膀胱镜检查是泌尿外科常用的诊疗技术,培养外科住院医师规范化培训(简称住培)学员独立实施该操作对缓解临床人力资源紧张、提升医疗服务效率具有重要意义。本研究设计并实施了膀胱镜检查培训课程,采用“智能体预辅导+虚拟仿真训练+临床实操”的混合教学方式。选取2025年1至7月在上海交通大学瑞金临床医学院泌尿外科轮转的40名膀胱镜操作零基础外科住培学员作为研究对象,在智能体引导下完成理论学习和交互训练后,进入虚拟仿真模拟操作训练并考核,通过模拟考核后接受临床实践培训和考核。初步教学效果显示,学员在模拟考核中均一次性通过,操作时长为(276.25±24.23)秒、模拟器评分为(94.65±3.04)分,损伤出血次数为0(0)次。在真实患者操作考核中,所有学员均能够在上级医师指导下独立完成检查,操作时长为(559.50±57.15)秒,考官评分为(89.71±3.18)分。教学满意率调查结果显示,学员对教学方式的兴趣度、知识理解的帮助度和操作自信心的提升度满意率分别为97.5%(39/40)、100.0%(40/40)和95.0%(38/40)。本课程的设计与实践,可以提高外科住培学员膀胱镜检查的理论认知水平和操作能力,为临床技能培训提供了新范式。
Cystoscopy is a commonly used diagnostic and therapeutic technique in urology. Training surgical residents to independently perform cystoscopy can effectively alleviate human resource shortages and improve the efficiency of medical services. We designed and implemented a cystoscopy training course employing a blended teaching approach of ″intelligent agent pre-tutoring + virtual simulation training + clinical case training″. Forty novice surgical resident physicians rotating in the Department of Urology at Shanghai Jiao Tong University School of Medicine, Ruijin Clinical Medical College from January to July 2025 enrolled in the study. After completing theoretical learning and interactive training guided by the agent, they proceeded to simulator operation training and assessment. Upon passing the simulator-based test, they received clinical practice training and evaluation. The teaching outcomes showed that all residents passed the simulator assessment with an operation time of (276.25±24.23) seconds, a simulator score of (94.65±3.04) points, and the number of injury and bleeding was 0(0) times. In real cases operation assessment, all residents were able to independently complete the examination under the guidance of a supervisor, with an operation time of (559.50±57.15) seconds and an examiner's score of (89.71±3.18) points. The teaching satisfaction survey indicated that the satisfaction rates for participants' interest in the teaching method, improvement in knowledge comprehension, and enhancement of operational confidence were 97.5%(39/40), 100.0%(40/40), and 95.0%(38/40), respectively. The design and implementation of this course can improve surgical residents' theoretical understanding and operational skills in cystoscopy, providing a new model for clinical skills training.
[1] Schöne M, Uhthoff H, Schöne S. Cystoscopy in the outpatient clinical routine: things to keep in mind][J]. Aktuelle Urol, 2023,54(2):129-134. DOI: 10.1055/a-1867-0560.
[2]何竑超,王佳玉,黄芳,等. 基于经尿道手术模拟器的系统培训在泌尿外科膀胱镜操作临床教学中的应用[J]. 中国毕业后医学教育,2021,5(5):455-458,467. DOI:10.3969/j.issn.2096-4293.2021.05.017.
[3] Eimen R, Scarpato KR, Bowden AK. Virtual simulator for cystoscopy containing motion blur and bladder debris to aid the development of clinical tools[J]. Biomed Opt Express, 2024,15(11):6228-6241. DOI: 10.1364/BOE.539741.
[4] Do L, Pasha K, Sanchez S, et al. A structured, hybrid cystoscopy simulation curriculum for obstetrics/gynecology residents[J]. Female Pelvic Med Reconstr Surg, 2021,27(10):637-641. DOI: 10.1097/SPV.0000000000001018.
[5] Llorente-Ortega M, Polo R, Chiva S, et al. The development and validation of a new simulator for endourology[J]. Actas Urol Esp (Engl Ed), 2023,47(4):236-243. DOI: 10.1016/j.acuroe.2023.01.004.
[6] Silva C, Nascimento D, Dantas GG, et al. Impact of artificial intelligence on the training of general surgeons of the future: a scoping review of the advances and challenges[J]. Acta Cir Bras, 2024,39:e396224. DOI: 10.1590/acb396224.
[7]李婧欢,肖遥,谢朗. 人工智能在医学人文教育的应用现状[J]. 中国医学教育技术,2022,36(3):286-291. DOI:10.13566/j.cnki.cmet.cn61-1317/g4.202203008.
[8]孙颖浩. 医师考核培训规范教程.泌尿外科分册[M].上海:上海科学技术出版社,2016:191-194.
[9] 冯师健,何语实,黄中力. 虚拟现实技术在泌尿外科临床手术教学中的应用[J]. 继续医学教育,2024,38(4):125-128. DOI:10.3969/j.issn.1004-6763.2024.04.032.
[10] Gkintoni E, Antonopoulou H, Sortwell A, et al. Challenging cognitive load theory: the role of educational neuroscience and artificial intelligence in redefining learning efficacy[J]. Brain Sci, 2025,15(2):203. DOI: 10.3390/brainsci15020203.
[11] Dave M, Patel N. Artificial intelligence in healthcare and education[J]. Br Dent J, 2023,234(10):761-764. DOI: 10.1038/s41415-023-5845-2.
[12]张晖,刘继海. 人工智能在医学教育中的应用发展及思考[J]. 今日科苑,2025(3):15-22. DOI:10.3724/j.issn.1671-4342.20250024.
[13]中国医院协会模拟医学专业委员会,秦文健,吕建平. 临床实践技能虚拟仿真应用技术体系标准专家共识[J]. 中国全科医学,2025,28(23):2833-2840. DOI:10.12114/j.issn.1007-9572.2025.0076.
[14]周学贤,于澄钒,林燕丽,等. 以熟练度为依据的膀胱镜虚拟现实模拟技能培训实证的有效性[J]. 现代泌尿外科杂志,2020,25(1):46-49. DOI:10.3969/j.issn.1009-8291.2020.01.011.
