目的 观察在住院医师规范化培训重症医学科轮转培训过程中应用查房单对培训效果的影响。方法 将2016年4月~2017年1月分不同批次入重症医学科(intensive care unit,ICU)进行规范化培训的114名住院医师为研究对象,随机分为实验组和对照组,两组均由经验丰富的ICU高年资主治医师按住院医师规范化培训要求一对一带教。对照组常规进行查房和交接班。实验组实行查房单制度,医师入科后由带教教师培训查房单应用,查房时按查房单顺序及要求引导医师进行病例汇报和病情分析,每天早晚交接班应用查房单,并由带教教师不定期抽检督促查房单应用。培训过程中由带教教师和质控医师进行日常考核,培训结束出科前进行题库考核和迷你临床演练评估(mini-clinical evaluation exercise,Mini-CEX)及满意度评价。结果 共114人完成全部临床培训和考核。实验组医师在日常综合考核、Mini-CEX的体格检查、临床判断、沟通技能、组织效能及整体表现方面成绩均优于对照组医师(均P<0.05)。实验组医师和带教教师的教学满意度更高(均P<0.05)。结论 查房单制度有助于提高住院医师日常工作质量、出科Mini-CEX成绩和培训满意度,这可能与应用查房单有助于住院医师理顺思路、减少遗漏、提高诊疗质量、增加自信有关。
Objective To observe the training effect of checklist in the process of standardized resident training of the critical care medicine. Methods From April 2016 to January 2017 the residents entered intensive care unit for standardized resident training were randomly divided into experimental group and control group. A checklist was used in the experimental group during daily rounds and shifting of duty while the control group trained completely through traditional way. The residents' clinical competence were assessed by mixed method include daily assessment, question bank examination(QBE), mini-clinical evaluation exercise(Mini-CEX). Results Finally 114 residents finished this program. The experimental group achieved higher examination score in daily assessments and final Mini-CEX, including medical interview, physical examination, clinical decision, communication skills, organization efficiency (all P<0.05). Experimental group showed higher satisfaction no matter for trainee or trainer (all P<0.05). Conclusions Checklist utilization for standardized training residents during critical care rotation would be helpful in improving the clinical training performance and satisfaction.
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