Research on the training of primary medical care personnel based on CBL data model in Jiangsu Province
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摘要:
目的 探索运用基于案例的教学方法(CBL)数据模型，提升江苏省基层卫生人才培训效果。 方法 选取2022年1—6月江苏省5个市(南京、苏州、无锡、宿迁、盐城)123名全科医生作为研究对象。应用基于CBL数据模型的临床病例库进行线上培训，培训前后开展临床知识结构水平测试。采用t检验和单因素方差分析全科医生能力水平差异。采用多元线性回归分析研究影响培训效果的因素。 结果 全省123名全科医生摸底测试分数为(73.4±16.7)分。其中苏州分数最低，盐城分数最高。线上CBL案例培训3个月后，123名医生测试分数为(86.3±24.7)分，明显提高，差异有统计学意义(P＜0.001)。培训后测试中循环系统、皮肤、急诊、眼耳鼻喉、康复的核心知识正确率低于摸底测试，其他各项核心知识正确率均较摸底测试提高。循证医学思维各项知识点正确率均较摸底测试提高。多元线性回归分析结果显示参加全科住院医师规范化培训和线上学习时长是培训效果的主要影响因素。培训满意度调查总平均分为(67.58±12.30)分。其中得分最高的是培训时间安排[(4.38±0.84)分]和培训效果中掌握新型冠状病毒感染的诊断标准[(4.38±0.81)分]，得分最低是培训题目难易程度[(3.88±1.15)分]。培训内容、培训组织、培训效果、培训方法4个维度满意度得分差异有统计学意义(P=0.014)。大部分研究对象认为线上培训有利于节省培训时间，提高培训效率，但题目的难度略高。 结论 基于CBL数据模型的培训有利于提升全科医生临床能力，有助于培训过程的同质化管理。 Abstract:Objective To explore a new way to improve the training effect of primary medical care personnel (PMCP) in Jiangsu Province based on the application of a case based learning (CBL) data model. Methods A total of 123 PMCP from 5 cities (including Nanjing, Suzhou, Wuxi, Suqian and Yancheng) in Jiangsu Province were selected as subjects from January to June in 2022. The clinical case database based on the CBL data model was used for online training, and the test of clinical knowledge structure was conducted before and after the training. T-test and one-way ANOVA were used to analyze the difference in PMCP ability. Multiple linear regression was used to analyze the factors affecting the training effect. Results The mean scores of 123 PMCP were (73.4±16.7) points. The score of Suzhou was the lowest, while Yancheng was the highest. After 3 months of online CBL case training, the mean scores of 123 PMCP significantly improved (86.3±24.7) points, the difference was statistically significant (P < 0.001). The correct rate of core knowledge of circulatory system, skin, emergency, eye, ear, nose and throat, and rehabilitation in the post-training test was lower than that of the pre-training test, and other aspects were higher than that of the bottom test. The accuracy rate of all knowledge points of evidence-based medical thinking improved compared with the thorough test. The results of multiple linear regression analysis showed that the standardized training and online learning time of general practice residents were the main influencing factors affecting the training effect. The overall mean score of the training satisfaction survey was (67.58±12.30) points. Among them, the highest-scoring parameters were training schedule with a score of (4.38±0.84) and mastery of the new coronavirus infection diagnosis standards (4.38±0.81). The lowest-scoring parameters was the difficulty of the training questions with a score of (3.88±1.15). There were significant differences in satisfaction scores in four dimensions: training content, training organization, training effect and training method (P=0.014). Most of the research subjects believed that online training is conducive to saving training time and improving training efficiency, but the difficulty of the topic is slightly high. Conclusion Training based on CBL data model is conducive to improving the clinical ability of general practitioners and helping to homogenize the management of training process. -
Key words:
- COVID-19 /
- Case based learning /
- Primary medical care personnel
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表 1 123名全科医师的基本情况
Table 1. Basic information of 123 general practitioners
项目 人数(%) 学历 大专 4(3.25) 本科 106(86.18) 硕士研究生 13(10.57) 性别 男性 39(31.71) 女性 84(68.29) 地区 南京 35(28.46) 盐城 20(16.26) 苏州 33(26.83) 无锡 24(19.51) 宿迁 11(8.94) 职称 初级 14(11.38) 中级 55(44.72) 副高级 46(37.40) 正高级 8(6.50) 科室 全科 96(78.05) 预防保健 27(21.95) 是否参加全科规培 是 62(50.41) 否 61(49.59) 注册全科 注册 37(30.08) 加注 86(69.92) 是否转岗 是 74(60.16) 否 49(39.84) 是否曾经参加线上培训 是 65(52.85) 否 58(47.15) 注：“加注”为执业医师范围加注全科医学。“转岗”为参加全科转岗培训。 
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表 2 自变量赋值情况
Table 2. Variable assignment
自变量 赋值方法 性别 女性=1，男性=2 科室 预防保健=1，全科=2 学历 大专=1，本科=2，硕士研究生=3 职称 初级=1，中级, 2，副高级=3，正高级=4 是否参加全科规培 是=1，否=2 地区 南京=(0，0，0，1)，盐城=(0，0，1，0)，苏州=(0，1，0，0)，无锡=(1，0，0，0)，宿迁=(0，0，0，0) 是否转岗 是=1，否=2 是否曾经参加线上培训 是=1，否=2
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表 3 培训效果的多元线性回归分析
Table 3. Multiple regression analysis of training effect
变量 B SE β t值 P值 是否参加全科规培 -5.061 2.060 -0.102 -2.457 0.016 线上学习时长 0.038 0.003 0.816 11.329 < 0.001
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表 4 满意度调查得分(x±s，分)
Table 4. Satisfaction survey scores(x±s, points)
项目 得分 均分 1.培训内容 4.09±0.16 培训内容条理 4.25±0.83 培训内容有针对性 4.17±1.09 培训题目难易程度 3.88±1.15 培训题目分配比例 4.07±1.03 2.培训组织 4.29±0.06 培训时间安排 4.38±0.84 学习情况及时反馈 4.24±0.84 培训考核形式合理 4.27±0.87 培训操作界面便捷性 4.30±1.91 3.培训效果 4.28±0.06 新知识和技能获取 4.28±0.83 学科新进展获取 4.23±0.89 培养临床思维 4.24±0.94 掌握新冠病毒感染的诊断标准 4.38±0.81 掌握对新冠疑似患者的初步处理、隔离及转诊流程 4.35±0.83 心理干预技能提升 4.25±0.89 突发公共卫生事件的应急管理和处置能力提升 4.25±0.94 4.培训方法 CBL案例方法 4.05±1.10
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