翻转课堂和同伴互助学习的教学方式都具有让学习者更加灵活、主动、深度参与教学的优势。本研究以华中科技大学同济医学院附属同济医院麻醉科74名住院医师规范化培训(简称住培)学员的超声引导穿刺训练课程为例,阐述了翻转课堂联合同伴互助学习在本课程中的设计与实施。通过问卷调查、操作评价从个人感受、学习成绩和行为改变3个方面评价教学效果。结果显示,在回收的71份有效课堂教学反馈表中,71名(100.0%)学员对课堂训练满意;训练后与训练前比较,住培学员的自信心评分增加[7(2)分比4(3)分,P＜0.001];穿刺成功的操作时间缩短[37.5(35.5)秒比80.5(70.0)秒, P＜0.001],穿刺时调整进针次数减少[1(1)次比(3(2)次,P＜0.001],穿刺针显影得分增加[10(0)分比6(3)分, P＜0.001];课程结束2周后随访回收的56份有效问卷中,有50名(89.3%)学员已经在临床实践中运用超声引导下穿刺技术,其中49名(98.0%)学员在临床工作中超声引导穿刺成功。翻转课堂联合同伴互助学习用于住培学员超声引导穿刺课程有助于提高其教学满意度和操作自信心,有助于提高其超声引导穿刺操作成绩和临床操作技能。

Both flipped classroom and peer assisted learning have their advantages on making learners more flexible, active and deeply involved in learning. This study described the design and implementation of flipped classroom combined with peer-assisted learning in ultrasound-guided puncture training course, taking standardized training resident physicians in department of anesthesiology, Tongji Hospital, Huazhong University of Science and Technology as an example. Through questionnaire and operation evaluation, the teaching effect is evaluated from three aspects: personal perception, academic achievements, and behavioral changes. The results showed that 71 students (100.0%) were satisfied with the classroom training in 71 effective classroom teaching feedback forms. After training, compared with before training, residents' self-confidence in completing ultrasound-guided puncture operation was improved [7(2) points vs. 4(3) points, P<0.001]. The operation time of successful puncture was shortened [37.5(35.5)s vs. 80.5(70.0)s, P<0.001], and the number of adjusting needles was reduced [1(1) vs. 3(2)], and the development score of puncture needle was increased [10(0) points vs. 6(3) points, P<0.001]. Of the 56 valid questionnaires collected 2 weeks after the course ended, 50 (89.3 %) trainees had used ultrasound-guided puncture technique in clinical practice, of which 49 (98.0 %) trainees had successful performance. The flipped classroom and peer assisted learning used in the ultrasound guided puncture course for residential trainees can help to improve their teaching satisfaction and perceived self-confidence, and help to improve their performance of clinical skills.