全科门诊接诊桌和带教方式的改进及其在全科规培医师带教中的应用

目的 观察一种改进的全科门诊接诊桌及带教方法及其在全科规培医师门诊带教中的应用效果。 方法 接诊桌的改进包括桌面加长60 cm,键盘托加长50 cm,使之适合学员及教师并列相座同时接诊,电脑显示器、键盘及鼠标等可在学员及教师之间移动。选择嘉兴市第一医院规培第2年的全科住院医师60名,采用随机数字表法分为A、B两组(各30名),分别采用改进法、传统教学法进行门诊带教。2组学员在接受门诊带教前及1个月的门诊带教后分别进行3个不同病种3个考站的Mini-CEX评估,规培医师和带教教师对2次评估进行满意度的评分。 结果 门诊带教后,2组学员Mini-CEX各项评分比带教前均有明显提高,差异有统计学意义(均P<0.05)。A组学员在医学面谈技能、沟通技巧、条理性/效率、临床综合能力的评分上均高于B组(均P<0.05);在查体技能、人文素质/专业精神、临床判断的比较上,2组差异无统计学意义(均P>0.05)。规培医师及带教教师对2次Mini-CEX评价满意度的比较,差异均无统计学意义(均P>0.05)。 结论 通过对全科诊室接诊桌及门诊带教方法的改进,能提高全科规培医师在人文关怀、沟通表达、问诊技巧、病历书写、组织效能等方面的技能水平,达到更好的门诊带教效果。 

Improvements on the general practice clinic reception table and the mentoring method as well as its effect on standardized training of general practice

Objective To observe the effect of an improved general practice clinic reception table and mentoring method on the mentoring effectiveness of the outpatient clinic resident physicians under the standardized training procedure. Methods The improvement on the reception table included tabletop lengthening by 60 cm and keyboard tray lengthening by 50 cm, which made it suitable for the resident physicians and the mentors to sit side by side while receiving patients. The computer monitors, keyboards, and mice could also be moved freely between the resident physicians and their mentors. Subsequently, 60 resident physicians in the second year of standardized training in the department of general practices of hospital to which the author is affiliated were selected and randomly divided into Group A and Group B, with 30 people in each group. Group A and B were respectively mentored with the improved mentoring method and the traditional mentoring method, respectively. Before and 1 month after outpatient clinic mentoring, the mentors in both groups were evaluated by 3 examination stations(the cases assigned differ from station to station) using the Mini-CEX scale. Finally, the resident physicians of the standardized training procedure and the mentors scored the satisfaction of two rounds of evaluations. Results After outpatient clinic mentoring, however, the Mini-CEX scores in both groups have improved significantly compared with that beforehand, showing statistically significant differences(all P<0.05). The resident physicians in Group A scored higher than those in Group B in terms of the medical interview skills, communication skills, organization/efficiency, and clinical comprehensive ability(all P<0.05). No statistically significant differences were found in the physical examination skills, humanistic quality/professionalism, or clinical judgment between both groups(all P>0.05). The level of satisfaction in both Mini-CEX evaluations between the resident physicians of the standardized training procedure and the mentors showed no statistically significant differences(all P>0.05). Conclusion The improvement on the clinic reception table and the mentoring method in the department of general practices is conducive to the skill development of the general practices resident physicians in the aspects of humanistic care, communication and expression, inquiry skills, medical record writing, and organizational efficiency. This proved that the improvements can achieve a better mentoring effect.