基于SPO模型构建全科医学教学案例库的探索和实践

朱夏媛; 吴浩; 葛彩英; 刘新颖; 孔慜; 李智莉; 高文娟; 于潇漪

doi:10.16766/j.cnki.issn.1674-4152.003478

基于SPO模型构建全科医学教学案例库的探索和实践

doi: 10.16766/j.cnki.issn.1674-4152.003478

朱夏媛^{1, 2},
吴浩^1, ,,
葛彩英^{1, 2},
刘新颖^{1, 2},
孔慜^{1, 2},
李智莉^{1, 2},
高文娟^{1, 2},
于潇漪^{1, 2}

1.
首都医科大学全科医学与继续教育学院，北京 100069
2.
北京市丰台区方庄社区卫生服务中心，北京 100078

基金项目:

北京市高层次公共卫生技术人才培养计划 2022-1-005

首都医科大学2023教育教学改革研究课题立项项目 2023JYY081

详细信息

通讯作者:
吴浩，E-mail：wushunzhe@ccmu.edu.cn

中图分类号: R192.3 R499
计量
- 文章访问数: 132
- HTML全文浏览量: 34
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2023-12-06
- 网络出版日期: 2024-05-29

Exploration and practice of constructing a general practice teaching case library based on SPO model

ZHU Xiayuan^{1, 2},
WU Hao^{1
, ,},
GE Caiying^{1, 2},
LIU Xinying^{1, 2},
KONG Min^{1, 2},
LI Zhili^{1, 2},
GAO Wenjuan^{1, 2},
YU Xiaoyi^{1, 2}

1.
School of General Practice and Continuing Education, Capital Medical University, Beijing 100069, China

摘要

摘要: 目的通过介绍方庄社区卫生服务中心在构建全科医生接诊教学案例库的实践经验，为其他基层教学基地实施案例教学提供借鉴和参考。方法基于结构-过程-结果(SPO)模型，从结构、过程、结果3个维度梳理全科医生接诊教学案例库建设实践经验，以LAP为培训内容进行全科医生接诊能力的培训，以KSA为工具，进行接诊案例评价。选取2023年2—11月在方庄社区卫生服务中心培训的8名全科医生进行“一对一”的半结构化访谈，评价案例库使用效果。结果共录制11个全科接诊教学案例视频，覆盖心血管系统、呼吸系统、消化系统、泌尿生殖、内分泌等8个系统，涉及知识、技能、素养等3个方面能力的培养。通过半结构化访谈发现，全科医生学习积极性、知识掌握程度、全科诊疗思维、学习兴趣、团队协作意识明显提高。结论通过基于SPO模型建立的全科医生接诊教学案例库，能够激发全科医生学习的主观能动性，提高全科医生接诊能力，实现由学生向医生的转变，同时有助于推动全科医学学科建设，应重视全科医学教学案例库的建设，以案例教学为“抓手”提高全科医生的接诊能力，进而培养出更多合格的全科医生。
- 全科医生 /
- 接诊能力 /
- 教学案例库 /
- SPO模型
Abstract: Objective To introduce the practical experience of Fangzhuang Community Health Service Center in constructing a case library of general practitioner reception and teaching, and to provide reference for the implementation of case teaching in other grassroots teaching bases. Methods Based on the SPO (structure-process-outcome) model, the practical experience of the construction of the general practitioner reception teaching case library was sorted out from the three dimensions of structure, process and result, and the training of general practitioners ' reception ability was carried out with LAP as the training content, and the case evaluation was carried out with KSA as the tool. Eight general practitioners trained at Fangzhuang Community Health Service Center from February to November 2023 were selected to conduct "one-on-one" semi-structured interviews to evaluate the effectiveness of the case database. Results A total of 11 general practice teaching case videos were recorded, covering 8 systems, including cardiovascular system, respiratory system, digestive system, genitourinary system, and endocrine, involving the cultivation of knowledge, skills, and literacy. Through semi-structured interviews, it was found that the learning enthusiasm, knowledge mastery, general practice diagnosis and treatment thinking, learning interest, and teamwork awareness of general practitioners were significantly improved. Conclusion The general practitioner teaching case database based on the SPO model can stimulate the subjective initiative of general practitioners, improve the ability of general practitioners, realize the transformation from students to doctors, and help to promote the construction of general practice discipline.
- General practitioners /
- Capacity /
- Teaching case library /
- SPO model

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图 1 案例库建设的SPO模型

Figure 1. SPO model of case library construction

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图 2 全科医生接诊能力

Figure 2. Capacity of general practitioners

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图 3 全科医生接诊案例库

Figure 3. Case library of general practitioner visits

下载: 全尺寸图片幻灯片

表 1 案例能力分析框架

Table 1. Framework of case competence analysis

案例	知识层面(K)	技能层面(S)	基本素养层面(A)
案例1：高血压案例	◆高血压的临床理论知识：症状、体征、诊断及鉴别诊断、治疗和预防；	◆高血压的重点查体，包括双侧血压测量、心肺查体、下肢查体、周围血管征等；	◆沟通交流能力主要包括解除患者担忧，医患共同决策；
	◆高血压在社区的健康管理；	◆高血压的规范诊疗能力，合理检查，合理用药；	◆团队协作能力，医护防进行高血压的长期管理能力；
	◆高血压的分级诊疗与双向转诊	◆高血压的危急重症处理； ◆“RAPRIOP”管理策略	◆医学人文关怀：以患者为中心，尊重患者，保护患者隐私
案例2：冠心病案例	◆冠心病的临床理论知识：症状、体征、诊断及鉴别诊断、治疗和预防；	◆冠心病的重点查体，包括心脏视触叩听查体、眼睑、下肢查体等；	◆沟通交流能力主要包括医患共同决策；◆团队协作能力，医护防进行冠心病的长期管理能力；
	◆冠心病的社区健康管理； ◆冠心病的分级诊疗与双向转诊；	◆冠心病的常规诊疗能力； ◆冠心病的急诊急救能力；	◆以患者为中心，关注患者就诊的原因、想法、担忧以及期望
	◆冠心病的双心管理理念	◆“RAPRIOP”管理策略
案例3：糖尿病案例	◆糖尿病的临床理论知识：症状、体征、诊断及鉴别诊断、治疗和预防； ◆糖尿病的社区健康管理；	◆糖尿病的重点查体，包括心肺查体、糖尿病专科查体等； ◆糖尿病的常规诊疗能力；	◆沟通交流能力主要包括医患共同决策； ◆医学人文关怀：以患者为中心，尊重患者，保护患者隐私；
	◆糖尿病的分级诊疗与双向转诊；	◆糖尿病的急性并发症的识别；	◆合理利用社区医疗资源，控制患者医疗费用
	◆糖尿病的并发症管理	◆“RAPRIOP”管理策略
注：RAPRIOP管理策略指患者管理的7个方面，包括解释担忧(reassurance and explanation，R)、非药物建议(advice，A)、药物处方(prescription, P)、转诊(referral，R)、辅助检查(investigation，I)、观察(observation，O)、预防(prevention，P)。

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表 2 案例库使用效果的定性访谈情况

Table 2. Qualitative interviews on the effectiveness of the use of the case library

关键词	频次	原话引用
学习积极性	8	“案例中所涉及的知识，需要课前完成学习及课后延伸知识学习”
知识掌握程度	8	“沉浸接诊案例当中，将理论知识更好地应用于临床实践”
全科诊疗思维	8	“案例教学可以更好地锻炼全科诊疗思维”
学习兴趣	6	“真实的接诊案例视频，更容易激发学习兴趣及探索欲望”
团队协作	4	“对案例中有异议的地方展开讨论，对案例脚本的研讨可增强团队协助意识”

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