Zhongguo cuzhong zazhi (Sep 2024)
多元化教学模式在大学附属教学医院卒中绿色通道培训中的应用 Application of Diversified Teaching Model in Stroke Green Channel Training at a Medical University-Affiliated Teaching Hospital
Abstract
目的 本文以大学附属教学医院的卒中急救绿色通道培训医师为主要研究对象，旨在提高新进医疗岗位医师的学习效率，改善临床工作的多种质控指标。 方法 设计多元化教学方法，包括临床案例式协作教学法、基于问题教学法、翻转课堂、一带一学习、情景模拟及临床疗效反馈等，以一家教学医院区域性高级卒中中心的绿色通道患者和医师为调查对象，收集多环节时间点的质控指标以及教学互评反馈来评价教学效果。 结果 纳入2021年6月—2023年7月急诊卒中绿色通道诊疗环节中符合条件的患者194例，其中接受单纯静脉溶栓治疗者171例（88.14%），桥接治疗或者直接机械取栓者23例（11.86%），纳入观察学员为低年资住院医师10名，高年资住院医师5名。培训前收治患者88例（45.36%），培训后收治患者106例（54.64%），人口学基线特征差异无统计学意义。中位入院至静脉溶栓时间（door-to-needle time，DNT）缩短了4 min（44 min vs. 48 min，P=0.150），DNT≤60 min比例分别为73.86%、65.09%（P=0.188）。培训后，中位知情同意谈话时间缩短了3.5 min（6.5 min vs. 10 min，P=0.001）；溶栓相关出血事件减少（培训前：牙龈出血1例，硬膜下血肿1例，消化道出血1例；培训后：无相关事件）；大血管闭塞患者血管内治疗比例提升（16.98% vs. 5.68%，P=0.015）。高年资与低年资住院医师对多元化教学模式绿色通道教学方法的认可度、对绿色通道学习方式的兴趣程度、病例质控环节提升满意度、影像库对解决问题适配度、文献指南库对解决问题适配度和自我学习能力提升6个方面的满意度相当，差异均无统计学意义。 结论 多元化培训方案可以提高绿色通道医师的卒中急救应对能力、谈话沟通技能及诊疗水平，改善工作质量和教学满意度，而且对低年资和高年资住院医师的临床学习均有帮助。 Abstract: Objective This study took the training physicians in the green channel of stroke in a medical university-affiliated teaching hospital as the main research object, aiming to improve their learning efficiency and the quality control indicators of clinical work. Methods Diversified teaching methods were designed, including case-based collaborative learning, problem-based learning, flipped classroom, one-on-one learning, scenario simulation, and clinical feedback, to assess the teaching effects by collecting multiple quality control indicators and peer feedback for the patients and physicians in the green channel of a teaching hospital’s regional advanced stroke center. Results A total of 194 eligible patients from June 2021 to July 2023 were collected. There were 171 (88.14%) cases receiving intravenous thrombolysis, and 23 (11.86%) cases receiving bridging treatment or direct mechanical thrombectomy. The study included 10 junior residents and 5 senior residents. There were 88 (45.36%) patients admitted before training and 106 (54.64%) patients admitted after training. There was no significant difference in demographic baseline characteristics. After training, the median of door-to-needle time (DNT) was shortened by 4 min (44 min vs. 48 min; P=0.150), and the ratios of DNT≤60 min were 73.86% and 65.09% in the two groups (P=0.188). Median informed consent time was shortened by 3.5 min (6.5 min vs. 10 min; P=0.001). Also, thrombolysis-related bleeding events decreased (before training: 1 case of gingival bleeding, 1 case of subdural hematoma, 1 case of gastrointestinal bleeding; after training: no related events), and the proportion of endovascular treatment for large vessel occlusion cases increased significantly (16.98% vs. 5.68%, P=0.015). After training, no significant differences were observed between the senior and junior groups in terms of recognition of the green channel teaching methods of the diversified teaching model, interest in the learning mode of the green channel, satisfaction with the improvement of case quality control, the adaptability of image libraries to problem-solving, the adaptability of literature guide libraries to problem-solving, and the improvement of self-learning ability. Conclusions This diversified training program can enhance the learners’ stroke emergency response ability, communication skills, and the level of diagnosis and treatment, improve work quality and teaching satisfaction, and help the clinical learning of both junior and senior residents.
