联合教学模式在麻醉科住院医师规范化培训临床紧急事件处理教学中的应用

目的 探讨基于案例学习(CBL)结合迷你临床演练评估(Mini-CEX)教学模式在麻醉科住院医师规范化培训(规培)处理临床紧急事件中的应用效果。方法 选择2020—2021年20名麻醉科规培医师作为观察组,2018—2019年20名麻醉科规培医师作为对照组,分别采用CBL结合Mini-CEX教学模式和传统规培教学模式对紧急事件处理进行临床教学。规培1年后,记录临床理论考试成绩和应急案例分析成绩以及问卷调查结果(教学生动性、教学吸引性、学员参与度、分析全面性、印象深刻程度等教学反馈结果)和对教学方法的满意情况。结果 规培1年后,观察组理论考试成绩为(93.5±1.6)分,应急案例分析考核成绩为(89.8±2.2)分,对照组理论考试成绩为(89.0±1.8)分,应急案例分析考核成绩为(83.9±1.7)分,观察组临床理论考试成绩和应急案例分析成绩明显高于对照组(P<0.05)。观察组教学反馈结果和对教学方法的满意率明显高于对照组(P<0.05)。结论 CBL结合Mini-CEX教学模式在麻醉科规培临床紧急事件处理教学中的应用效果优于传统规培教学模式,能够明显提高规培医师的临床综...     

普通外科对临床八年制医学生教学查房中PBL+LBL联合教学法的应用研究

目的:为探讨PBL+LBL联合教学模式在普外科教学壹房中的应用效果,将2005级40名临床八年制医学生随机分成两组:试验组为PBL+LBL联合教学模式,对照组为单纯的PBL教学模式.通过考核及同卷调查评价教学效果.结果显示两组在基础理论知识的得分上试验组高于对照组,差异有统计学意义(P<0.05),学生对PBL+LBL联合的教学模式满意度较高.     

基于电磁导航支气管镜技术的教学模式在胸外科医师规范化培训中应用价值的前瞻性试验研究

目的 探讨基于电磁导航支气管镜技术的教学模式在胸外科医师规范化培训中应用价值。方法 前瞻性纳入2022-12—2023-05在某三甲医院胸外科接受胸腔镜肺手术培训的规培医师，依据教学模式分为胸腔镜基础理论学习及手术视频讲解模式组(对照组)和采用电磁导航支气管镜(ENB)教学联合胸腔镜基础理论学习及手术视频讲解模式组(观察组)。通过12学时的教学后，评估2组规培医师的考核成绩和对教学的满意度。结果 共纳入16名规培医师，每组8名，均顺利完成培训。2组规培医师的基本资料差异无统计学意义(P>0.05)。观察组规培医师的理论评分、扶镜评分，以及授课评分均优于对照组，差异均有统计学意义(P<0.05)。结论 与胸腔镜基础理论学习及手术视频讲解模式的教学方式比较，联合ENB教学方式有利于规培医师对肺手术解剖学、影像学及术式的学习，可以有效缩短学习曲线，提高教学效果，值得进一步探讨和完善。     

特殊情况下LBL-CBL-PBL三轨教学模式在整形美容进修医师面部解剖教学中的应用

目的：探讨特殊情况下LBL-CBL-PBL三轨教学模式在整形美容进修医师面部解剖教学中的应用效果。方法：回顾性纳入2018年12月-2021年11月在北京大学第三医院成形外科三批次34名进修医师作为研究对象，分为A组LBL教学及尸头实操解剖组、B组传统LBL教学组及C组LBL-CBL-PBL三轨教学组。课程开始前和后进行两次理论考试，课程结束后进行教学质量问卷评分调查，对各组得分进行对比分析。结果：三组第一次考试成绩基本一致，第二次考试成绩和第一次对比均有显著性提高（P<0.05）;A组和C组在第二次考试成绩及教学质量问卷评分对比上差异无统计学意义（P>0.05），但均高于B组且差异有统计学意义（P<0.05）。结论：LBL-CBL-PBL三轨教学模式应用于整形美容进修医师面部解剖教学较传统LBL教学模式相比具有良好教学效果，在特殊情况下能够达到平时LBL教学结合尸头实操解剖的教学水平。     

基于BOPPPS模型的教学模式在整形外科进修医师颌面外科学带教中的应用

目的探讨基于BOPPPS模型的教学模式在整形外科进修医师颌面外科学带教中的应用效果。方法选取自2017年5月至2019年5月在空军军医大学第一附属医院整形外科进行颌面外科学习的50名进修医师作为研究对象,并随机分为研究组与对照组(每组25名)。对照组采用传统教学方法,研究组采用基于BOPPPS模型的教学方法。在教学结束后比较两组学员理论操作技能考核成绩、临床能力得分以及教学满意度情况。结果研究组学员的理论知识、操作技能以及案例分析得分均明显高于对照组(P0.05)。研究组学员在病史采集、体格检查、临床诊断、治疗方案等方面得分均明显高于对照组(P0.05)。研究组学员对教学的满意度(100%)明显高于对照组(88%),P0.05。结论在整形外科进修医师颌面外科学带教中应用基于BOPPPS模型的教学方式取得了良好的教学效果,能够有效提高学员的临床综合能力,同时有助于学员临床思维能力与兴趣的培养,并且提高了学员对教学质量的满意度,值得进一步研究与推广。     

快充式经鼻湿化高流量通气在非麻醉专业学员气管内插管培训中的应用

目的评价快充式经鼻湿化高流量通气(THRIVE)在非麻醉专业住院医师规范化培训(住培)学员气管内插管培训中的应用效果。方法选择20名非麻醉专业住培学员,根据全麻诱导操作时供氧方式分为面罩通气组(C组,n=10)和THRIVE组(T组,n=10)。选择择期行气管内插管全麻手术的患者60例随机分入C组和T组,诱导插管期C组采用面罩通气供氧,T组采用THRIVE供氧。记录患者声门暴露分级、总体插管成功例数、成功插管时间、并发症发生情况、SpO_2插管成功即刻低于入室基础值的例数。采用问卷调查评估学员对气管内插管操作的自信心、学习兴趣及带教满意度,采用麻醉科改良Mini-CEX和DOPS测评表评估学员理论与实践技能掌握度。结果与C组比较,T组学员总体插管成功率明显升高(P0.05),成功插管时间明显延长(P0.05),误入食管与SpO_2插管成功即刻低于入室基础值的发生率明显降低(P0.05),学员操作的自信心、学习兴趣及带教满意度明显提高(P0.05)。两组学员的Mini-CEX评分差异无统计学意义,而DOPS评分T组高于C组(P0.05)。结论在全身麻醉气管插管诱导采用THRIVE供氧,可提高非麻醉专业住培学员气管内插管成功率,提高学员的自信心、兴趣、带教满意度及临床操作能力,有助于提升患者安全性。     

高职急救护理课程教学改革探索

目的提高急救护理学教学质量。方法对照组(2006级高职高专护生)采用理论讲授加单项技能训练的传统教学模式进行急救护理学教学;实验组(2007级高职高专护生)采用任务驱动的教学模式进行急救护理学教学,包括改革教学内容为院前救护、院内急诊室救护、重症监护3个模块20个工作任务,改革教学方法和实践教学等。结果实验组理论成绩和操作成绩显著高于对照组(均P<0.01)。结论急救护理课程教学改革提高了急救护理教学质量。     

基于BOPPPS模型的5G+智慧课堂在临床护理教学中的应用

目的 探讨基于BOPPPS模型的5G+智慧课堂在胸外科护理临床教学中的应用效果。方法 将胸外科实习的90名本科护生按照实习时间分为对照组43名,试验组47名。对照组采用传统教学方法;试验组采用基于BOPPPS模型的5G+线上、线下、临床实践三位一体智慧课堂教学模式。比较两组护生实习成绩、自主学习能力和对教学模式的满意度。结果 试验组护生实习成绩、自主学习能力得分显著高于对照组(均P<0.05);两组教学满意度比较,差异无统计学意义(P,>0.05)。结论 基于BOPPPS模型的5G+智慧课堂教学模式的应用可提高护生实习成绩及自主学习能力,提升临床教学效果。     

问题式学习与案例式学习相结合的教学模式在牙周护理教学中的应用研究

目的:探讨问题式学习(Problem-Based Learning,PBL)与案例式学习(Case-Based Learning,CBL)相结合的教学模式在牙周护理教学中的应用效果。方法:将2014-2015年在第四军医大学口腔医院实习的40名护士随机分组,分别设为对照组和实验组。对照组采用传统教学法,实验组采用PBL与CBL相结合的综合式教学法。比较两组学生的理论考试和对教学的满意度评价。结果:实验组实习护士理论考试成绩显著高于对照组。80.3%的实验组认为PBL与CBL相结合的教学模式有利于加深理论知识,强化临床病例诊断。结论:PBL与CBL相结合的综合教学模式适用于牙周护理教学,能激发学生学习兴趣,开发学习潜能,提高教学质量。     

PBL教学法在口腔颌面外科临床实习带教中的应用

目的 观察PBL教学法在口腔颌面外科临床实习带教中的应用效果。方法 选取2019年4月-2022年 4月于我院口腔颌面外科实习的60名口腔医学专业五年制学生为研究对象，随机分为试验组和常规组，各 30名。常规组给予传统教学模式，试验组给予PBL教学模式，比较两组考核成绩和教学满意度。结果 试验 组理论知识、病例分析及实践操作成绩及总分均高于常规组（P＜0.05）；试验组对培养自学能力、提高学 习兴趣、提高资料检索能力、培养综合思维能力、增强团队协作意识、提升沟通和表达能力的教学满意度 均高于常规组（P＜0.05）。结论 PBL教学法在口腔颌面外科临床实习带教中的应用效果确切，可提升学 生的知识掌握程度，培养学生的综合分析和解决问题的能力，同时学生对该教学模式的满意度较高。     

Evaluation of the airway of the SimMan full-scale patient simulator

BACKGROUND: SimMan is a full-scale patient simulator, capable of simulating normal and pathological airways. The performance of SimMan has never been critically evaluated. METHODS: Sixty subjects (anesthesiologists, nurse anesthetists, and anesthesia residents) performed mask ventilation, laryngeal mask insertion and endotracheal intubation on SimMan. The simulator's airway was evaluated using visual analog scales (VAS) and by measuring the subject's performances. RESULTS: The SimMan full-scale patient simulator's airway is generally acceptably realistic but it significantly differs from the human airway in important aspects. Mask seal was more difficult than in humans whereas Laryngeal mask (LMA) insertion and function was acceptable. The distance from the teeth to the vallecula was too short. Cervical spine mobility was significantly reduced in the 'reduced neck movement' mode but the intubation was only slightly more difficult than in the 'normal' mode. CONCLUSION: The SimMan full-scale patient simulator's airway is generally acceptably realistic but it significantly differs from the human airway in important aspects. The user must be aware of these aspects in order to obtain maximum benefit from training and evaluation scenarios and when using the simulator for testing new equipment and techniques.     

Use of a virtual immersion computer simulator as a model for basic training in laparoscopic urology

Backgroundto date, it has not been defined the best method for teaching urologic laparoscopy, however it is well recognized that it involves a steep learning curve.MethodsA course of Laparoscopic Urology was done in our Institute. The program included skill practices in a virtual immersion simulator which evaluated, the score and time to complete each activity. This was done in a group of residents with previous experience with this virtual simulator (group 1) and another group of residents with no experience (group 2). Four different basic tasks were performed in the virtual simulator, which included: coordination, cutting, clip application and performing a simple suture.ResultsWhen we compared the scores between both groups the mean scores for each task were superior in group 1 compared to the group 2, with no statistically significant difference, however when we compared the time to complete each task, it was shorter in group 1 compared to group 2 with a statistically significant difference.ConclusionsThe performance of residents without experience in a virtual simulator was similar to that of previously trained residents, however it takes less time to complete each task as the resident gains experience in these simulators. The use of virtual simulators for laparoscopy training are useful when learning basic techniques allowing the surgeon to improve hand dexterity and coordination in laparoscopic surgery.     

Training residents using simulation technology: experience with ultrasound for trauma

BACKGROUND: The need for surgeons to become proficient in performing and interpreting ultrasound examinations has been well recognized in recent years, but providing standardized training remains a significant challenge. The UltraSim (MedSim, Ft. Lauderdale, Fla) ultrasound simulator is a modified ultrasound machine that stores patient data in three-dimensional images. By scanning on the UltraSim mannequin, the student can reconstruct these images in real-time, eliminating the need for finding normal and abnormal models, while providing an objective method of both teaching and testing. The objective of this study was to compare the posttest results between residents trained on a real-time ultrasound simulator versus those trained in a traditional hands-on patient format. We hypothesized that both methods of teaching would yield similar results as judged by performance on the interpretive portion of a standardized posttest. It is designed as a prospective, cohort study from two university trauma centers involving residents at the beginning of their first or second postgraduate year of training. The main outcome measure was performance on a standardized posttest, which included interpretation of ultrasound cases recorded on videotape. METHODS: Students first took a written pretest to evaluate their baseline knowledge of ultrasound physics as well as their ability to interpret basic ultrasound images. The didactic portion of the course used the same teaching materials for all residents and included lectures on ultrasound physics, ultrasound use in trauma/critical care, and a series of instructional videos. This didactic session was followed by 1 hour for each student of hands-on training on medical models/medical patients (group I) or by training on the ultrasound simulator (group II). The pretest was repeated at the completion of the course (posttest). Data were stratified by postgraduate year, i.e., PG1 or PG2. RESULTS: A total of 74 residents were trained and tested in this study (PG1 = 48, PG2 = 26). All residents showed significant improvement in their pretest and posttest scores (p = 0.00) in both their knowledge of ultrasound physics and in their interpretation of ultrasound images. Importantly, we could not demonstrate any significant difference between groups trained on models/patients (group I) versus those trained on the simulator (group II) when comparing their posttest interpretation of ultrasound images presented on videotapes (PG1, group I mean score 6.9 +/- 1.4 vs. PG1, group II mean score 6.5 +/- 1.6, p = 0.32; PG2, group I mean score 7.7 +/- 1.4 vs. PG2, group II mean score 7.9 +/- 1.2, p = 0.70). CONCLUSION: The use of a simulator is a convenient and objective method of introducing ultrasound to surgery residents and compares favorably with the experience gained with traditional hands-on patient models.     

Assessment of learning in blind orotracheal intubation with Fastrach masks usinga cumulative sum curves (CuSum) in the SimMan Universal Simulator

ObjectiveTo assess training in blind intubation with the Fastrach laryngeal mask in a simulation model by applying the cumulative sums (CuSum) method.Material and methodsSix anaesthesiology resident doctors, with no previous experience of the technique, participated, three in their first year, and three in the second. The study was conducted with the help of the SimMan Universal Simulator. Fifty attempts by each one of them over a four month period, divided into two stages: the first 20 with minimum airway difficulty, and the next 30 with limitations of flexion-extension movements to <80°. An unacceptable failure rate was set at 10% after a second failed attempt. The time limit set to be considered a success was 60 seconds.ResultsA total of 120 attempts in the first stages, and the remaining 180 in the second were analysed individually, all managing to achieve acceptable success rates of 90%: 84% in the first attempt and 13.33% in the second. A total of 2.66% failures were recorded. The learning curve showed that the residents began to achieve an acceptable 90% success rate in case number 25±11.76 of the 50 attempts.ConclusionsThis statistical method and the SimMan simulator, used together, have demonstrated to be very useful tools in assessing learning curves in this technique.     

氢气对内毒素小鼠急性肺损伤的影响

目的 探讨氢气对内毒素(LPS)诱导的急性肺损伤的影响及机制。方法 选择SPF级雄性ICR小鼠12只,6～8周龄,体质量25～35 g。采用随机数字表法将小鼠分为四组：对照组(C组)、吸入氢气组(H组)、肺损伤模型组(L组)和肺损伤模型+吸入氢气组(LH组),每组3只。C组不做处理;H组仅吸入4%氢气,持续12 h; L组和LH组采用腹腔注射LPS 10 mg/kg建立肺损伤模型,LH组在建立肺损伤模型后即刻吸入4%氢气。于建模后12 h行肺超声检测肺水肿,超声检测完成后迅速处死小鼠,开胸取双肺组织,左肺组织采用Western blot法检测p-AMPK、p-ERK和p-p38蛋白含量,右肺组织采用HE染色行肺损伤评分并观察肺组织病理学改变。结果 与C组比较,L组和LH组B线面积明显增大,p-AMPK、p-ERK和p-p38蛋白含量明显升高(P<0.05);H组p-AMPK蛋白含量明显升高(P<0.05);L组肺损伤评分明显升高(P<0.05)。与L组比较,LH组B线的面积明显减小,p-ERK、p-ERK和p-p38蛋白含量、肺损伤评分明显降低(P<0.05)。...     

Validation of computer-based training in ureterorenoscopy

OBJECTIVES: To evaluate the outcome of training both urological novices and experts, using the recently developed UroMentor (Simbionix Ltd, Israel) trainer, that provides a realistic simulation of rigid and flexible ureterorenoscopy (URS). SUBJECTS AND METHODS: Twenty experienced urologists (total number of previous flexible URSs 21-153) were monitored during simulated flexible URS for treating a lower calyceal stone, and the outcome was correlated with individual experience. A score was compiled based on the variables recorded, including total operation time, stone contact time, complications such as bleeding or perforation, and treatment success. A further five urological residents with no endourological experience were trained on the UroMentor in rigid URS for ureteric stone treatment. Their acquired clinical skills were subsequently compared to those of five urological residents who received no simulator training. RESULTS: All 20 experienced urologists disintegrated the stone on the simulator, and the score achieved was related to their personal experience; there was a significant difference in performance in those with < 40 and > 80 previous flexible URSs. For the five urological residents with no endourological experience, simulator training improved their skills, and comparison with urological residents who had received no simulator training showed advantages for the trained residents. After being trained on the simulator, the group performed better in the first four URSs on patients. CONCLUSIONS: Individual experience correlates with individual performance on the simulator. Simulator training was helpful in improving clinical skills. Although the distribution of computer-based simulators is limited by high prices, virtual reality-based training has the potential to become an important tool for clinical education.     

The validity of take-home surgical simulators to enhance resident technical skill proficiency

Background

It is unknown whether surgical residents who learn minimal-access surgery skills in an unstructured environment (ie, at home), will develop a technical skill set that rivals that of those trained in the more traditional, structured learning environment.

Methods

Seven surgery residents were provided structured learning through didactic and hands-on skills training sessions and consistent supervision throughout training. A second group of 7 residents participated in an unstructured learning curriculum of training without supervision. End points were determined at the end of training using a standardized simulator based on predetermined performance measures.

Results

Both groups achieved high task scores, with comparable scores on gesture proficiency, hand movement smoothness, instrument movement smoothness, errors, and time elapsed. There was no significant difference between group differences in final skills scores.

Conclusions

Unstructured learning is equally effective in delivering quality skills training when compared with structured training.     

PBL教学模式在泌尿外科临床教学中的应用

目的 探讨PBL(problem-based learning)教学法在泌尿外科临床教学中的应用效果.方法 对2013年及2014年来本科室实习的63名学生分别采用传统教学模式和PBL教学模式,实习结束后行理论测试、临床阅片能力、疾病诊断和鉴别诊断、问卷调查学生对教学评价等综合评价.结果 采用PBL教学模式组学生理论测试、临床阅片能力、疾病诊断和鉴别诊断均高于采用传统教学模式组学生(P＜0.05).PBL教学模式组学生比较认可该教学模式能提高学生自主学习能力、分析、解决问题能力、培养科学思维、加强交往能力及表达能力等.结论 PBL教学法较传统教学模式教学效果更好,能较大提高学生综合能力,有利于培养泌尿外科专业人才.