近年来抗肿瘤药物快速发展,从而形成了大量的循证证据。高级别的证据被纳入临床指南,但并未满足真实世界中每个患者的实际需求,肿瘤内科专科医师需要对指南中未涉及但在临床中遇到的问题进行深入的循证思考。2019年10月至2023年3月,复旦大学附属中山医院肿瘤内科对接受专科规范化培训的17名医师进行了循证思维强化训练,重点培养其证据质量评价和数据提取分析的能力。本文阐述了该训练的设计和实施过程,并通过循证思维考核评价训练效果。每名专科医师至少接受了2次考核。结果显示,17名专科医师第二次考核的总平均分较第一次提高9.6分(P＜0.001),其中深度解读文献的能力提升最明显,第二次考核的平均分较第一次提高2.4分(P＜0.001)。我们初步建立了一套针对肿瘤内科专科医师循证思维强化训练的方法,有助于提高专科医师围绕临床问题深度解读文献、进而提取有效数据应用于临床的能力。
徐晓晶
,
王妍
,
郭曦
,
于珊
,
李倩
,
余一祎
,
崔越宏
,
周宇红
,
刘天舒
. 循证思维强化训练在肿瘤内科专科医师规范化培训中的应用探索[J]. 中华医学教育杂志, 2023
, 43(9)
: 692
-696
.
DOI: 10.3760/cma.j.cn115259-20221202-01518
In recent years, the rapid development of anti-tumor drugs has led to the accumulation of a large amount of evidence. High-level evidence has been incorporated into clinical guidelines but does not meet the needs of each patient in the real world. Oncology specialists need to conduct in-depth evidence-based thinking on issues that are encountered in clinic but not covered in the guidelines. From October 2019 to March 2023, the Oncology Department of Zhongshan Hospital Affiliated to Fudan University conducted intensive evidence-based thinking training for 17 physicians who were receiving standardized training for oncology specialists, focusing on developing their abilities in evaluating evidence quality, extracting and analyzing clinical data. This article elucidates the design and implementation process of the training and evaluates the training effect through evidence-based thinking assessment. Each physician has undergone at least 2 assessments. The results showed that the total average score of the 17 physicians in the second assessment increased by 9.6 points compared to the first assessment (P<0.001). The most significant improvement was observed in the ability to interpret literature deeply with the average score of the second assessment increasing by 2.4 points compared to the first assessment (P<0.001). We have established a preliminary evidence-based thinking training method for standardized training for oncology specialists to improve their ability to deeply interpret literature around clinical issues, and then extract effective data for clinical application.
[1] Shiravand Y, Khodadadi F, Kashani S, et al. Immune checkpoint inhibitors in cancer therapy[J].Curr Oncol,2022,29(5):3044-3060. DOI: 10.3390/curroncol29050247.
[2] Vere J, Gibson B. Evidence-based medicine as science[J].J Eval Clin Pract,2019,25(6):997-1002. DOI: 10.1111/jep.13090.
[3] Freddi G, Romàn-Pumar JL. Evidence-based medicine: what it can and cannot do[J].Ann Ist Super Sanita,2011,47(1):22-25. DOI: 10.4415/ANN_11_01_06.
[4] Labrie M, Brugge JS, Mills GB, et al. Therapy resistance: opportunities created by adaptive responses to targeted therapies in cancer[J].Nat Rev Cancer,2022,22(6):323-339. DOI: 10.1038/s41568-022-00454-5.
[5] Ciardiello F, Ciardiello D, Martini G, et al. Clinical management of metastatic colorectal cancer in the era of precision medicine[J].CA Cancer J Clin,2022,72(4):372-401. DOI: 10.3322/caac.21728.
[6] Rodrigues-Ferreira S, Nahmias C. Predictive biomarkers for personalized medicine in breast cancer[J].Cancer Lett,2022,545:215828. DOI: 10.1016/j.canlet.2022.215828.
[7] 王鹏, 江晓华, 耿浩非, 等. 迷你临床演练评估在肿瘤专科医师规范化培训中的应用[J].重庆医学,2021,50(12):2149-2152. DOI: 10.3969/j.issn.1671-8348.2021.12.038.
[8] 姚榕, 周磊磊, 岳顺, 等. PBL联合MDT的教学模式在肿瘤专科医师规范化培训中的应用[J].继续医学教育,2019,33(3):43-44. DOI: 10.3969/j.issn.1004-6763.2019.03.023.
[9] 石岩岩, 何旋, 卢贵胜, 等. 医学生见习阶段循证临床实践课程的设计和实施[J].中华医学教育杂志,2022,42(4):305-308. DOI: 10.3760/cma.j.cn115259-20210903-01117.
[10] 姚亚妮, 王玉玲, 杨新玲. 临床研究生循证医学教学改革实践[J].中华医学教育探索杂志,2015(2):155-157. DOI: 10.3760/cma.j.issn.2095-1485.2015.02.012.
[11] 陈亚男, 阮晓岚, 欧阳雯, 等. PBL结合EBM教学在住院医师规范化培训中应用的系统评价[J]. 中华医学教育探索杂志, 2022,21(6):722-726.DOI: 10.3760/cma.j.cn116021-20200601-00888.
[12] Mehmi I, Hamid O. Immunotherapy of cancer in the era of checkpoint inhibitor[J].Clin Exp Metastasis,2022,39(1):231-237. DOI: 10.1007/s10585-021-10132-9.
[13] Wu Z, Chen Q, Qu L, et al. Adverse events of immune checkpoint inhibitors therapy for urologic cancer patients in clinical trials: a collaborative systematic review and meta-analysis[J]. Eur Urol,2022,81(4):414-425. DOI: 10.1016/j.eururo.2022.01.028.
[14] Morganti S, Tarantino P, Ferraro E, et al. Next generation sequencing (NGS): a revolutionary technology in pharmacogenomics and personalized medicine in cancer[J].Adv Exp Med Biol,2019,1168:9-30. DOI: 10.1007/978-3-030-24100-1_2.
[15] Schiavenato M, Chu F. PICO: What it is and what it is not[J].Nurse Educ Pract,2021,56:103194. DOI: 10.1016/j.nepr.2021.103194.
[16] 周登远, 汪培山. 临床对照试验文献质量评价的发展与现状[J].药物流行病学杂志,2004,13(4):211-214. DOI: 10.3969/j.issn.1005-0698.2004.04.017.
[17] Filleron T, Gilhodes J, Delord JP, et al. Subgroup analysis and forest plots: limitations and interests[J].Bull Cancer,2017,104(1):92-100. DOI: 10.1016/j.bulcan.2016.09.023.
