全面质量管理结合递进教学在麻醉专业住院医师规范化培训实践中的应用

目的探讨全面质量管理结合递进教学在麻醉专业超声引导臂丛神经阻滞教学实践中的应用和效果。方法选取2018-09/2019-10期间进入我院麻醉科接受住院医师规范化培训学员(简称“住培学员”)48人,拟行B超引导下的臂丛神经阻滞学习,随机分为试验组(A组)和传统教学组(C组),每组24人。由武汉大学人民医院麻醉科超声质量控制小组拟定“B超引导下神经阻滞实施流程和质量管理”,所有学员统一完成所有理论学习课程,A组住培学员严格按照质量管理办法分层递进通过模拟操作考核,C组住倍学员则通过传统的带教,比较2组住倍学员在B超引导下臂丛神经阻滞的操作成功率及并发症发生率,以及住倍学员自我评价和带教老师满意度评估。结果全面质量管理结合递进教学组住培学员的臂丛神经阻滞操作成功率显著提高,操作时间显著缩短,并发症明显降低(P<0.05),住培学员以及带教老师的满意度均明显高于A组(P<0.05)。结论全面质量管理结合递进教学方法指导下的麻醉住院医师规范化培训模式可进一步保证住培学员操作的规范性和同质化,加深住倍学员对超声引导下臂丛神经阻滞的理解和运用,树立了住倍学员操作的信心,提高了培训效果及麻醉相关操作的安全性,值得在麻醉专业住院医师规范化培训中进一步推广。

Application of total quality management combined with progressive teaching method in the standardized training for anesthesia residents

Objective To explore the effect of total quality management combined with progressive teaching method in ultrasound-guided brachial plexus block during the standardized training for anesthesia residents.Methods Altogether 48 residents received the standardized training,from September 2018 to October 2019,were randomly divided into two groups,the experiment group(group A,n=24),receiving treatments of ultrasound-guided brachial plexus block guided,and the traditional group(group C,n=24).The Implementation Process and Quality Management of Resident Ultrasound-Guided Nerve Block was drawn up by the Ultrasonic Quality Control management Team.The residents in group A strictly followed the process through the simulation of Progressive Operation Assessment in accordance with the quality management.The residents in group C received the traditional trainings.The success rate of practice and the incidence rate of complications of brachial plexus block between the two groups were compared with each other,as well as the self-evaluation of the residents and the satisfaction rate of examiners.Results The success rate of brachial plexus block operation in group A was greatly improved and higher than that of group C,the incidence rate of complications in group A was lower than that in group C(P<0.05).The satisfaction rate of residents and examiners were both higher in group A than those in group C(P<0.05).Conclusion Total quality management combined with the progressive teaching method can further ensure the standardization and homogenization of trainees practice,deepen their understanding and application of ultrasound-guided brachial plexus block,build up their confidence in operation,and improve the training effect and the safety of anesthesia-related practice.It is worth further popularizing in the standardized training of residents.