目的 探讨耳鼻喉科教学门诊在住院医师门诊教学中的应用效果。方法 选取2018年1月至2019年12月在首都医科大学宣武医院耳鼻喉科的住院医师(全科医师)20人为研究对象,开展以住院医师为主体的耳鼻喉科教学门诊。培训结束后,采用迷你临床演练评估(mini-clinical evaluation exercise,Mini-CEX)评分表对住院医师实施测评,并进行问卷调查,以了解培训效果。结果 培训后住院医师的Mini-CEX评分均高于培训前,例如医疗面谈[(7.30±0.57)分比(5.35±0.75)分],临床判断[(6.15±0.75)分比(5.00±0.73)分],沟通技能[(7.25±0.97)分比(5.10±0.72)分],整体表现[(7.60±0.69)分比(5.40±0.68)分],7个评分项目差异均具有统计学意义(均P<0.05)。调查结果显示,20名住院医师对教学门诊教学提升接诊能力、沟通和以症状为线索的临床判断及决策力、激发学习兴趣这4项给予5分评价;在临床思维和专业素养提升方面,19名住院医师给予5分评价,其余1名住院医师给予4分评价。结论 耳鼻喉科教学门诊的实施有助于提高门诊教学质量,使住院医师在对门诊患者的诊疗中主动学习和思考,更好地掌握与病房不同的知识和技能。    

Objective To set up a teaching clinic in otolaryngology head and neck surgery and to explore its effect in the outpatient teaching for residents. Methods Twenty residents (including general practitioners) who were in the otolaryngology department of Xuanwu Hospital Capital Medical University from January 2018 to December 2019 participated in the otolaryngology teaching clinic training for residents. At the end of the training, the mini-clinical evaluation exercise (Mini-CEX) was used to evaluate training outcomes of these residents with questionnaire survey. Results After training,the Mini-CEX scores were all higher than those before training. For example, medical history of inquiry [(7.30±0.57)vs.(5.35±0.75)], the clinical judgment [(6.15±0.75)vs.(5.00±0.73)], communication skill [(7.25±0.97)vs.(5.10±0.72)], and the overall performances [(7.60±0.69)vs.(5.40±0.68)], the difference of seven scoring items was statistically significant (all P<0.05). The questionnaires showed that twenty residents gave a 5-point rating on improvement of the capacity of consulting, communication, clinical reasoning and decision-making based on symptoms and stimulating learning interest. In terms of clinical reasoning and professional accomplishment improvement, nineteen of residents gave a 5-point rating and one resident gave a 4-point rating. Conclusions Teaching clinic in otolaryngology head and neck surgery enabled residents to take the initiative to learn and think in the process of outpatient management and to better master different knowledge and skills from the ward, which was helpful to improve the teaching quality of outpatient teaching. In the process of implementation, it was the key that teachers played a supervisory role and adopted hierarchical progressive training methods.