasia respectively. The difference were all statistically significant (all P<0.001). In conclusion, the SETD teaching method can ensure the effectiveness of theoretical learning while improving students' confidence level in hemostasis skills, thus enhancing the overall effect of short-term skills training.
[1] Ciraulo LA, Ciraulo NA, Ciraulo RS, et al. American college of surgeons committee on trauma “stop the bleed program”: quantifying the impact of training upon public school educators readiness[J]. Am Surg, 2020,86(11):1520-1524. DOI: 10.1177/0003134820933550.
[2] Lei R, Swartz MD, Harvin JA, et al. Stop the bleed training empowers learners to act to prevent unnecessary hemorrhagic death[J]. Am J Surg, 2019,217(2):368-372. DOI: 10.1016/j.amjsurg.2018.09.025.
[3] SCHROLL R, SMITH A, MARTIN M S, et al. Stop the Bleed Training: Rescuer Skills, Knowledge, and Attitudes of Hemorrhage Control Techniques [J]. J Surg Res, 2020, 245: 636-42.DOI:
[4] AlSabah S, Al Haddad E, AlSaleh F. Stop the bleed campaign: a qualitative study from our experience from the middle east[J]. Ann Med Surg (Lond), 2018,36:67-70. DOI: 10.1016/j.amsu.2018.10.013.
[5] Schroll R, Smith A, Zeoli T, et al. Efficacy of medical students as stop the bleed participants and instructors[J]. J Surg Educ, 2019,76(4):975-981. DOI: 10.1016/j.jsurg.2019.02.006.
[6] 牟飞飞, 李晓倩, 于超. 微课教学结合案例式PBL教学在肿瘤科临床护理带教中的应用[J].齐鲁护理杂志,2019,25(7):133-135. DOI: 10.3969/j.issn.1006-7256.2019.07.048.
[7] Bobko JP, Badin DJ, Danishgar L, et al. How to stop the bleed: first care provider model for developing public trauma response beyond basic hemorrhage control[J]. West J Emerg Med, 2020,21(2):365-373. DOI: 10.5811/westjem.2019.11.44887.
[8] Muret-Wagstaff SL, Faber DA, Gamboa AC, et al. Increasing the effectiveness of “stop the bleed” training through stepwise mastery learning with deliberate practice[J]. J Surg Educ, 2020,77(5):1146-1153. DOI: 10.1016/j.jsurg.2020.03.001.
[9] Zhao KL, Herrenkohl M, Paulsen M, et al. Learners' perspectives on stop the bleed: a course to improve survival during mass casualty events[J]. Trauma Surg Acute Care Open, 2019,4(1):e000331. DOI: 10.1136/tsaco-2019-000331.
[10] 张卫社, 邓佑霞, 吴佳捷. 在临床见习中培养学生临床科研思维的体会[J].中国现代医学杂志,2003,13(14):61-61. DOI: 10.3969/j.issn.1005-8982.2003.14.069.
[11] 冒山林,曹隽.止血带的急诊应用专家共识[J].临床急诊杂志,2020,21(06):429-436. DOI:10.13201/j.issn.1009-5918.2020.06.002.
[12] JONES A R, BROWN M R, ESSLINGER A, et al. Evaluation of “Stop the Bleed” training among K-12 faculty and staff in Alabama [J]. Public Health Nurs, 2019, 36(5): 660-6.DOI:
