目的 构建基于虚拟病人(virtual patient, VP)的阶梯式护理问诊训练模式并评价其应用效果。方法 基于护理问诊的培养规律,本研究构建了一种从单一症状问诊过渡到综合病例问诊的阶梯式VP训练模式。3所大学护理学专业392名本科生于2020年3月至2022年6月参与本研究。2019级206名学生作为试验组接受阶梯式VP问诊训练模式教学,首先在基础课程,即健康评估课程阶段进行VP症状问诊练习,后续在专业课程,即内科护理学课程阶段进行VP病例问诊练习。2018级186名学生作为对照组接受传统问诊教学。数据收集分别在健康评估课程初期(T0)、健康评估课程结束(T1)和内科护理学课程结束(T2)时进行。采用广义估计方程对结局指标进行统计分析。结果 试验组学生自评问诊能力评分在T1和T2时分别提高2.24分和3.28分,与对照组相比,其评分变化差异均具有统计学意义(T1:P=0.04,T2:P=0.03)。试验组学生评判性思维评分在T1和T2时分别提高3.26分和4.60分,与对照组相比,其评分变化差异仅在T2时有统计学意义(T1:P>0.05,T2:P<0.001)。两组学生支持性沟通评分变化在T1、T2时差异均无统计学意义(均P>0.05)。结论 阶梯式VP问诊训练模式可以显著提高学生的问诊能力和评判性思维水平。
Objective To design a virtual patient (VP)-based stepwise history-taking training model and to evaluate its effectiveness. Methods Based on the natural progression of history-taking ability training, this study developed a VP-based stepwise training model that transitions from single-symptom history to comprehensive case history. A total of 392 nursing undergraduates participated from March 2020 to June 2022. The grade 2019 of 206 students formed the experimental group and underwent stepwise VP history-taking training: symptom history-taking during the basic health assessment course and case history-taking during the professional internal medicine nursing course. The grade 2018 of 186 students received traditional teaching. Data were collected at the beginning of the health assessment course (T0), the end of the health assessment course (T1), and internal medicine nursing courses (T2). Due to the data not following a normal distribution, Generalized Estimating Equations were used to conduct statistical analysis on the outcome indicators. Results The experimental group's self-assessed history-taking scores increased by 2.24 points at T1 and 3.28 points at T2; the between-group differences in score change were statistically significant at both time points (T1:P =0.04; T2: P=0.03). The experimental group's critical thinking scores increased by 3.26 points at T1 and 4.60 points at T2; the between-group difference in score change was statistically significant only at T2 (T1: P>0.05; T2: P< 0.001). The difference in supportive communication score changes of two groups was not significant at T1 and T2 (P>0.05). Conclusions The stepwise VP history-taking training model can significantly improve students' history-taking skills and critical thinking abilities.
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