李烨 李浩然 易彬 周健

[摘要]目的探討推广应用以问题为导向的命题演讲联合视频点评培训模式的可行性。方法选取2020年1月至2021年6月在苏州大学附属第一医院普通外科轮转的2018级和2019级外科学住院医师规范化培训学员80名，采用随机数字表法分为对照组和观察组，每组各40名。对照组采取传统培训模式，观察组采取以问题为导向的命题演讲联合视频点评培训模式。采用理论考试、技能考核及问卷调查的方式对两组学员带教质量及效果进行主、客观评价。结果观察组学员的理论考试平均得分为（92.47±2.78）分，明显高于对照组的（89.45±4.14）分，差异有统计学意义（ P <0.05）。观察组的技能考核平均得分为（92.75±2.79）分，高于对照组的（88.45±4.08）分，差异有统计学意义（ P <0.05）。观察组学员在规培前后的学习积极、临床思维提高、动手能力提高、自学能力提高方面均优于对照组，差异有统计学意义（ P <0.05）。结论以问题为导向的命题演讲联合视频点评培训模式可提高规培学员的带教质量，提高规培医师的岗位胜任力，提高规培学员的学习积极性、临床知识掌握程度及临床思维和动手能力。

[关键词]住院医师规范化培训;临床带教;命题演讲;视频点评

[中图分类号] R-4;C975  [文献标识码] A   [文章编号]2095-0616（2021）23-0086-04

The application of propositional lecture combined with video review in the standardized training of general surgery residents

LI  Ye    LI  Haoran    YI  Bin    ZHOU  Jian

Department of General Surgery， the First Affiliated Hospital of Soochow University， Jiangsu， Suzhou 215006， China

[Abstract] Objective To explore the feasibility of promoting and applying the training mode of question- oriented propositional lecture combined with video review. Methods  A total of 80 trainees from grade 2018 and 2019 who participated in the standardized training of general surgery residents rotating in the Department of General Surgery of The First Affiliated Hospital of Soochow University from January 2020 to June 2021 were selected as study subjects. They were divided into the control group and the observation group by the random number method， the control group received the traditional teaching mode and the observation group received the training mode of question-oriented propositional lecture combined with video review. Subjectively and objectively evaluate the quality and effectiveness of the two groups of trainees through theoretical examinations， skill assessments and questionnaire surveys. Results  The average score of the theoretical examination of the trainees in the observation group was （92.47±2.78）， which was significantly higher than that of the control group （89.45±4.14）， with statistically significant difference （P <0.05）. The average score of the skill assessment of the observation group was （92.75±2.79）， which was higher than that of the control group （88.45±4.08）， with statistically significant difference （P <0.05）. The trainees in the observation group were better than those in the control group in terms of learning enthusiasm， improvement of clinical thinking ability， hands-on ability， and self-learning ability before and after the training， with statistically significant differences （P <0.05）. Conclusion The training mode of question- oriented propositional lecture combined with video review can improve the quality of teaching provided to the trainees， and improve the job competence of the standardized training physicians. In addition， it can improve the learning enthusiasm， the mastery degree of trainees on clinical knowledge， the clinical thinking ability and hands-on ability of the trainees.

[Key words] Standardized residency training; Clinical teaching; Propositional lecture; Video review

住院医师规范化培训（以下简称“规培”）是临床医学生毕业后教育的第一个必经阶段，自2014年国家卫生和计划生育委员会颁发《住院医师规范化培训管理办法（试行）》[1]以来，对住院医师岗位胜任能力的培养已成为临床带教工作的重要内容[2]。提高住院医师的临床思维、临床基本操作和专科操作能力，培养其自学能力、科研能力、创新能力和沟通能力，是规培的重要部分[3-4]。普通外科是外科学的基础，在外科住院医师为期三年的规范化培训中，普通外科的轮转占据了大部分时间。住院医师需经过系统、专业的规范化培训，才能熟练掌握普通外科的相關知识和临床操作能力。传统的规范化培训模式，主要依靠规培学员自我学习，即“师傅领进门，修行在个人”。……