腹腔镜胆囊切除术(laparoscopic cholecystectomy)作为腹腔镜胆道手术的基石,已经在平原地区广泛实施,但针对年轻医师的系统化教学体系尚未建立。海军特色医学中心从2022年开始对西藏自治区那曲尼玛县人民医院进行了持续的“组团式”医疗援助。在对高原基层医院外科提供医疗援助期间,医疗援助团队结合平原地区的腹腔镜手术教学经验,因地制宜地开展了外科手术团队教学探索,其中小规模限制性在线课程(small private online course)发挥了关键作用。该教学通过构建定制化、集中化的在线学习平台,有效满足了地处偏远、资源匮乏的高原地区学员的学习需求,赋予了学员自主规划学习进度的灵活性,同时确保了教学内容的高质量与高度一致性。从传统的开腹胆囊切除术教学逐步过渡至微创小切口胆囊切除术,最终拓展至腹腔镜胆囊切除术,小规模限制性在线课程始终贯穿于整个教学过程,在特高海拔地区基层外科学教学实践中取得了显著的教学成效。
As the cornerstone of laparoscopic biliary surgery, laparoscopic cholecystectomy has been widely implemented in plain areas, yet a systematic training system for young surgeons remains underdeveloped. Since 2022, the Naval Medical Center has provided continuous ″group″ medical assistance to the People′s Hospital of Nyima County in Nagqu, Tibet Autonomous Region. During surgical support for this high-altitude primary hospital, the medical team adapted laparoscopic surgical training experience in plain areas to local conditions, developing an innovative surgical team training approach where Small Private Online Courses played a pivotal role. This approach established a customized, centralized online learning platform that effectively addressed the needs of remote, resource-limited high-altitude learners, providing flexible self-paced learning while ensuring high-quality, standardized content delivery. The curriculum progressively transitioned from open cholecystectomy training to minimally invasive small-incision cholecystectomy, ultimately advancing to laparoscopic cholecystectomy, with Small Private Online Courses consistently integrated throughout. This approach demonstrated remarkable efficacy in surgical education at extremely high-altitude primary hospitals.
[1] 刘旭, 刘文虎. “组团式”医疗援藏中“师带徒”医学人才培养模式的探索[J].医学教育管理,2021,7(2):133-137. DOI:10.3969/j.issn.2096-045X.2021.02.006.
[2] Fox A. Viewpoint: from MOOCs to SPOCs[J].Communications of the ACM, 2013,56(12):38-40.
[3] Xu J, Huang S, Wu C, et al. Effectiveness of the small private online course-based flipped teaching program for enhancing nursing students′ self-directed learning ability in the surgical nursing course: a practical study[J].Heliyon, 2024,10(17):e36698. DOI:10.1016/j.heliyon.2024.e36698.
[4] Zhang XM, Yu JY, Yang Y, et al. A flipped classroom method based on a small private online course in physiology[J].Adv Physiol Educ, 2019,43(3):345-349. DOI:10.1152/advan.00143.2018.
[5] Vaysse C, Fize AL, Despas F, et al. Small private online course in teaching oncology-feedback after 1 year: what lessons?[J].J Cancer Educ, 2021,36(1):65-71. DOI:10.1007/s13187-019-01598-z.
[6] Li H, Zhao W, Li B, et al. Effects of the small private online course combined with simulation-based training in a patient safety education program among nursing students: a quasi-experimental study[J].Int J Nurs Sci, 2023,10(4):555-561. DOI:10.1016/j.ijnss.2023.09.014.
[7] Hamoen EC, De Jong P, Van Blankenstein FM, et al. Design and first impressions of a small private online course in clinical workplace learning: questionnaire and interview study[J].JMIR Med Educ, 2022,8(2):e29624. DOI:10.2196/29624.
[8] 王选忠. 变迁中的尼玛县[N].西藏日报,2002-03-14(005).
[9] 谢毅, 李喆, 白玛次仁, 等. 高原海拔5 000 m以上尼玛县藏民健康体检情况分析[J].海军医学杂志,2023,44(8):779-782. DOI:10.3969/j.issn.1009-0754.2023.08.008.
[10] 谢毅, 陈森林, 于菲菲. 特高海拔地区基层医院援藏手术医师在不同给氧条件下开展小切口胆囊切除术的效果评价[J].中华航海医学与高气压医学杂志,2024,31(4):509-512. DOI:10.3760/cma.j.cn311847-20230802-00021.
[11] 于菲菲, 李喆, 陈森林, 等. 特高海拔地区某部官兵训练伤调查与分析[J].海军医学杂志,2024,45(8):779-783. DOI:10.3969/j.issn.1009-0754.2024.08.001.
[12] 胡奇达, 阙日升, 梁廷波. 多模式新媒体辅助CBL教学法在腹腔镜胆囊切除术规范化培训中的应用[J].中国高等医学教育,2023(7):125-127. DOI:10.3969/j.issn.1002-1701.2023.07.056.
[13] 陈艳艳, 蒋东霖, 丁子桐. SPOC精准教学模式的运用路径研究[J].长春师范大学学报,2024,43(4):144-148. DOI:10.3969/j.issn.1008-178X.2024.04.023.
[14] 王善合, 水锨崎, 姜晓瑜, 等. SPOC教学模式在临床医学外科手术教学中的应用[J].现代医药卫生,2023,39(22):3941-3944. DOI:10.3969/j.issn.1009-5519.2023.22.034.
[15] Potts L, Eshleman JW, Cooper JO. Ogden R. Lindsley and the historical development of precision teaching[J].Behav Anal, 1993,16(2):177-189. DOI:10.1007/BF03392622.
[16] 格日力. 高原医学[M].北京: 北京大学医学出版社, 2020:2-7.
[17] 郑阳, 陈瑶. 基于PBL联合CBL教学法的住院医师规范化培训教学实践[J].现代职业教育,2024(15):177-180.
[18] 马晓婧, 付云柯, 郝春香, 等. 全麻诱导合并呼气末正压通气在麻醉科气管插管规培教学中的应用[J].安徽医专学报,2023,22(3):97-100. DOI:10.20072/j.cnki.issn2097-0196.2023.03.032.
[19] 徐明, 孙传洋, 陶伟, 等. “视频-实践-视频”教学在后腹腔镜手术持镜手培训中的价值[J].中国继续医学教育,2021,13(21):81-84. DOI:10.3969/j.issn.1674-9308.2021.21.022.
[20] 赵森林. 高海拔地区水电工程的职业健康保障措施[J].能源与环境,2020(6):118-120. DOI:10.3969/j.issn.1672-9064.2020.06.042.
