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医学教育

基于 Mini-CEX 的可视化思维导图联合案例教学在全科住院医师规范化培训中的应用效果

Effect of visual mind mapping combined with case teaching based on Mini-CEX for standardized training of general practitioners

:1153-1157
 
      目的   探讨基于迷你临床演练评估(Mini-CEX)的可视化思维导图联合案例教学在全科住院医师规范化培训中的应用效果。方法   选取参加全科住院医师规范化培训的52例学员并分为试验组(n=26)和对照组(n=26)。对照组采取以案例讲授为主的传统教学模式,试验组采取基于Mini-CEX的可视化思维导图联合案例教学模式。对比两组Mini-CEX评分、考核成绩及教学满意度。结果   试验组Mini-CEX测评的问诊技巧、体格检查、临床判断、诊治能力、技能操作及整体表现得分均高于对照组(P<0.05)。试验组理论知识[(86.89±4.75)分 vs (82.96±4.87分)]、专业技能[(84.20±3.46)分 vs (70.18±4.93)分]及病历书写成绩[(80.64±5.26)分 vs (75.58±5.94)分]均高于对照组t分别为2.678、13.685、2.764,P分别为0.009、<0.001、0.007)。试验组住院医师教学满意度高于对照组(P<0.05)。结论   基于Mini-CEX的可视化思维导图联合案例教学模式用于全科住院医师规范化培训,有助于提高教学效果及教学满意度。
       Objective  To evaluate the effect of visual mind mapping combined with case teaching based on mini-clinical evaluation exercise(Mini-CEX)for standardized training of general practitioners.Methods  A total of 52 students who participated the standardized training of general practitioners were selected and divided into an experimental group(n=26)and a control groupn=26).The control group adopted the traditional teaching mode based on case teaching and the experimental group adopted the visual mind mapping combined with case teaching based on Mini-CEX.The Mini-CEX score,assessment  results and teaching satisfaction of two groups were compared.Results  The interrogation skills,physical examination,clinical judgment,diagnosis and treatment ability,skill operation and overall performance of Mini-CEX in experimental group were higher than control group(P<0.05).Theoretical knowledge score([86.89±4.75] vs [82.96±4.87]),professional skills score([84.20±3.46] vs[70.18±4.93])and medical record writing score([80.64±5.26] vs [75.58±5.94])of experimental groups were higher than control group(t=2.678,13.685,2.764,P=0.009,<0.001,0.007).The teaching satisfaction of residents in experimental group was higher than control group(P<0.05).Conclusions  The visual mind mapping combined with case teaching based on Mini-CEX for standardized training of general practitioners is helpful to improve teaching effect and teaching satisfaction.
论著

综合康复训练对脑卒中后轻度认知障碍患者的应用效果及认知功能影响

The application effect and cognitive function impact of comprehensive rehabilitation training on patients with mild cognitive impairment after stroke

:1080-1086
 
     目的   探讨综合康复训练对脑卒中后轻度认知障碍患者的应用效果及认知功能影响。方法   选取2022年2月—2023年2月暨南大学附属广州红十字会医院收治的80例脑卒中后轻度认知障碍患者展开前瞻性研究,应用抽签法将其分为综合康复组与常规组,各40例。常规组实施常规干预,综合康复组在常规组基础上增加综合康复训练,对比其认知功能,简易智能精神状态检查量表(MMSE)、美国国立卫生院卒中量表(NIHSS)评分变化,运动功能与平衡功能,日常生活能力与生活质量。结果   干预后综合康复组患者洛文斯顿作业疗法认知量表评分注意力为(3.36±0.42)分、思维运动为(17.34±2.31)分、定向力为(13.19±1.24)分,均高于常规组,且两组干预后高于干预前(P<0.05);干预后综合康复组患者MMSE评分为(25.58±4.12)分高于常规组,且两组干预后高于干预前,NIHSS评分为(14.53±2.62)分,低于常规组,且两组干预后低于干预前(P<0.05);干预后综合康复组患者Fugl-Meyer运动功能评定量表评分为(14.51±3.23)分、手臂动作调查测试表评分为(26.86±5.25)分、平衡量表评分为(43.06±5.13)分,高于常规组,且两组干预后高于干预前(P<0.05);干预后综合康复组患者日常生活活动能力量表评分为(53.02±4.43)分、脑卒中专用生活质量量表评分为(97.11±12.23)分,高于常规组,且两组干预后高于干预前(P<0.05)。结论   针对脑卒中后轻度认知障碍患者采取综合康复训练可促进患者认知功能恢复,提升患者运动功能及机体平衡功能,改善患者智力水平与神经功能,进一步提升患者日常生活能力与生活质量。
        Objective  To explore the effect of comprehensive  rehabilitation training on cognitive function in patients with mild cognitive impairment after stroke.Methods  A  prospective  study was conducted on  80  patients with mild cognitive impairment after stroke,who admitted to the hospital from February 2022 to February 2023.They were divided into a comprehensive rehabilitation group and a control group using a lottery method,with 40 patients in each group.The control group  received  routine intervention,while the comprehensive  rehabilitation group  received additional comprehensive  rehabilitation training on the basis of the control group.Their cognitive function,Mini Mental State Examination Scale(MMSE),National  Institutes of Health Stroke Scale in the United States(NIHSS)score changes,motor function and balance function,daily living ability and quality of life were compared.Results  After intervention,the Lowenstein Occupational Therapy Cognitive Scale scores of attention(3.36±0.42),thinking and motor(17.34±2.31),and orientation(13.19±1.24)in the comprehensive  rehabilitation group were higher than those in the control group,and both groups had higher scores after intervention than before(P<0.05).After intervention,the MMSE score(25.58±4.12)of patients in the comprehensive rehabilitation group was higher than that of the control group,and both groups had higher scores after intervention compared to those before intervention.The NIHSS score(14.53±2.62)was lower than that of the control group,and both groups had lower scores after intervention compared to those before interventionP<0.05).After intervention,the Fugl Meyer Assessment score(14.51±3.23),Arm Movement Survey Test Form score(26.86±5.25),and Balance Scale score(43.06±5.13)in the comprehensive rehabilitation group were higher than those in the control group,and both groups had higher scores after intervention than before(P<0.05).After intervention,the Basic Activity of Daily Living score(53.02±4.43)and stroke specific quality of life score(97.11±12.23)in the comprehensive  rehabilitation group were higher than those in the control group,and both groups had higher scores after intervention than before(P<0.05).Conclusions  Comprehensive  rehabilitation training for patients with mild cognitive impairment after stroke can promote cognitive function recovery,improve motor function and balance function,enhance intelligence and neurological function,and further improve daily living ability and quality of life.
论著

早期针刺结合康复训练对急性脑卒中康复影响的随机对照研究

Effects of early acupuncture combined rehabilitation training on acute stroke rehabilitation:A Randomized controlled study

:982-987
 
        目的   观察急性期脑卒中患者早期针刺结合康复训练的临床疗效。方法   采用单盲、分层、区组随机设计分组,随机分成针康组与康复组。针康组35例,康复组35例,按5 d为一个疗程,共4个疗程。采用Fug-Meyer运动功能评分法(FMA)、巴氏指数(BI)、脑卒中专用生活质量量表(SS-QOL)对治疗前及治疗后4周末、出院后8周末及随访期3个月、6个月末的死亡率、残疾率、复发率评估,比较两组的疗效。结果   两组基线比较差异无统计学意义(P>0.05)。组间比较:4周末 FMA、BI评分两组相比差异均无统计学意义(P>0.05),8周末则具有统计学意义(P<0.01)。SS-QOL评分在第4周末和第8周末相比差异无统计学意义(P>0.05)。随访3个月、6个月末的死亡率、致残率和复发率差异均无统计学意义(P>0.05)。组间多重比较,两组4、8周末 FMA、 BI和SS-QOL评分较治疗前比较差异有统计学意义(P<0.01)。针刺康复组8周末疗效优于4周末(P<0.01),康复组8周末与4周末相比差异无统计学意义(P>0.05)。针刺康复组4、8周末SS-QOL评分显著高于治疗前(P<0.01),8周末与4周末相比差异无统计学意义(P>0.05),康复组各时间点SS-QOL评分两两比较差异有统计学意义(P<0.01)。结论   对急性脑卒中患者进行早期针刺结合康复训练,可明显改善其肢体运动功能和日常生活活动能力。
       Objective  To observe the clinical efficacy of early acupuncture combined with rehabilitation training in acute-phase stroke patients.Methods  Single-blind,stratified,zone group randomized design grouping was adopted,and  randomly divided into acupuncture rehabilitation group and rehabilitation group.There were 35 cases in the acupuncture rehabilitation group and 35 cases in the rehabilitation group,received 4 courses,5 days in each course.Fugl-Meyer Assessment(FMA),Barthel Index(BI),Stroke Specific Quality of Life Scale(SS-QOL) scores and mortality,disability and recurrence rates at the end of 3 and 6 months of follow-up were used to compare the efficacy of the two groups.Results  Comparing the basic conditions of the two groups,the difference was not significant(P>0.05).Comparison between groups:differences FMA and BI scores between two groups at the end of 4 weekends were not significant(P>0.05),while differences were significant(P<0.01)at the end of 8 weekends.SS-QOL scores at the end of 4 weekends and the end of 8 weekends were not significant different between two groups(P>0.05).Mortality,disability and  recurrence  rates at the end of 3 and 6 months of follow-up were not significantly different(P>0.05).Multiple comparisons between groups:there were significant differences in FMA,BI and SS-QOL scores at the end of 4 and 8 weeks between the two groups compared with the pre-treatment period(P<0.01).The efficacy of the acupuncture rehabilitation group at the end of 8 weekends was significantly better than that at the end of 4 weekends(P<0.01),and there was no statistically significant difference between the rehabilitation group at the end of 8 weekends and that at the end of 4 weekends(P>0.05).The SS-QOL scores at the end of 4 and 8 weekends in the acupuncture rehabilitation group were significantly higher than those before treatment(P<0.01),and there was no statistically significant difference at the end of 8 weekends compared with that at the end of 4 weekends(P>0.05),and there was a statistically significant difference in the two-by-two comparisons of SS-QOL scores at each time point in the rehabilitation group(P<0.01).Conclusions  Early acupuncture combined with rehabilitation training for acute stroke patients can significantly improve their extremities motor function and daily vitality.

医学教育

BOPPPS 模式下模块化教学结合模拟演练在创伤急救培训中的应用

Application of modular teaching combined with simulation exercise in trauma first aid training under BOPPPS model

:422-428
 
       目的   探讨BOPPPS[(导引(B),目标(O),课前测试(P),参与式学习(P),课后测试(P),总结(S)]模式下模块化教学结合模拟演练在创伤急救培训中的应用效果。方法   选取福建省泉州市正骨医院急诊科2022年8月—2024年2月90名护士,随机分为对照组和干预组,每组45名护士。对照组采用传统授课模式进行教学培训;干预组采用BOPPPS模式下模块化教学结合模拟演练进行教学培训。培训结束对两组学员的创伤急救综合理论及单项技能、创伤急救救护综合能力、培训效果满意度进行统计分析。结果   干预组的综合理论成绩为(80.74±6.87)分、单项技能成绩为(92.13±2.26)分,相较于对照组均提高(P<0.05)。干预组对创伤急救课程的总体满意度:非常同意23例、同意20例,比例均高于对照组(P<0.05)。干预组的创伤急救救护综合能力如病情评估预判能力,优秀26例、良好15例;护理计划分析实施能力,优秀25例、良好13例;团队协作与资源管理能力,优秀27例、良好15例;情景感知与应变能力,优秀30例、良好11例;综合救护能力,优秀36例、良好5例。显著优于对照组(P<0.05)。结论  BOPPPS模式下模块化教学结合模拟演练能够提高急诊科护士的综合创伤救护能力,且取得了较高的满意度,值得进一步推广应用。
       Objective  To explore the application effect of modular teaching combined with simulation exercise in trauma 
first aid training under BOPPPS model.Methods  A total of 90 nurses in the emergency department from August 2022 to February 2024 were randomly divided into control group(n=45) and intervention group(n=45).The control group was trained  by traditional teaching mode.The intervention group was trained by BOPPPS modular teaching combined with simulation exercise.After the training,the comprehensive theory of trauma first aid,individual skills,comprehensive ability of trauma first aid and satisfaction degree of training effect of the two groups of nurses were statistically analyzed.Results  The comprehensive theoretical scores and single skill scores of the intervention group were significantly improved compared with the control group(P<0.05).The satisfaction degree of trauma first aid training in the intervention group was significantly higher than that in the control group(P<0.05).The comprehensive ability of trauma first aid in the intervention group was significantly better than that in the control group(P<0.05).Conclusions  The combination of modular teaching and  simulation exercise in BOPPPS model can improve the comprehensive trauma rescue ability of nurses in emergencydepartment,and has obtained a high degree of satisfaction,which is worthy of further popularization and application.
医学教育

住院医师规范化培训师资教学能力提升效果评价

Evaluation on the improvement of resident standardization training teachers’ teaching ability

:416-421
 
       目的   对该培训基地师资2021—2023年教学能力进行评价,了解和分析“1+3+n”的院级督导推行前的2021年、“1+3+n”的院级督导推行后的 2022年、2023年师资的教学能力变化。方法   采用问卷调查法收集评价数据,采用SPSS.27.0对教学评价资料进行统计分析,采用净推荐值计算教学口碑,对多年度结果进行纵向比较分析。结果  2021—2023年教学评价次数共5 483次;2021—2023年对师资教学设计能力评价由实施前的8.8提高到9.6、教学实施能力由实施前的9.0提高到9.5、教学热情由实施前的9.0提高到10.0、时间投入由实施前的9.3提高到10.0,不同年份组间比较的差异均有统计学意义(P<0.001);课程净推荐值由实施前的60.5%提高到81.3%,师资课程推荐者占比由实施前的65.5%提高到83.2%,贬损者占比由实施前的5.0%降低到1.9%,差异有统计学意义(χ 2 =175.4,P<0.001)。结论   “1+3+n院级督导模式的相关举措,对师资教学能力的提高具有促进作用,且该促进作用持续存在,师资教学能力逐年递增。
    Objective  To evaluate the teaching ability change of teachers  from 2021 to 2023,including of teachers’ teaching ability in 2021 before the implementation of "1+3+n" college-level supervision,and in  2022  and  2023  after the implementation of "1+3+n" college-level supervision.Methods  Questionnaire survey was used to collect evaluation data,SPSS.27.0 was used to make statistical analysis of teaching evaluation data,and NPS(Net Promoter Score)was used to evaluate teaching quality.Results  From 2021 to 2023,there were 5483 teaching evaluations.From 2021 to 2023,teaching design ability evaluation score increased from 8.8 before the implementation to 9.6,teaching implementation ability evaluation score increased from 9.0 before the implementation to 9.5,teaching enthusiasm evaluation score increased from 9.0 before the implementation to 10.0,time investment evaluation score increased from 9.3 before the implementation to 10.0,and the differences between different years were statistically significant(P<0.001).The courses quality increased from 60.5% before the implementation to 81.3%,and the proportion of teachers' course recommenders has increased from 65.5% before the implementation to 83.2%,while the proportion of detractors has decreased from 5.0% before the implementation to 1.9%,with statistical significance(χ 2 =175.4,P<0.001).Conclusions  The measures of "1+3+n" college-level supervision mode promote the improvement of teachers’ teaching ability,the promotion effect persists,and the teaching ability increases year by year.
医学教育

基于 BOPPPS 模型的课程设计在基层护理培训中的应用

The application of course design based on BOPPPS model in nursing basic training

:282-287
 
      目的   探讨导言-目标-前测-对照-后测-总结(BOPPPS)教学模式在基层护理培训中的应用效果。   采用类实验研究方法,将2021年5月—2021年12月参加培训的96名护士设为对照组,使用传统教学模式,将2022年1月—2022年12月参加培训的325名护士设为研究组,使用BOPPPS教学模式。对两组学员的教学效果通过理论、操作考核及问卷调查进行比较。结果   对照组学员理论知识、技能操作以及培训满意度均高于对照组,差异均有统计学意义(均P<0.05)。结论  BOPPPS教学模式在基层护理实训课中具有重要意义,可提高学员理论和技能操作能力,提升学员满意度。
      Objective  To explore the application effect of BOPPPS teaching mode in nursing primary training.Methods  Adopting class experimental research method,96 nurses who participated in the training from May 2021 to December 2021 were the control group,using the traditional teaching method.The 325 nurses who participated in the training from January 2022 to December 2022 were set up as a study group using the BOPPPS teaching model.The teaching effectiveness of the two groups of nurses was compared through theoretical and operative examinations and questionnaires.Results  The theoretical knowledge,skill operation and training satisfaction of the trainees in the experimental group were higher than those in the control group,and the differences were statistically significant(P<0.05).Conclusions  BOPPPS teaching mode is of great significance in nursing primary practical training course,which can improve the theory and skill operation ability of trainees and enhance the satisfaction of trainees.
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