目的 探讨“三明治”教学方法在临床医学专业本科实习生气管拔管技能学习中的应用,并通过学习曲线分析,确定其掌握该技能的最低实践次数。方法 选取2023年6月至9月在嘉兴大学附属医院麻醉科轮转实习的嘉兴大学医学院2019级五年制临床医学专业15名实习生作为研究对象。采用“三明治”教学法对学生进行相关培训。每名实习生独立完成30例气管拔管操作(共450例),使用德尔菲法验证的量表记录操作质量评分,通过累积和值构建学习曲线,分别拟合2次与3次多项式函数并比较拟合优度(R2),采用导数分析法分析拟合曲线斜率确定技能转折点。结果 3次多项式函数对学习曲线的拟合效果最佳(R2=0.914),确定第18次操作为学习曲线斜率转折点,标志着技能提升速度显著趋缓并进入平台期。结论 “三明治”教学法可以有效应用于实习生气管拔管技能培训。学习曲线分析结果显示,掌握该技能所需要的最低实践次数为18次,为教学目标设定与教学资源优化配置提供了循证支持。
Objective To explore the minimum number of practice attempts required for undergraduate medical interns to master endotracheal extubation skills under the ″sandwich″ teaching method. Methods Fifteen fifth-year undergraduate clinical students from the Class of 2019 at Jiaxing University medical college, who completed a rotation in the Department of Anesthesiology at the Affiliated Hospital of Jiaxing University between June and September 2023, were enrolled in the study. The ″Sandwich″ teaching method was employed for training in tracheal extubation procedures. All bedside extubation practices were independently supervised and assessed by the same two senior attending physician. Each intern independently completed 30 cases of tracheal extubation (a total of 450 cases), The quality score of the operation was recorded using a scale validated by the Delphi method, and a learning curve was constructed using the Cumulative Sum (CUSUM) method. They fitted quadratic and cubic polynomial functions and compared the goodness of fit (R2). The derivative analysis method was used to analyze the slope of the fitted curve and determine the skill turning point. Results The cubic polynomial function has the best fitting effect on the learning curve (R2=0.914). Using polynomial fitting derivative analysis method, the 18th operation is the inflection point of the learning curve slope, indicating a significant slowdown in skill improvement speed and entering a stable plateau period. Conclusions The ″sandwich″ teaching method can serve as an effective approach for training interns in endotracheal extubation skills. Learning curve analysis indicated that the minimum number of practice attempts required to achieve skill mastery was 18, providing evidence-based support for setting teaching objectives and optimizing resource allocation.
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