Practical research on standardized patient teaching combined with feedback teaching mode in the training of general practice resident training instructors
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摘要:
目的 探讨标准化病人教学联合反馈式教学模式在全科住院医师规范化培训（简称住培）指导教师中的实践效果，以提升全科住培指导教师的教学能力和教学质量。 方法 选取2023年2月—2024年1月中南大学湘雅二医院全科医学住培基地30名指导教师为研究对象，采用随机数字表法将其分为研究组和对照组，每组各15例。研究组采用标准化病人教学联合反馈式教学模式，对照组采用传统授课教学模式。经过6个月培训和6个月带教后，对指导教师的标准化病人角色扮演教学能力、Mini-CEX评估教学能力、反馈式教学能力进行考核。采用自行设计的满意度调查问卷，评价技能导师、全科医学住培基地核心成员、全科住培医师对指导教师的满意度。 结果 研究组指导教师标准化病人角色扮演教学能力总分优于对照组[（83.33±4.37）分vs.(74.87±7.55)分，t=3.760, P=0.001]；指导教师带教的全科住培医师Mini-CEX评估能力总分优于对照组（P=0.002）；反馈式教学能力总分优于对照组（P=0.001）。研究组技能导师满意度总分高于对照组（P＜0.001)；住培基地满意度总分高于对照组（P=0.001）；全科住培医师满意度总分高于对照组（P＜0.001）。 结论 标准化病人教学联合反馈式教学模式能提高指导教师的标准化病人角色扮演教学能力、Mini-CEX评估教学能力、反馈式教学能力，提高全科住培医师Mini-CEX评估运用能力，提高指导教师的教学满意度。 Abstract:Objective In order to improve the teaching ability and teaching quality of general practice resident training instructors, this paper was discussed to explore the practical effect of standardized patient teaching and feedback teaching mode among general practice resident training instructors. Methods From February 2023 to January 2024, a total of 30 instructors from the general practice residential training base of the Second Xiangya Hospital of Central South University were selected as the research objects, and the instructors were divided into the study group and the control group according to random number table, with 15 cases in each group. The study group adopted the standardized patient teaching and feedback teaching mode, and the control group adopted the traditional teaching mode. After 6 months of training and 6 months of teaching, the instructors' standardized patient role-playing teaching ability, Mini-CEX assessment teaching ability, and feedback teaching ability were assessed. A self-designed satisfaction questionnaire was used to evaluate the satisfaction of skill tutors, core members of the general practice resident training base, and general practice resident physicians with the instructors. Results The total score of the research group of the standardized patient's role-playing teaching ability was better than that of the control group [(83.33±4.37) points vs. (74.87±7.55) points, t=3.760, P=0.001]; The total score of the study group of Mini-CEX assessment ability of general practice resident physicians taught by the instructor was better than that of the control group (P=0.002); The total score of the study group of feedback-based teaching ability was better than that of the control group (P=0.001). The total score of the skill tutor satisfaction study group was higher than that of the control group (P < 0.001). The total score of satisfaction with the residential training base in the study group was higher than that in the control group (P=0.001). The total score of satisfaction with resident physicians in general practice in the study group was higher than that in the control group (P < 0.001). Conclusion The standardized patient teaching and feedback teaching mode improved the instructors' standardized patient role-playing teaching ability, Mini-CEX assessment teaching ability, and feedback teaching ability, improved the ability of general practice resident physicians to use Mini-CEX assessment, and improved the teaching satisfaction of instructors. -
表 1 2组指导教师基本资料比较
Table 1. Comparison of the basic information between the two groups of instructors
组别 例数 年龄(x±s, 岁) 年资(x±s, 年) 性别(男性/ 女性, 例) 博士(例) 职称(主治医师/ 副主任医师, 例) 硕士生导师(是/否, 例) 对照组 15 43.8±5.7 18.6±7.3 4/11 15 4/11 4/11 研究组 15 42.1±6.6 16.7±7.2 5/10 15 7/8 5/10 统计量 0.775a 0.706a 0.690b ＜0.001b 0.256b 0.690b P值 0.445 0.486 0.159 0.999 1.292 0.159 注：a为t值，b为χ2值。 
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表 2 2组指导教师标准化病人教学角色扮演能力评分比较(x±s, 分)
Table 2. Comparison of standardized patient role-play scores between the two groups of instructors (x±s, points)
组别 人数 准确扮演患者的临床表现 心理状态 准确回答 适当提问 建设性反馈 总分 对照组 15 13.60±2.35 14.53±2.36 15.33±2.19 16.33±1.63 17.07±2.25 74.87±7.55 研究组 15 16.00±2.67 16.40±2.32 17.27±1.34 16.60±1.72 15.07±1.75 83.33±4.37 t值 2.610 2.185 2.917 0.435 2.716 3.760 P值 0.014 0.037 0.007 0.667 0.011 0.001
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表 3 2组指导教师反馈式教学能力评分比较(x±s, 分)
Table 3. Comparison of feedback teaching evaluation results between the two groups of instructors (x±s, points)
组别 人数 教学设计与组织能力 观察与评估能力 反馈与指导能力 沟通与互动能力 批判性思维与分析能力 教学创新与自学能力 总分 对照组 15 81.33±6.24 81.40±4.87 79.80±3.39 75.00±15.83 81.60±4.58 80.20±5.00 479.33±20.50 研究组 15 88.60±5.33 78.80±4.00 85.27±5.11 84.73±4.04 86.27±5.11 85.27±4.77 508.93±21.43 t值 3.429 1.598 3.456 2.308 2.643 2.838 3.866 P值 0.002 0.121 0.002 0.035 0.013 0.008 0.001
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表 4 2组技能导师对指导教师满意度评分比较(x±s，分)
Table 4. Comparison of satisfaction ratings between the two groups of skill mentors towards the instructors (x±s, points)
组别 人数 教学模式运用能力 Mini-CEX评估 标准化病人角色扮演 教学设计与组织能力等6项能力 个性化教学 教学内容创新能力 及时反馈/ 调整策略 理论和操作 教学进度和质量 遵循教学公平/ 公正原则 总分 对照组 15 8.57±0.57 8.39±0.72 8.47±0.57 8.61±0.56 8.40±0.76 8.55±0.44 8.47±0.51 8.37±0.57 8.32±0.35 8.76±0.54 84.91±2.51 研究组 15 9.09±0.37 9.09±0.71 9.11±0.55 9.08±0.59 8.93±0.36 8.85±0.34 8.81±0.48 8.81±0.48 8.72±0.41 8.36±0.59 89.00±1.90 t值 2.965 2.696 3.133 2.227 2.467 2.120 2.590 2.297 2.881 1.950 5.035 P值 0.006 0.012 0.004 0.034 0.020 0.043 0.015 0.029 0.008 0.061 ＜0.001
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表 5 2组住培基地核心成员对指导教师满意度评分比较(x±s，分)
Table 5. Comparison of the satisfaction scores between the two groups of core members of the residential training base on the instructors (x±s, points)
组别 人数 教学模式运用能力 Mini-CEX评估 标准化病人角色扮演 教学设计与组织能力等6项能力 个性化教学 教学内容创新能力 及时反馈/ 调整策略 理论和操作 教学进度和质量 遵循教学公平/ 公正原则 总分 对照组 15 9.03±0.58 8.51±0.79 8.58±0.56 8.09±0.07 8.18±0.82 8.31±0.58 8.31±0.58 8.23±0.58 8.58±0.64 8.45±0.83 83.25±4.37 研究组 15 8.23±0.82 9.05±0.56 9.03±0.61 8.72±0.59 8.74±0.61 8.87±0.61 8.89±0.51 8.55±0.82 9.01±0.47 8.17±0.69 88.06±2.64 t值 3.115 2.166 2.132 2.678 2.136 3.070 2.889 1.205 2.114 1.007 3.656 P值 0.004 0.039 0.042 0.012 0.042 0.005 0.007 0.238 0.044 0.323 0.001
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表 6 2组全科住培医师对指导教师满意度评分比较(x±s，分)
Table 6. Comparison of the satisfaction scores between the two groups of general practice resident physicians on instructors (x±s, points)
组别 人数 教学模式运用能力 知识掌握/ 能力提升 带教资历 个性化教学 接收反馈/ 及时改进 课堂参与度 角色扮演/ 评估反馈 教学设计与组织能力等6项能力 病史采集/ 体格检查 遵循教学公平/ 公正原则 总分 对照组 15 7.53±1.28 8.35±1.00 8.48±0.52 8.20±1.41 8.03±1.30 8.10±1.10 8.30±0.90 8.49±0.37 8.28±0.71 7.67±1.47 81.41±5.50 研究组 15 8.42±0.88 9.05±0.46 8.49±1.06 9.06±0.72 9.08±0.62 8.62±1.33 8.99±0.69 9.03±0.66 9.13±0.51 9.08±0.48 88.95±4.33 t值 2.228 2.469 0.022 2.110 2.831 1.180 2.362 2.773 3.763 3.530 4.170 P值 0.034 0.020 0.983 0.044 0.008 0.248 0.025 0.010 0.001 0.003 ＜0.001
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表 7 2组全科住培医师Mini-CEX评估能力比较(x±s，分)
Table 7. Comparison of the results of Mini-CEX assessment ability between the two groups of general practitioners (x±s, points)
组别 人数 病史采集 体格检查 临床诊断 诊疗计划 沟通技能 人文关怀 反馈总结 总分 对照组 30 81.80±10.09 87.60±4.22 87.80±3.67 88.47±2.78 87.43±3.59 88.03±2.97 84.73±4.71 605.87±19.79 研究组 30 86.67±6.46 89.93±3.67 90.07±3.83 88.73±3.80 89.87±3.82 88.37±3.02 88.00±5.12 621.63±17.14 t值 2.225 2.285 2.340 0.311 2.543 0.431 2.573 3.299 P值 0.030 0.026 0.023 0.757 0.014 0.668 0.013 0.002
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