目的 评价分层级综合培训体系在开放性眼外伤一期手术教学中的应用效果。 方法 采用试验对照方法。选择2023年1至12月在北京同仁医院眼外伤科参与住院医师规范化培训轮转的首都医科大学44名临床医学硕士专业学位研究生作为研究对象。将2个不同院区的各22名学生分为试验组和对照组。试验组学生采用集理论授课、教学视频观摩、Wetlab培训和临床实践为一体的分层级综合培训体系;对照组学生采用传统的临床师带徒教学模式。对两组学生采用手术考核评价教学效果,对试验组学生进行满意度问卷调查。数据分析采用t检验和χ2检验。 结果 试验组学生手术用时为(27.0±1.5)分钟,短于对照组学生的(28.9±1.7)分钟,其差异具有统计学意义(P<0.001)。试验组学生手术考核总分为(90.64±4.91)分,高于对照组学生的(82.86±7.44)分,其差异具有统计学意义(P<0.001)。试验组学生均认为分层级综合培训体系有助于更快适应显微手术和提升基本操作熟练度。 结论 分层级综合培训体系可有效提升眼科住培学生开放性眼外伤一期缝合手术操作的熟练度和手术操作水平。
Objective To evaluate the effect of the hierarchical comprehensive training system in the teaching of primary surgery for open globe injuries. Methods A retrospective analysis was conducted on the use of the hierarchical comprehensive training system for the teaching of primary surgery for open globe injuries among residents rotating the ocular trauma department in the ophthalmology standardized training base of Beijing Tongren Hospital from January 2023 to December 2023. The experimental group used a hierarchical comprehensive training system that integrated theoretical lectures, video teaching, Wetlab training and clinical practice, while the control group used the traditional clinical apprenticeship teaching model. The teaching effect was evaluated by surgical assessment for both groups, and a questionnaire survey was conducted for the experimental group. Data analysis was performed using t-test and χ2 test. Results The average surgery time of the experimental group was significantly shorter than that of the control group [(27.0±1.5) minutes vs. (28.9±1.7) minutes, P<0.001]. The total score for the surgery assessment of the experimental group was significantly higher than that of the control group [(90.64±4.91) vs. (82.86±7.44), P<0.001]. The results of the questionnaire showed that students in the experimental group believed that the hierarchical comprehensive training system was helpful in adapting to microsurgery more quickly and improving the proficiency of basic operations (satisfaction rate was 100% for both). Conclusions The hierarchical comprehensive training system can effectively enhance the proficiency and level of surgical operation in primary suture surgery for open globe injuries among standardized training ophthalmology residents.
[1] Lee AG, Volpe N. The impact of the new competencies on resident education in ophthalmology[J]. Ophthalmology, 2004,111(7):1269-1270. DOI: 10.1016/j.ophtha.2004.04.004.
[2]郑克, 余晓波, 罗怡, 等. 培训眼科住院医师显微手术技能的探索[J].中国继续医学教育,2020,12(13):64-67. DOI: 10.3969/j.issn.1674-9308.2020.13.027.
[3]江晓丹, 李学民, 陆遥. 国内外眼科显微手术培训体系的现状分析与分层分级综合培训体系的探索[J].中华医学教育探索杂志,2021,20(10):1191-1194. DOI: 10.3760/cma.j.cn116021-20200715-00647.
[4]Coelho J, Ferreira A, Kuhn F, et al. Globe ruptures: outcomes and prognostic analysis of severe ocular trauma[J]. Ophthalmologica, 2022,245(4):376-384. DOI: 10.1159/000523705.
[5]崔莹, 李冬梅. Wetlab培训在眼整形手术教学中的应用[J].眼科,2019,28(5):392-394. DOI: 10.13281/j.cnki.issn.1004-4469.2019.05.017.
[6]赵静, 陈荣新, 张小娟, 等. 全眼模型在Wetlab眼科手术教学中的应用[J].眼科学报,2021,36(10):830-835. DOI: 10.3978/j.issn.1000-4432.2021.06.07.
[7]樊宁, 申晓丽, 司姣, 等. 增强现实教学在眼科专业型硕士生显微手术培训中的应用[J].科教导刊,2021(25):58-60,68. DOI: 10.16400/j.cnki.kjdk.2021.25.020.
[8]张晓辉, 王嘉琦, 邢瑶. 眼科住院医师临床操作技能培训的问题与策略[J].继续医学教育,2023,37(2):84-87. DOI: 10.3969/j.issn.1004-6763.2023.02.022.
[9]Liu EY, Li B, Hutnik C. Canadian ophthalmic microsurgery course: an innovative spin on wet lab-based surgical education[J]. Can J Ophthalmol, 2016,51(5):315-320. DOI: 10.1016/j.jcjo.2016.04.021.
[10]Pantanelli SM, Papachristou G, Callahan C, et al. Wet lab-based cataract surgery training curriculum for the PGY 2/PGY 3 ophthalmology resident[J]. MedEdPORTAL, 2018,14:10782. DOI: 10.15766/mep_2374-8265.10782.
[11]敖明昕, 王薇, 邱伟强, 等. 眼科住院医师显微手术培训效果评价的质性研究[J].中华医学教育杂志,2016,36(5):772-777. DOI: 10.3760/cma.j.issn.1673-677X.2016.05.035.
