目的 探讨目标导向的进阶式教学在住院医师营养不良全球领导倡议(Global Leadership Initiative on Malnutrition,GLIM)标准化重症营养支持培训中的应用效果。方法 以2024年3月至2025年5月在四川省医学科学院·四川省人民医院重症医学科(intensive care unit,ICU)轮转的124名住院医师为研究对象,按照随机数字表法将其分为试验组和对照组,每组均为62名住院医师,分别采用目标导向的进阶式教学方式和传统教学方式进行重症医学营养支持培训。教学结束后,比较两组学员的考核成绩、问卷调查结果、对所管床患者开具的营养处方评价相应教学效果。采用χ²检验、独立样本t检验或Mann-Whitney U检验分析相关数据。结果 教学结束后,试验组住院医师的考核总成绩高于对照组住院医师[(85.4±3.4)分比(82.2±2.8)分,P<0.001]。试验组住院医师的临床思维成绩高于对照组住院医师[(48.3±1.6)分比(45.3±1.8)分,P<0.001]。在医数据APP中随机抽取的营养治疗处方中,试验组和对照组住院医师的营养质控项目百分比均较前提高,其中营养筛查均是100.0%;48小时肠内营养启动率(入住ICU后48小时内启动肠内营养的患者数/同期内符合肠内营养指征的患者总数),试验组住院医师明显高于对照组住院医师(88.7%比 62.9%,P<0.001);1周内肠外营养支持启动率(入ICU后1周内开始肠外营养的患者数/同期内所有启动营养支持的患者总数),试验组住院医师明显低于对照组住院医师(35.5%比59.7%,P=0.007);1周热卡达标率(在营养支持第七天达到目标热量摄入的患者数/同期内接受营养支持且应进行热量评估的患者总数),两组住院医师差异无统计学意义(74.2%比 61.3%,P=0.124)。培训效果调查结果显示,试验组住院医师的知识接受度、临床思维能力、培训满意度、学习主动性和团队协作能力评分均高于对照组住院医师[(8.8±0.7)分比(6.9±1.0)分、(8.8±0.5)分比(6.9±0.9)分、(9.6±0.6)分比(7.0±1.0)分、(8.7±0.6)分比(7.2±0.9)分、(8.6±0.6)分比(7.2±0.7)分,均P<0.001]。结论 在重症医学科规范化培训中采用目标导向的进阶式教学方式,有助于提升住院医师重症营养支持的临床思维能力、实践能力,提升培训效果,这为其在临床实践中系统掌握和应用营养支持技术提供了有效路径。

Objective To explore the application of goal-oriented progressive teaching in the standardized critical care nutrition support training of the Global Leadership Initiative on Malnutrition (GLIM) for resident physicians. Methods From March 2024 to May 2025 at the Sichuan Academy of Medical Sciences, a total of 124 resident physicians on rotation in the intensive care unit (ICU) of Sichuan Provincial People's Hospital were selected as the research subjects. They were randomly divided into the experimental group and the control group, with 62 resident physicians in each group. The targeted-oriented progressive teaching method and the traditional teaching method were respectively adopted for the training of critical care nutrition support. After the teaching, the assessment results, questionnaire survey results, and the evaluation of the nutritional prescriptions issued for the patients under their care were compared to assess the corresponding teaching effects. The relevant data were analyzed using the χ² test, independent sample t-test, or Mann-Whitney U test. Results After the training, the total assessment score of the resident physicians in the experimental group was higher than that in the control group [(85.4±3.4) vs. (82.2±2.8), P<0.001]. The clinical thinking scores of the resident physicians in the advanced group after training were higher than those in the control group [(48.3±1.6) vs. (45.3±1.8), P<0.001]. Among the randomly selected nutritional treatment prescriptions in the Medical Data APP, the percentages of nutritional quality control items in both the advanced group and the control group increased compared with before. Among them, the nutritional screening was 100.0% in both groups. The initiation rate of 48-hour EN (The number of patients who initiated enteral nutrition within 48 hours after admission to the ICU / The total number of patients who met the criteria for enteral nutrition during the same period) in the experimental group was significantly higher than that in the control group (88.7% vs. 62.9%, P=0.007). The initiation rate of PN (The number of patients who started parenteral nutrition within one week after admission to the ICU / The total number of all patients who initiated nutritional support during the same period) support within one week was significantly lower than that of the control group (35.5% vs. 59.7%, P<0.001), while there was no statistically significant difference in the one-week calorie compliance rate (Number of patients who reached the target calorie intake on the 7th day of nutritional support / Total number of patients who received nutritional support during the same period and were supposed to undergo calorie assessment) between the two groups (74.2% vs. 61.3%, P=0.124). In terms of training effectiveness, the scores of knowledge acceptance, clinical thinking ability, training satisfaction, learning initiative, and teamwork ability of the trainees in the experimental group were all higher than those in the control group [(8.8±0.7) vs. (6.9±1.0),(8.8±0.5) vs. (6.9±0.9),(9.6±0.6) vs. (7.0±1.0),(8.7±0.6) vs. (7.2±0.9),(8.6±0.6) vs. (7.2±0.7), all P<0.001]. Conclusions The adoption of a goal-oriented and progressive teaching approach in the standardized training of critical care medicine helps to enhance the clinical thinking and practical skills of resident physicians in critical nutrition support, and improves the training outcome. This provides an effective path for them to systematically master and apply nutrition support techniques in clinical practice.