情景模拟教学结合迷你临床演练评估在胸外科住院医师规范化培训中的应用

  目的  探索情景模拟教学法结合迷你临床演练评估(mini-clinical examination exercise，Mini-CEX)在胸外科住院医师规范化临床技能训练中的应用，以改善临床教学质量及考核效果。  方法  选取2019年3—12月中国科学技术大学附属第一医院胸外科参加轮转学习并按期顺利结业的外科住院规培学员共47人，按学员入科月份奇偶数分成传统教学组(24人)及情景模拟教学组(23人)，奇数月学员归为传统教学组，偶数月学员归为情景模拟教学组。采用Mini-CEX测评量表从手术告知同意面谈、体格检查、操作技能、临床判断、人文关怀、手术组织效能、整体表现等7个方面对2组学员能力进行量化评分，比较2组学员模拟考核成绩及满意度调查情况的差别。  结果  情景模拟教学组学员的Mini-CEX操作技能项总均分(7.53±0.49)分]高于传统教学组总均分(6.62±0.49)分]；临床判断总均分(6.24±0.28)分]高于传统教学组总均分(5.94±0.19)分]，差异均有统计学意义(均P < 0.01)。情景模拟教学组学员对教学的满意度高于传统教学组，根据是否提高学习兴趣、是否提高自主学习能力、是否培训临床思维能力及是否提高医患沟通能力4个方面进行比较，差异均有统计学意义(均P < 0.05)。  结论  情景模拟教学能够提高胸外科住院医师规范化技能操作培训的教学效果，采用Mini-CEX量化考核能更全面反映出学员临床综合能力，学员满意度更高，值得在胸外科临床教学中推广。 

The application of scenario simulation teaching method combined with mini-clinical examination exercise in resident standardized training of thoracic surgery

  Objective  To explore the application of scenario simulation teaching method combined with mini-clinical examination exercise (Mini-CEX) in resident standardized skill training of thoracic surgery to improve the clinical teaching quality and assessment effect.  Methods  A total of 47 students who attended and graduated successfully from the Thoracic Surgery Department of the First Affiliated Hospital of University of Science and Technology of China between March 2019 and December 2019 were randomly divided into the traditional teaching group (24 people) and the situational simulation teaching group (23 people) according to the odd-even number of students in the course month. Students with odd number of months were classified into the traditional teaching group, whereas students with even number of months were classified into the situational simulation teaching group. The Mini-CEX scale was used to score the ability of the two groups of students quantitatively from seven aspects, namely, interview of surgical consent, physical examination, operational skills, clinical judgment, humanistic care, surgical organizational effectiveness and overall performance. The difference between the two groups in the simulation examination achievement and satisfaction survey was determined.  Results  The total mean score of mini-CEX in the scenario simulation teaching group (7.53±0.49) points] was higher than that in the traditional teaching group (6.62±0.49) points]. The total mean score of clinical judgment was higher in the scenario simulation teaching group (6.24±0.28) points] than in the traditional teaching group (5.94±0.19) points], and the difference was statistically significant (all P < 0.01). Students in the scenario simulation teaching group were more satisfied with teaching than those in the traditional teaching group. The differences were statistically significant (all P < 0.05) according to whether the learning interest was improved, whether the autonomous learning ability was improved, whether the clinical thinking ability was trained and whether the doctor-patient communication ability was improved.  Conclusion  Scenario simulation teaching method can improve the teaching effect of standardized skill training for thoracic surgery residents. The Mini-CEX quantitative assessment can more comprehensively reflect the clinical comprehensive ability of trainees, leading to higher satisfaction. It is worth promoting in clinical thoracic surgery teaching.